United India Insurance

**adv.sumit** · 09-27-2009, 10:29 AM

M/s. Rashriya Seva Samithi (RASS),

Rep.by its General Secretary,

Sri.G.Munirathnam,

S/o. G. Rangaiah Naidu,

Hindu, aged 73 years through his

Authorised person Ganji Venkateswarlu,

Seva Nilayam,

Annamayya Marg,

A.I.R. By-pass Road,

Tirupati – 517 502. … Complainant

vs

The Divisional Manager,

United India Insurance Company Ltd.,

First Floor, Room Nos.7 and 8,

Sridevi Complex,

Tilak Road,

Tirupati. … Opposite party

ORDER

This complaint is filed under Section-12 of Consumer Protection Act 1986, to pass an order directing the opposite party to reimburse a sum of Rs.1,11,523/- towards loss incurred, to pay Rs.25,000/- towards damages for causing mental agony and to pay the costs of the complaint to the complainant.

2. The averments of the complaint in brief are :- The complainant insured cash belonging to Rashtriya Seva Samithi (RASS) with the opposite party under policy No.051200/48/07/07/00000362 for the period from 07.11.2007 to 06.11.2008 against burglary. On the night of 18.01.2008 some unknown offenders stolen a sum of Rs.1,21,523/- from the cash chest (iron safe) by breaking the house at Varadarajaswamy street, Srikalahasti. Immediately the complainant reported the matter to the police on 19.01.2008.

A case in crime No.11/2008 of Srikalahasti Urban Police Station for the offences under Sections 457 and 380 IPC was registered and the same was charge sheeted in C.C.138/2008 against one Vellakuri Leela Mohan of Naidupeta. Out of Rs.1,21,523/- stolen in burglary, police seized Rs.10,000/- from the accused V.Leela Mohan and delivered the same to the complainant. The complainant made a claim to the opposite party in as much as the policy was in force on the date of burglary and as per the said policy the opposite party is liable to reimburse the same. The opposite party expressed their inability to settle the claim as per the M.I.T. Policy condition (Money in Transit), that cash secured in the safe lock or locked strong room only is covered. The amount was stolen from the iron safe, which was locked. The F.I.R. also is to that effect. Hence the contention of the opposite party that there is violation of basic condition is highly untenable.

A notice was issued to opposite party on 20.02.2009 and the opposite party got issued reply notice on 03.03.2009 with all false and baseless allegations. There is deficiency of service on the part of opposite party. The allegations in the reply notice that the investigator of opposite party inspected the building and found that the cash was not kept as per the terms and conditions of the policy are highly untenable. RASS is a social service organization and money was kept in the safe being the Self Help Group (SHG) collections pertaining to the institution. Due to the inaction and deficiency in service on the part of opposite party, the complainant suffered damages to a tune of Rs.25,000/- apart from mental agony. Hence the complaint.

3. The opposite party resisted the complaint. In the written statement filed on behalf of opposite party, while admitting that the complainant taken policy with opposite party for the period from 07.11.2007 to 06.11.2008 under the Burglary Policy and denying the other allegations made in the complaint, it is stated that the complainant has not followed the terms and conditions mentioned in the policy. The opposite party has no knowledge about un-known offenders committing burglary on 18.01.2008 and lodging of complaint by the complainant on 19.01.2008. The opposite party appointed an investigator and obtained report with regard to the said offence. As per the report, the cash was kept in steel cupboard.

As per the policy condition the cash received must be placed in a locked safe or locked strong room and the policy will be covered only if the cash is kept in locked safe or locked strong room. In as much as the cash was kept in the steel cupboard, there is violation of policy condition and the opposite party on 08.07.2008 informed the complainant that the policy cannot be honoured. The complaint is not entertainable in view of the fact that the authorized person is named as complainant, where as G.Munirathnam signed the affidavit and complaint. In order to lodge a complaint the person who has been aggrieved must present the same as per the Consumer Act. There is no rule made under the Act in permitting the authorized agent to lodge a complaint. The opposite party got issued suitable reply on 03.03.2009 to inform the complainant that there is a violation of policy and hence the claim was rejected. There is no deficiency in service in order to entertain the complaint. The complaint is liable to be dismissed with costs.

