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TAMIL NADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION
M. Thanikachalam, President, J. Jayaram and S. Sambandam, Members
UNITED INDIA INSURANCE CO. LTD. - Appellant
Versus
VYSYA BANK LTD. AND ANR. - Respondents
First Appeal No. 496 of 2008
Decided on : 11-04-2011
Mr. S. Arunkumar, Advocate, for the Appellant; Mr. K. Sukumaran, Advocate, Mr. S. Kaithaimalai Kumaran, Advocate, for the Respondent
Delay in claiming the amount does not disentitle the legal heir from claiming the sum assured under the insurance policy.
Headnote:
Insurance Claim - Group Insurance Policy - 90 days - Negligence and Deficiency in Service - [FACT OF THE CASE] The deceased had a premium Savings Bank Account with a tie-up with an Insurance Company for Group Accident Insurance Policy. He died due to a snake bite, and the legal heir claimed Rs. 3 lakh as compensation. The Insurance Company resisted the claim citing delay and lack of necessary documents. The District Forum found the Insurance Company negligent and ordered compensation. [FINDING OF THE COURT] The court found that the delay in claiming the amount did not disentitle the legal heir from claiming the sum assured. The court also held that the Insurance Company's insistence on certain documents was negligent and deficient. [ISSUES] Delay in claiming the amount, negligence, and deficiency in service. [RATIO DECIDENDI] The delay in claiming the amount did not disentitle the legal heir from claiming the sum assured. The Insurance Company's insistence on certain documents was negligent and deficient. [FINAL DECISION] The appeal was allowed in part, setting aside the order of compensation alone, otherwise confirming the order of the District Forum.
ORDER
M. Thanikachalam, President - The opposite party is the appellant.
2. The facts leading to the appeal.
The 1st respondent/Complainant's son, by name S. Marlan Brando had premium Savings Bank Account No. 10808, with the 2nd opposite party/bank, which had a tie up with the 1st opposite party/Insurance Company, for Group Accident Insurance Policy, wherein the sum assured was Rs. 3 lakh. The premium for the above said policy, for the complainant's son was debited from the account, and the policy commences from 10.7.2000 and terminates on 9.7.2003.
3. The complainant's son, who was working in a hotel at Yercaud, was bitten by snake on 14.3.2001, for which treatment was given immediately by Dr. S. Neelamegam, who advised to take Marlan Brando, to Salem, for further treatment. Unfortunately, on the way, he died, and thereafter he was buried as per the religious custom, available in Christianity.
4. Under the Group Insurance Policy, his legal heirs are entitled to Rs. 3 lakh as compensation, and the complainant being the only legal heir/mother, entitled to the said amount. The complainant furnishing the necessary documents available, that could be furnished, lodged a claim, not settled unjustifiably, claiming documents, which are not available, thereby the opposite parties have committed negligent act, as well as deficiency in service, for which the complainant is entitled to compensation of Rs. 1 lakh also, in addition to the sum assured under the policy. Hence the claim.
5. The 1st opposite party/appellant, exhibiting their ignorance as if they do not know about the premium Savings Bank Account, resisted the claim and the complaint inter alia contending, that the complainant violated the terms and conditions of the insurance policy, which are printed in the premium, savings bank account application form itself, that when a claim was lodged, belatedly, for necessary and proper adjudication, required documents were sought for (as detailed in para 7 of the written version), not submitted, and therefore the claim was closed as "no claim" which cannot be termed as deficiency in service, that as per the procedure for claim, within 90 days, from the date of the accident, claim should have been lodged, but in this case, it was informed through an Advocate notice, only on 4.5.2002, though the alleged accident, said to have been taken place on 4.3.2001, and in this view, for the highly belated claim, this opposite party is not answerable, since they have not committed any deficiency, and the complaint is liable to be dismissed.
6. The 2nd opposite party, admitting that the deceased Marlan Brando, was having Premium Savings Bank Account, with them, and he was covered under the Group Insurance Accident Policy, covering Rs. 3 lakh, for which one time premium was collected, opposed the claim, inter alia contending that the claim has to be settled, only by the Insurance Company, and their duty is to facilitate the arrangement of insurance cover and otherwise there is no responsibility, that they have no role except to forward the claim, that in this case, since they have not committed any deficiency, not liable to answer the claim of the complainant.
7. The District Forum, by its order dated 19.9.2007, recorded a finding, that the 1st opposite party, insisting unnecessary documents, not available, refusing to settle the claim, had committed deficiency in service, whereas the 2nd opposite party did nothing against the complainant, or adverse to the complainant. In this view, a direction was issued against the 1st opposite party alone, to pay a sum of Rs. 3 lakhs, being the sum assured, with interest thereon at 9% p.a., from the date of claim, along with compensation of Rs. 25,000, with cost of Rs. 2,000, which is impugned by the 1st opposite party.
8. The learned Counsel for the appellant, urged before us, that as demanded by them, under Ex.A3, necessary documents were not produced, and therefore they were unable to settle the claim, which cannot be d
