The case of the complainant is that her claim for accidental death benefits of her husband Sri.Umesha has been repudiated by opposite party on the ground that at the time of death of her husband the registration was discontinued. According to complainant her husband joined in a scheme of plot allotment of opposite parties as per the payment plan 13/7Y and registered as No.U.167044498 on 28-02-04. The policy issued by the opposite parties extends the benefit of the scheme to the accident victims also. Sri. Umesha involved in a Road Traffic Accident on 16-11-06. The fact of the accident intimated to opposite party No.1. From the opposite party No.2 office it was informed that the policy having a break for non-payment of instalments and they advised first to remit the arrears of dues and keep alive the policy to claim the accident benefits. Accordingly the due instalments were remitted to opposite party No.1 up to date on 17-11-06. The opposite party No.1 assured that the victim Umesha will be informed soon about his claim. But on 18-11-06 Sri Umesha succumbed to injuries sustained in the accident. Hence the complainant, wife of the deceased Umesha placed claim with opposite party No.1 for the accidental death benefits mentioned in the scheme. But the opposite party No.1 rejected the claim for the reason that at the time of accident registration was discontinued. The accident benefits comes to Rs.45,000/- for disability as per the plan of the scheme joined by complainantís husband Umesha and the accident death benefit to the maximum Rs.1,00,000/-. Hence the complaint claiming the accidents death benefits due as per the scheme of opposite parties.
2. Opposite parties filed separate versions. According to opposite party No.1 (i) the agreement executed between complainantís husband and the opposite party does not have any clause with regard to accidental/death policy. Hence complainant is not entitled for any claim.
(ii) The complaint is not maintainable in view of the arbitration clause contained in the agreement executed by the deceased husband of the complainant with opposite party No.1.
(iii) The opposite party No.1 company is not in the business of insurance and does not insure any of its customers. The opposite party company is engaged in the business of sale, purchase, development and maintenance of agricultural land at various places all over India. The agreement entered between the complainantís husband and the opposite party is the agreement for allotment of land and complainantís husband was the customer under the said agreement and not a policy holder as alleged. The agreement executed between the parties nowhere provides for accidental/death policy as alleged by complainant and therefore the question of payment of any money/compensation does not arise. So the denial of accidental/death claim on the part of opposite party does not amount to any deficiency in service.
3. According to opposite party No.2 he is a commission agent of opposite party No.1. Complainant paid the amount to opposite party No.1 and opposite party No.1 issued the receipt and certificate to complainant. If at all complainant is eligible to get any accidental benefits the opposite party No.1 is liable to give the benefit to the complainant.
4. On the side of complainant Exts A1 to A7 marked. On the part of opposite party No.1 DW1 was examined and Exts B1 to B8 marked. Both sides heard and the documents perused.
5. The issue regarding the maintainability of the complaint in view of the arbitration clause contained in the agreement and the jurisdiction of the Forum were heard as a preliminary issue and a separate order was passed holding that complaint is maintainable. The said order was passed relying on the decision of the Honíble Supreme court in the case of Skypak Couriers Ltd V. Tata Chemicals (2000) 5 SCC 294.6. On merits it is the case of opposite party No.1 that they are not doing any insurance business and they are not any insurance company to pay compensation to accident victims.
6. The learned counsel for the complainant Sri.Srikanta Shetty invited our attention to Ext.A4 dated 23-01-07. that is a copy of a reply letter issued by opposite party No.1 PACL INDIA LIMITED New Delhi to its C.S.C-in-charge, Mangalore with reference No. PACL/DLH/CO/PS&CC 23592 with subject: OBJECTION claim sanction. The said reply is sent in reference to I.O.M. No. 1654 dt.16-1-07 of C.S.C.-in-charge-Mangalore in Ext.A4 it is stated as follows.
SUBJECT: OBJECTION Claim Sanction.
Refer your I.O.M. No.1654 dt. 16-01-07 wherein you have submitted document for sanction of claim sanction as per detail hereunder:-
------------------------------------------------------------------------------------------------------------------------Customer Name Reg.No. Case Number
MR.UMESHA.S U167044498 17122
In this connection please note that we have not sanctioned claim sanction on above registration following Objection.
AT THE TIME OF ACCIDENT REGISTRATION IS DISCONTINUED.
7. So the contents of Ext.A4 turns against the contention of the opposite party No.1 that the agreement executed between complainantís husband and the opposite party does not have any clause with regard to accidental/death policy. Had it been so, the rejection of the claim for the accidental benefits would have been on that ground.
8. Now the question to be considered is whether the objection of opposite party No.1 is justifiable or not.
The Ext.B4 is the agreement executed between the husband of complainant Sri.Umesha and opposite party No.1. In that the General Terms and Conditions are explained. The 3rd condition states that in case of instalment payment plans, if customer makes a default by not paying one or more instalments for a period of 12 consecutive months from the due date, such default shall be treated as Breech of Agreement.
9. In this matter the opposite party No.1 has no case that the deceased Umesha has committed breach of agreement by not paying one or more instalments for a period of 12 consecutive months from the due date where as immediately on the next day of accident all the dues till that period is collected saying that in order to prefer the claim for accident benefits all the dues shall be remitted.
10. Therefore it could not be considered that on the date of accident the registration is discontinued. Had it been so the opposite party No.1 ought not have collected the dues on the following day. The collection of dues on the subsequent day of accident i.e. on 17-11-06 itself shows that the registration of Sri.Umesha was not discontinued.
11. The further contention of opposite party No.1 that they are engaged in the business of sale, purchase, development and maintenance of agricultural land and not doing any insurance business is also not acceptable in view of Ext.A5. On the overleaf of Ext.A5 the specialities of opposite party No.1 company is printed in vernacular language. The 9th peculiarity is that accident benefits are given to depositors is between the age of 12 to 65 subject to maximum of Rs.1,00,000/-.
12. In this regard the learned counsel appearing for opposite party No.1 Sri. M.T.Narayana Shetty vehemently argued that opposite party No.1 is not an insurance company and opposite party No.1 has no connection with Ext.A5. The said contention is made only to escape from the liability from making the payment of accidental benefits to the complainant. After enjoying all the benefits of such a notice such as attracting large numbers of depositors, disowning the said notice on the ground that it was printed without their knowledge is definitely proves the deceptive nature of services rendered by opposite party No.1. As per Ext.A5 notice the maximum amount is payable Rs.1,00,000/- as accidental benefits. But as per the table shown in Ext.A5 the accident benefits payable to a member who joined in the scheme as that of the deceased Umesha is Rs.45,000/-. Hence the complainant is entitled to get the said amount.
Therefore the complaint is allowed and opposite party No.1 is directed to pay Rs.45,000/- to the complainant within 30 days from the date of receipt of copy of order with a cost of Rs.2500/-. Failing which the said amount Rs.45,000/- will carry interest @ 12% from the date of complaint till payment. Opposite party No.2 is exonerated from liabilities.