BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MYSORE-570023

CONSUMER COMPLAINT NO.233/2015

DATED ON THIS THE 21^st October 2016

      Present:  1) Sri. H.M.Shivakumara Swamy

B.A., LLB., - PRESIDENT   

    2) Smt. M.V.Bharathi                    

                                   B.Sc., LLB., -  MEMBER

                     3) Sri. Devakumar.M.C.                  

                                                          B.E., LLB.,    - MEMBER

Sri Devakumar.M.C.

Member

1.     The complainant filed the complaint under section 12 of the C.P.Act, against the opposite party alleging deficiency in service and seeking a direction to pay Rs.1,00,000/- along with interest at 24% from the date of filling of the complaint till the date of payment and to pay Rs.10,000/- compensation for hardship, inconvenience and mental agony caused with cost of the proceedings and such other reliefs.
2.      The complainant’s husband obtained the comprehensive insurance policy from opposite party, in respect of his scooter, which was valid from 05.10.2014 to 04.10.2015.  On 12.11.2014 the complainant’s husband met with an accident and died on 13.11.2014.  The police registered the case.  The complainant submitting all relevant documents to opposite party, requested for the claim, but opposite party kept on dodging without making payment.  A legal notice caused on 19.02.2015, and served on 20.02.2015, the opposite party neither replied nor complied, thereby the aggrieved complainant alleging the deficiency in service filed the complaint and sought for the reliefs.
3.     The opposite party denies all the allegations in its version and pleaded that the complaint is not maintainable for want of cause of action against the opposite party.  Opposite party submits that, the complainant has not approached and submitted the claim form with relevant documents.  As per the terms and conditions, the insurer shall gets a right to dishonour the belated claims.  The information relating the occurrence of accident and death of the insured has not been intimated to the insurer until the issuance of legal notice on 19.02.2015.  The delay in intimation is attributed as violation of policy terms and conditions.  Hence, the complaint is liable to be dismissed and the complainant is not entitled for any reliefs sought.
4.     To establish the facts, the complainant filed affidavit and relied on several documents.  The opposite party filed its affidavit.  Written arguments filed by both and heard the oral submissions.  Perusing the material on record, matter posted for orders.
5.     The points arose for our consideration are:-

1. Whether the complainant establishes the deficiency in service on the part of opposite party in not settling the insurance claim and thereby she is entitled for the reliefs sought?
2.  What order?

6.    Our findings on the aforesaid points are as follows:

Point No.1 :- Partly in the affirmative.

Point No.2 :- As per final order for the following

:: R E A S O N S ::

7.    Point No.1:- The scooter owned by the complainant’s deceased husband, has comprehensive policy for a period from 05.10.2014 to 04.10.2015.  The scooter met with an accident on 12.11.2014 injuring the owner, who succumbed to injuries on 13.11.2014.  Police registered FIR.  The complainant was the nominee to the insurance policy.  The complainant approached the opposite party office and requested for payment of the insurance policy amount on several occasions.  But, opposite party failed to make payment.  A legal notice caused on 19.02.2015 to opposite party calling upon to make payment of Rs.1,00,000/- policy amount.  The opposite party neither replied nor complied the requests.  Hence aggrieved complainant, filed the complaint and sought for the reliefs.
8.    The opposite party contended that, though the accident took place on 12.11.2014 and the owner died on 13.11.2014, same was not intimated to it until 19.02.2015.  The complainant ought to have made the claim by submitting duly filled claim form with necessary particulars along with all relevant documents.  Because of the delay in intimation of the death and non-submission of the claim form with necessary documents, it could not process the claim and made the payment.  The delay in giving intimation amounts to breach of policy terms and conditions.  Further, the opposite party was deprived of investigation with regard to cause of death of the vehicle owner, thereby the policy condition is violated.  Hence, the complaint is not maintainable and opposite party is not liable to pay any compensation as claimed.  As such, prays for dismissal of the complaint.  
9.    The material available on record, established the policy in respect of the vehicle of the deceased and the same was valid between 05.10.2014 to 04.10.2015.  The vehicle has comprehensive policy.  The owner of the vehicle died in the accident occurred on 12.11.2014 i.e. during the subsistence of the policy. The bereaved family could not intimated the opposite party immediately due to lack of knowledge and illiteracy.  Later, after lapse of considerable time, approached the opposite party without submitting the claim form and demanded for payment of insurance amount.  In absence of the claim form with necessary documents could not process the claim and make the payment.  Further, the opposite party came to know about the accident only on receipt of the legal notice on 19.02.2015.  The policy terms and conditions prescribes the time limit for intimation regarding any eventualities.  Thereby, there is violation of the policy conditions.
10. However, the opposite party ought to have make the payment of the policy amount on receipt of intimation of death, cannot take the shelter of delay in intimation as the reason for non-payment of the death claim, even for belated intimation.
11. The complainant relied on judgement rendered by Hon’ble State Commission of Chandigarh, reported in 4(2015) CPJ 48 (Punjab), which relied on the decision of the Hon’ble National Commission, in National Insurance Co.Ltd., V/s Kulwanthsingh (IV 2014 CPJ 62 NC), it was observed that, the insurance company should not repudiate the claims for the reason of delay in giving information to it, when there was no delay in filing FIR with police, where the accidental death is proved in record.  In view of the above, point No.1 is answered partly in the affirmative.   
12. Point No.2:- In view of the above observations, we proceed to pass the following

:: O R D E R ::

1. The complaint is allowed in part.
2. The opposite party is hereby directed to pay the policy amount of Rs.1,00,000/-, by considering the policy claim particulars with interest at 9% p.a. to the complainant, within 60 days of this order.  Failing to comply, the opposite party is liable to pay interest at 12% on the amount from the date of filing the complaint.
3. The opposite party is hereby directed to pay Rs.2,000/- towards hardship, mental agony caused and Rs.1,000/- towards cost of the proceedings to the complainant, within 60 days of this order.  In default to comply, the opposite party shall pay interest at 12% p.a. on the total sum of Rs.3,000/-, until payment made.
4. In case of default to comply this order, the opposite party shall undergo imprisonment and also liable for fine under section 27 of the C.P.Act, 1986.
5. Give the copies of this order to the parties, as per Rules.

(D