IMPORTANT POINT
Insurance co-exists with membership for period of insurance benefit but coverage under insurance would be a direct liability of Insurance company.

ORDER

A.P. Sahi, President—This is an Appeal filed by the Complainant after her Complaint No.122 of 2012 filed before the State Consumer Disputes Redressal Commission, Andhra Pradesh has been dismissed with an observation that in view of the nature of the dispute and the questions of facts pleaded the same would require an assessment on the basis of evidence to be led and has accordingly made an observation that the case deserves to be tried by the Civil Court. The reason for this observation was that fraud, impersonation and the other related allegations cannot be gone into in a summary jurisdiction of the Commission and consequently with the allegations and counter allegations on record, the case required a deeper probe which was not possible to be conducted by the Commission, hence the observation that the complaint deserves dismissal without prejudice to the rights of the Complainant to approach the Civil Court.

2. The background of the dispute is that the Complainant filed a complaint alleging non-settlement of the disbursement of the amount admissible under the policies taken by the late husband of the Complainant in the capacity of the Member of the second Respondent Road Safety Club Pvt. Ltd. that facilitated insurance cover to its members provided by the Respondent No.1 M/s. Bajaj Allianz General Insurance Co. Ltd. The policy is a Group Personal Accident Master policy of which the deceased was a member and the complainant is a beneficiary. The policies were marketed by the Respondent No.3 and Respondent No.4. The deceased policy holder had acquired 11 certificates as follows:—

3. Out of these, two of the policies were purchased through Golden Multi Services Club of GTFS for the insured capital sum of Rs.3 lakhs each. Rest of the policies were purchased through Respondent No.4, M/s. SKI Insurance Marketing Pvt. Ltd. It seems that the said Respondent No.4 was deleted from the contest through I.A. No.1594/18 on which orders were passed on 16.07.2018.

4. The dispute in the present case is therefore regarding only about the eight policies taken through the membership of Road Safety Club Pvt. Ltd., the certification of insurance whereof was issued by M/s. Bajaj Allianz General Insurance Co. Ltd. It is the dispute of these eight membership certificates that came up for consideration before the State Commission.

5. The nature of the risk assured under the policy was an accidental death coverage and the sum insured of all these 8 policies was Rs.3 lakhs each, thus covering a total of Rs.24 lakhs for eight policies.

6. According to the Complainant her husband, while walking down the road near Lakshmi Palyam Village on Badwel-Poru Mamilla route at about 5.00pm on 12.04.2007, was hit by an auto from behind. He, according to the Complainant, was rushed to the hospital but by the time he arrived at the hospital he was dead and therefore could not be admitted in the hospital and his body was deposited in the Mortuary awaiting the arrival of the police as it was an accidental case. The FIR was lodged on the same date around midnight being FIR No.58/2007 and the police submitted a report under Section 173 CrPC confirming the said accidental death.

7. A post-mortem was also conducted and it was therefore urged that the claim was indemnifiable. T