IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Saturday the 31st day of December, 2016.
Filed on 22.04.2016
Present
- Smt. Elizabeth George (President)
- Sri. Antony Xavier (Member)
- Smt. Jasmine D (Member)
in
C.C.No.150/2016
Between
Complainants:- Opposite parties:-
- Smt. Jolly Treesa 1. The regional Executive
W/o Late Georgekutty Kerala Fishermen
Arresseryil, Pathirapally.P.O Welfare Fund Board, Alappuzha
Alappuzha.
2. Sr. Divisional Manager
2. Merlin (Sayana) United India Insrance Comp Ltd D/o Late Georgekutty Divisional Office, No.2, 1st Floor
Arresseryil, Pathirapally.P.O Kurupam Road
Alappuzha. Trissur
(Adv. T.S.Suresh) 2nd op
3. Alan
S/o Late Georgekutty
Arresseryil, Pathirapally.P.O
Alappuzha.
4. Evan
S/o Late Georgekutty
Arresseryil, Pathirapally.P.O
Alappuzha.
5. Sri Antony
Arresseryil, Pathirapally.P.O
Alappuzha.
6. Smt.Alphonsa
Arresseryil, Pathirapally.P.O
Alappuzha.
(Adv. K.T. Aneesh mon)
O R D E R
SMT. JASMINE D. (MEMBER)
The case of the complainant in short is as follows:-
The complainants are the legal heirs of the deceased Sri. Georgekutty who availed an insurance policy with the 2nd opposite party under the Group Insurance Scheme. The said policy was provided by the 1st opposite party for the members of Kerala State Fishermen Welfare Fund Board Sri. Georgekutty died at Medical College Hospital Kottayam on 25.10.2015. According to the complainants the deceased Georgekutty was the only bread winner of the family and he has a valid insurance policy with the opposite parties and he died due to an accident. Therefore the complainants are entitled to get the insurance claim. The complainant submitted the claim form before the 2nd opposite party with all relevant documents but the 2nd opposite party rejected the claim saying that the deceased Georgekutty has no valid license at the time of accident. Since the opposite parties repudiated the claim the complainant sustained much mental agony and hardships, hence filed this complaint alleging deficiency in service on the part of the opposite parties.
2. Notice was served to the opposite parties. Both opposite parties appeared before the Forum and filed version.
3. Version of 1st opposite party is as follows:-
The husband of the 1st complainant was a member of the 1st opposite party holding membership no. 1662. The members was insured with the 2nd opposite party under the Group Insurance Scheme and the total sum assured in Rs. 5,12,000/- in case of accidental death. As per the agreement with the 2nd opposite party in case of the accidental death of a member the applicant must submit Postmortem report, FIR, Police Investigation report, Police final report along with claim form. Since the complainants have produced all the documents as per the agreement the 2nd opposite party bound to the pay the claim amount.
4. The version of 2nd opposite party is as follows:-
The complainant is not maintainable and there is no deficiency in service on the part of the opposite party. It is true that the deceased Georgekutty has a valid policy with the opposite party. When the claim received, opposite party while processing the claim it is noticed that the deceased Georgekutty has no driving license at the time of alleged accident. Hence this opposite party as per letter dated 25/2/2016 intimated the first opposite party who submitted the claim to produce the final report of police and the Driving license of late George kutty. But the first opposite party in response of the above letter produced Final police report alone and as per letter dated 15/3/2016 the first opposite party informed the second opposite party that the deceased does not have the driving license. Till this time the first opposite party and the petitioners here in have not produced the driving license of the deceased George kutty. Hence the company has no other way, and the claim was repudiated and as per letter dated. 17/3/2016 this opposite party intimates the repudiation of claim to the first opposite party.
5. It is also submitted that the repudiation of the claim is in accordance with law and policy conditions. It is also submitted that as per section 3 (1) of MV Act for driving vehicle driving license is mandatory. In the present case the deceased George kutty has absolutely no driving license. The petitioners herein also admitted the fact that the deceased has no driving license at the time of accident. More over the first opposite party also admitted the said fact. Hence it is clear that the deceased has no driving license at the time of accident and hence he violated Section 3(1) MV Act. Hence the deceased was a law breaker. Hence this Forum can very well see that the repudiation of claim is legal and genuine one and hence there is absolutely no deficiency of service on the part of this opposite party and hence the complaint may be dismissed.
