BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD.



F.A. No. 1508/2006 against C.C. No. 19/2004, Dist. Forum, Nellore.



Between:



Smt. N. Madhu

W/o. Late Guravaiah

Age: 30 years

R/o. Kusuma Harizanawada

Nawabpet, Nellore-3. *** Appellant/

Complainant

And

1). The Manager

The National Insurance Company Ltd.

Divisional Office-I, P.B. No. 236

Thaveri Mansion, Bank Street

Hyderabad-500 001. *** Respondent/

O.P. No. 1

2). The Branch Manager

Andhra Bank,

Stonehousepet

Nellore. *** Respondent/

O.P. No. 2



Counsel for the Appellants: Mr. C.P. Suresh

Counsel for the Respondent: Mr. P. Phanlguna Rao (R1)

(R2) Served.



HON’BLE SRI JUSTICE D.APPA RAO, PRESIDENT.

SMT.M.SHREESHA, LADY MEMBER

&

SRI K. SATYANAND, MEMBER





WEDNESDAY, THIS THE EIGTH DAY OF JULY TWO THOUSAND NINE



ORAL ORDER: (Per Hon’ble Sri Justice D.Appa Rao, President)



***





Unsuccessful complainants is appellant.



2) The case of the complainant in brief is that her husband late Guravaiah had opened Abhaya Gold Account with R2 Andhra Bank where under the account holder is covered by the insurance policy with R1 and in case of death by accident, the nominee is entitled to a sum of Rs. 1 lakh. While so, her husband met with accident on 12.4.2003 at about 10.00 p.m. while coming in an auto and sustained injuries. On report, the police registered a case. He died on 13.4.2003. Since she could know that her husband had opened Abhaya Gold account, she could not prefer the claim immediately, and after coming to know of it, she made the claim with all necessary documents, however, the same was repudiated by R1 solely on the ground that the claim was not made within 90 days. Therefore, she claimed Rs. 1 lakh with interest @ 18% p.a., together with compensation of Rs. 25,000/- and costs of Rs. 3,000/-.



3) R1 resisted the case, putting the complainant to prove that she is the wife of the deceased and that he died in an accident. R2 bank sent a letter on 27.11.2003 intimating the death of the deceased on 13.4.2003 claiming the amount covered under the policy. Since the claim was made not within 90 days the same was repudiated. The Dist. Forum had no jurisdiction. There was no deficiency in service on its part. No Succession Certificate was filed and therefore it prayed for dismissal of the complaint with costs.



4) R2 bank filed counter. It admitted the coverage of insurance for Abhaya Gold accountholders wherein on the death of the accountholder in an accident, and that the nominee was entitled to Rs. 1 lakh. After receipt of belated claim, they forwarded it along with necessary papers; however, the same was repudiated on the ground that the death was not intimated within 90 days. It is the insurance company that is liable to pay. It has no liability for settlement of the claim and therefore prayed for dismissal of the complaint.







5) The complainant in proof of her case filed her affidavit evidence and got Exs. A1 to A5 marked. Refuting her evidence the insurance company filed Exs. B1 to B4.



6) The Dist. Forum after considering the evidence placed on record opined that though the deceased died in an accident, the complainant could not prove that she was the nominee. Her two minor children were not made as parties as disclosed from family members certificate, and as she was not alone entitled to receive the claim it dismissed the complaint.



7) Aggrieved by the said decision, the complainant preferred this appeal contending that the Dist. Forum did not appreciate the facts in correct perspective. The family members certificate issued by the MRO undoubtedly show that she was the wife of the deceased entitled to the amount covered under the policy, and therefore prayed that the amount be paid to her.



8) During the course of hearing the complainant filed a petition F.A.I.A. No. 863/2009 to receive the certificate issued by the Manager of R2 bank mentioning that the deceased nominated her (the complainant) as the nominee. The respondent did not choose to file any counter. In the circumstances the petition is allowed and marked it as Ex. A6.



9) It is an undisputed fact that the complainant is the wife of the deceased Guravaiah who was holding Abhaya Gold account with R2. The accountholder is covered by policy Ex. B1 wherein, on the death of the account holder in an accident nominee is entitled to the amount. Copy of agreement is Ex. B1. The complainant alleges that her husband died in a motor vehicle accident on 13.4.2003 while he was travelling in an auto evidenced under FIR Ex. A1. The post-mortem examination was also conducted vide Ex. A2. Certificate of death Ex. A3 was issued by the Registrar of Births & Deaths.



10) The complainant after coming to learn that her husband was holding an account under Abhaya Gold Scheme, having found in the house, made the claim under Ex. A4 requesting the bank to pay the said amount. The same was forwarded by the bank to R1 by letter Ex. B3 along with death certificate, Post-mortem certificate. It was repudiated only on the ground that it was not intimated within 90 days.



11) The insurance company had repudiated the claim solely on the ground that the claim was not made within 90 days. Clause 8 of the terms and conditions of the policy reads as follows:

8) Procedure for claims:



Intimation of accidents giving rise to claims shall be given to the insurer through the branch of the banker within the reasonable time of 90 days from the date of accident. In case of claims, the following documents shall be submitted to the insurer along with a certificate of the branch of the banker in the format and the filled in claim forms issued by the insurer on intimation of accidents.





12) We may state that the stipulation of 90 days would apply only to the insured account holder for the accident that was caused to him. The complainant being the wife/nominee the stipulation of period of limitation prescribed would not be applied to her. The insurance company instead of verifying the claim harped on technicalities and repudiated the claim that too without any basis. The LRs of the deceased being not a party to the agreement the term was not applicable to her. Therefore this contention has no legs to stand. The other contention that was raised was the complainant did not file any proof to show that she was entitled by way of filing Succession Certificate. Rule 9 of the terms and conditions of the policy mandates the nomination facility. Rule 9(a) reads as follows:

9) NOMINATION FACILITY:

(a) Nomination facility in respect of the balance in the account maintained with the Bank may be obtained by the Bank as provided under BR Act and Rules.







13) The insurance company did not direct the bank to submit the nomination form taken under the rules as stipulated above. This question has not been taken seriously before the Dist. Forum. The insurance company did not repudiate the claim on the ground that nomination in favour of the complainant was not submitted. When the Dist. Forum dismissed the complaint solely on the ground that she did not file any document evidencing that she was entitled viz., that she was the nominee of the deceased, the complainant filed a certificate issued by the Branch Manager of R2 bank, marked as Ex. A6 in the appeal by way of additional evidence. The insurance company did not controvert anything in this regard. Since the document is furnished by none other than the Manager of the bank mentioning that the nomination was given in favour of the complainant, as per rules, necessarily she was entitled to the amount covered under the policy. The order of the Dist. Forum no longer sustains.



14) In the result the appeal is allowed setting aside the order of the Dist. Forum, consequently the complaint is allowed in part directing the insurance company to pay Rs. 1 lakh with interest @ 7.5% p.a., from the date of repudiation viz., 05. 12. 2003 till the date of realization with costs computed at Rs. 2,000/-. Time for compliance four weeks. The complaint against R2 bank is dismissed. No costs.





1) _______________________________

PRESIDENT





2) ________________________________

MEMBER





3) _________________________________

MEMBER

Dt. 08. 07. 2009.