4. In support of the averments made in the complaint, the complainant filed his affidavit and got marked Exs. A1 to A8. Ex.A1 is authorization letter dt:11.04.2009 given by the General Secretary of RASS in favour of G.Venkateswarlu. Ex.A2 is xerox copy of Money Insurance Policy bearing No.051200/48/07/07/00000362 dt:07.11.2007. Ex.A3 is xerox copy of complaint dt:19.01.2008 given by the complainant to the Sub-Inspector of Police, Srikalahasti. Ex.A4 is xerox copy of letter dt:24.01.2008 addressed by the complainant to the opposite party. Ex.A5 is xerox copy of F.I.R. No.11/2008 dt:19.01.2008 of Srikalahasti Police Station. Ex.A6 is xerox copy of Money-in-Transit claim form dt:03.03.2008 submitted by the complainant to the opposite party. Ex.A7 is office copy of legal notice dt:20.02.2009 got issued by the complainant to the opposite party with postal acknowledgement of opposite party. Ex.A8 is reply notice dt:03.03.2009 got issued by the opposite party to the complainant’s advocate.

5. In support of the version in the written statement, the opposite party filed his affidavit and got marked Exs. B1 to B3. Ex.B1 is xerox copy of letter dt:08.07.2008 addressed by the opposite party to the complainant. Ex.B2 is xerox copy of Investigator’s report dt:16.04.2008 on burglary claim of complainant. Ex.B3 is xerox copy of Money Insurance Policy bearing No.051200/48/07/07/00000362.

6. On behalf of the complainant and opposite party written arguments were filed and we have heard the oral arguments of counsel for both sides.

7. On the basis of pleadings of both sides, the points that arise for determination are:-

(i) Whether there is any deficiency in service on the part of the opposite party towards the complainant?

(ii) Whether the complainant is entitled to the reliefs as prayed? If so, to what extent?

(iii) To what result?

8. Point No.(i):- The facts which are not in dispute are:- The complainant insured cash belonging to Rashtriya Seva Samithi (RASS) with opposite party under the original of Exs.A2 and B3 policy for the period from 07.11.2007 to 06.11.2008 against burglary. On 19.01.2008 the complainant lodged the original of Ex.A3 complaint with the Sub-Inspector of Police, I Town Police Station, Srikalahsti, alleging that on the night of 18.01.2008 there was burglary in the office of Rashtriya Seva Samithi (RASS) at Srikalahasti and a sum of Rs.1,21,523/- was stolen from the locked office safe by some unknown offenders by breaking the house at Varadarajaswamy street, Srikalahasti. The Srikalahasti police registered the original of Ex.A5 F.I.R. No.11 dated 19.01.2008 for the offences under Sections 457 and 380 I.P.C. The complainant addressed the original of Ex.A4 letter to the opposite party informing about the theft of Rs.1,21,523/- from Srikalahasti branch of RASS on the night of 18.01.2008.

The complainant submitted the original of Ex.A6 Money-in-Transit claim form to the opposite party claiming the amount of Rs.1,21,523/-. The opposite party addressed the original of Ex.B1 letter dt:08.07.2008 to the complainant expressing their inability to settle the claim on the ground that the basic condition securing the cash in locked safe or locked strong room is violated. The complainant got issued Ex.A7 legal notice dt:20.02.2009 calling upon the opposite party to pay Rs.1,11,523/- as the police recovered Rs.10,000/- from the accused. The opposite party got issued Ex.A8 reply notice informing the complainant that the claim is rejected as the terms and conditions of the policy are violated. The complainant filed the complaint on 16.04.2009.

9. As per the policy conditions mentioned in Ex.A2 policy, cash secured in locked safe or locked strong room only is covered. The case of the opposite party is that they have appointed an investigator and obtained the report with regard to the said offence and as per the report the cash was kept in the steel cupboard and not in locked safe or locked strong room. The opposite party filed Ex.B2 xerox copy of report submitted by their investigator. In Ex.B2 report the investigator stated that the cash was kept in a steel cupboard. As seen from Ex.B2 the investigator conducted the survey on 05.02.2008 i.e., 17 days after the occurrence. In the complaint lodged to police on 19.01.2008 it is clearly mentioned that cash of Rs.1,21,523/- kept in locked office safe was stolen. In the complaint it is specifically alleged that police filed charge-sheet in C.C.138/2008 against one Vellakuri Leela Mohan of Naidupeta and that police seized a sum of Rs.10,000/- from the accused Leela Mohan and delivered the same to the complainant.

The opposite party did not specifically deny the above allegations made in the complaint. At the earliest point of time in the report given to the police it is clearly mentioned that cash of Rs.1,21,523/- kept in locked office safe was stolen. As submitted by the counsel for the complainant Ex.B2 report of the investigator appointed by the opposite party is only self-serving document and no reliance can be placed on it. The money belongs to a social service organization and there is absolutely no justification on the part of the opposite party to reject the claim made by the complainant.

10. For the above reasons, we find that there is no deficiency in service on the part of opposite party towards the complainant. This point is accordingly answered in favour of the complainant.

11. Point No.(ii):- In view of our finding on point No.1, the complainant is entitled for reimbursement of Rs.1,l1,523/- towards the loss incurred. The complainant claimed Rs.25,000/- towards damages for causing mental agony. The complainant is a social service organization. Claiming damages for mental agony by an organization is misconceived and untenable. It is only the natural person, who can claim damages for mental agony as held by the Hon’ble Supreme Court in Sikka Papers Ltd. Vs. National Insurance Company Ltd. & others – 2009 CTJ 706.

The complainant is, therefore, not entitled to damages of Rs.25,000/-. The complainant is, however, entitled to a sum of Rs.1,500/- towards costs of the complaint. Hence, we find that the complainant is entitled for reimbursement of Rs.1,11,523/- and Rs.1,500/- towards costs of the complaint. This point is accordingly answered.

12. Point No.(iii):- In the result, the complaint is allowed in part directing the opposite party to pay Rs.1,11,523/- towards loss incurred and Rs.1,500/- towards costs of the complaint to the complainant within six weeks from the date of receipt of copy of order, failing which the amount of Rs.1,11,523/- will attract interest at 9% per annum.

**adv.sumit** · 09-27-2009, 10:12 PM

Consumer Guidance Society Representing: Ch. Alivelu Mangamma, W/o Satyanarayana, House No.39-8-36, Pydaiah Street, Labbipet, Vijayawada – 520 010

…… Complainant.
vs

1. United India Insurance Company Ltd., Rep: by its Divisional Manager, 2nd Floor, Posenette Bhavan, Ramkote,
Tilak Road, Hyderabad – 500 001.
2. Good Health Plan Limited., Rep: by its Manager/ManagingDirector, Door No.8-2-1/B/1, S.V.R. Towers, 4th Floor, Srinagar Colony Road, Panjagutta, Hyderabad – 500 082.
3. Andhra Bank, Rep: by its Manager, Labbipet Branch, Vijayawada – 520 010.

…. Opposite parties.

ORDER

1. The averments of the complaint in brief are as follows:

That the complainant along with her husband purchased a medi claim policy (jointly) named as “A B Arogydaan Mediclaim Insurance Policy” bearing No.050400/48/07/41/000000075 three years back and in the year 2007 the policy was lapsed because of non-receipt of renewal notice but however, she paid the premium amount and coverage continued from 13.11.2007 to 12.11.2008. as things stood thus the complainant suffered with palpitations and was admitted in Care Hospital, Banjarahills, Hyderabad and was inpatient for three days and there after with a bill amount of Rs.83,588/- she was discharged and the Care Hospital claimed the amount basing on the medi claim policy but the opposite party repudiated the claim, so the complainant was forced to pay the above amount and paid and there after the complainant approached the opposite party No.1 but of no avail so, she got issued legal notice to the opposite parties but of no avail, as such the acts of the opposite parties falls within the purview of deficiency in service and unfair trade practice hence, the complaint.

2. The 1st opposite party filed version interalia admitting the issuance of policy and contended that the complainant concealed the ailment and thereby the complainant is not entitled to the claim that to as per Clause-4 (2) (a) of the policy any person who had preexisting ailment before taking medi claim policy that person is not entitled for reimbursement so much so the complainant herein. Infact, the policy is a new policy though, she had earlier policies as such the complainant is not entitled for the reliefs claimed and prayed to dismiss the complaint.

3. The 2nd opposite party remained exparte.

4. The 3rd opposite party filed separate version interalia stating that the complainant and her husband are the customers of this opposite party and they have purchased “A B Arogydaan Mediclaim Insurance Policy” for the period 2005-06 and it was lapsed on 07.11.2007. there after the husband of the complainant paid the premium for renewal on 13.11.2007 and the premium was remitted to the 1st opposite party on the same day and that the opposite party No.1 issued the policy and that this opposite party is only the middle man and as such the complaint against this opposite party is not maintainable and prayed to dismiss the complaint.

5. On behalf of the complainant Smt Alivelu Mangamma filed an affidavit and got marked Exs.A1 to A7. On behalf of the 1st and 3rd opposite parties Sri G. Syam Babu and Smt Ch. Sita Devi filed affidavits and Ex.B1 is marked.

6. Heard the counsel for all.

7. Now the point that arises for consideration in this complaint are:

I) Whether there was deficiency in service on the part of the opposite parties?

II) Whether the 1st opposite party adopted unfair trade practice?
III) Whether the complainant is entitled for the claim?
IV) To what relief the complainant is entitled?
8. Point Nos.1 and 2: Before adverting to rival contentions it is better to analyze the material on hand, by doing so there is no dispute about the purchase of policy by the complainant along with her husband whether it is renewal or fresh police vide Ex.A1 further, there is no dispute that the complainant was treated in Care Hospital vide Exs.A2 and A3, even as per Ex.A2 there is no scope to come to a conclusion that she suffered with ailment of palpitation since long but as per the material on hand she is known diabetic since one year so there is no scope to come to a conclusion that she concealed the ailment much less there is no scope to come to a conclusion that the ailment of the complainant was of pre-existing one, further there is no any cogent proof to come to a conclusion that the complainant had pre-existing ailment ofcourse, there may be rules and regulations in the policy that the person who concealed the ailment is not entitled for the claim etc., but herein this case there is no any material what so ever to come to a conclusion that the complainant had pre-existing ailment to which she undergone treatment in Care Hospital so no need to give any precedence to the plea of the learned standing counsel for the 1st opposite party much less to the 1st opposite party plea.

Further, there is no dispute that the complainant paid the charges to the hospital vide Ex.A4 and that she also got issued legal notice to the opposite parties vide Ex.A5 and that the opposite parties received legal notice vide Ex.A6 there after the 3rd opposite party got replied under Ex.A7 but the 1st opposite party much less the 2nd opposite party failed to comply or reply that amounts to deficiency in service.

That apart, it is the duty of the opposite party to examine or got examine the person who takes medi claim policy prior to issuance of policy. When once the policy was issued means the opposite party bound to accept the bills so much so in this case that to the complainant is having policy prior to the present policy so no need to bank upon Ex.B1. Further the 1st opposite party failed to examine the complainant atleast through his doctor or by a team of doctors so as to come to a conclusion that she had pre-existing ailment, simply saying that she had pre-existing ailment without cogent proof is not acceptable.

Further no need to bank on the evidence of the opposite party No.1 that the complainant had earlier ailment and that she had treatment prior to taking policy, as such the defence taken by the opposite party No.1 at this belated stage amounts to unfair trade practice so, no need to give any priority to the submissions of the learned standing counsel for the opposite party No.1. That apart, the policy was either renewed or fresh policy but it is valid from 13.11.2007 to 12.11.2008 and that she suffered ailment on 27.07.2008 that means after lapse of three months so, there is no scope to give much precedence to the plea of the 1st opposite party that the complainant had pre-existing ailment. On the whole the material on hand clinchingly show that the complainant had no pre-existing ailment and that the repudiation of the claim by the 1st opposite party is nothing but violation of principles of natural justice and amounts to deficiency in service and further the defence taken by the opposite party No.1 amounts to unfair trade practice so, when viewed the entire material in any perspective the complainant proved deficiency in service and unfair trade practice on the part of the 1st opposite party and so these points are answered accordingly.

Point No.3: In view of our findings in point Nos.1 and 2 the complainant is entitled for the bills since the complainant paid those amounts to Care Hospital Authorities and accordingly this point is answered.
Point No.4: In the result the complaint is allowed and the 1st opposite party is hereby directed to pay an amount of Rs.83,588/- (Rupees eighty three thousand five hundred and eighty eight) only to the complainant within one month from the date of this order failing, which the amount carries interest at 9% p.a., and do pay Rs.2,000/- (Rupees two thousand) only towards costs. Rest of the claim if any claimed by the complainant is rejected. C.C. against opposite parties 2 and 3 is dismissed as they are only proforma and necessary parties but no costs.