6. The 1st complainant was examined as PW1 and documents Ext. A1 to Ext.A were marked. 2nd Opposite party produced 2 documents which were marked as Ext.B1 to ExtB2
7. Considering the allegation of the complainants and contention of the Opposite Parties the Forum has raised the following issues:-
- Whether there is any deficiency in the service or unfair trade practice on the part of the Opposite Parties?
- Whether the complainant is entitled to get the relief as prayed for?
8. Issues 1 and 2
The case of the complainants is that the deceased Georgekutty has a valid insurance with the 2nd opposite party under the group insurance policy provided by the 1st opposite party. When the policy was live the said George kutty died in an accident. So the complainants are entitled to get the insurance benefit of accidental death, but the opposite party repudiated the claim saying that the deceased George kutty has no valid license at the time of accident. The act of the opposite party caused much mental agony and inconvenience to the complainant and hence filed this complaint alleging deficiency in service on the part of the opposite parties.
9. According to the 2nd opposite party the deceased George kutty has a valid policy at the time of the accident but they repudiated the claim only because the deceased Georgekutty has no valid license at the time of accident. The point to be considered is the whether the contention of the opposite party is a reasonable ground to repudiate the claim as per the agreement executed with them. Admittedly the deceased was insured with the 2nd opposite party under the Group Insurance Scheme of the 1st opposite party which was provided by the State Government with an objective to given help the families of the member of Kerala State Fishermen welfare fund board in case if any mishappening.
10. Here the case on hand, poor fishermen joined the opposite parties insurance scheme thinking that his family would get some benefit if any mishap may happen. Unfortunately he deed in an accident leaving his wife and three small children. The purpose of the policy is to provide assistance to the family if any mishap would happen to the insured. On a perusal of the documents it is seen that the deceased George kutty is having a valid insurance policy with the 2nd on at the time of his death. Ext. A2 clearly shows that the accident led to the death of the insured occurred not due to his negligence. According to the opposite party they repudiated the claim of the complainants only became the insured had no valid license at that time of the accident. As discussed earlier, the accident occurred only due to the negligence and carelessness of the other party involved in the accident and not due to the negligence of the insured. The contention is not at all substantial. The version of the 2nd opposite party it can be seen that the policy issued to the policy holder is not for the benefit of the insured but it is for protecting the interest of the 2nd opposite party. Now a day the insurers are behaving in a haphazard manner to suit the interest and convenience of the insurers. This is not a fair practice many insurers are ditched this way. It is high time to depreciate such unfair trade practice on the part of the insurers. Here in this case also the 2nd opposite party repudiated the claim of the poor helpless complainants by stating insensible statements. The 2nd opposite party collected premium from the insured to assist and aid the family when they are needy. So the act of repudiating the claim of the complainants cannot be justified. So we have no hesitation to attribute negligence on the part of the 2nd opposite party. The 2nd opposite party committed unfair trade practice and there is deficiency in service on their part. We exempt the 1st opposite party from the liability of deficiency in service as they have no role here and also they have done their duty well.
In the result the 2nd opposite party is directed to pay the insurance claim Rs. 5,12,000/- [Rupees Five lakh Twelve thousand only] to the complainants. 2nd opposite party is further directed to pay Rs. 1000/- [Rupees Thousand Rupees only] towards compensation and an amount of Rs.2000/- [Rupees Two thousand rupees only] towards cost of the proceedings. The order shall be compiled within one month from the date of the receipt of this order, failing the amount shall carry interest @ 8% per annum from the date of order till realization.
Pronounced in Open Forum on this the 31st day of December, 2016.
Sd/-Smt. Jasmine D (Member)
Sd/-Smt. Elizabeth George (President)
Sd/-Sri. Antony Xavier (Member)
Appendix:-
PW1- Jolly Treesa (Witness)
Evidence of the complainant:-
Ext.A1 - Copy of FIR.
Ext.A2 - Copy of Final Report.
Ext.A3 - Insurance letter Dtd. 25.2.2016
Evidence of the opposite parties:-
Ext.B1 - Copy of the Letter Dtd. 25.02.2016
Ext.B2 - Copy of the Letter Dtd. 15.03.2016
-//True copy//-
By Order,
Senior Superintendent.
To
Complainants/Opposite parties/S/F
Typed by:Br/-
Compd.By:
