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2014 DIGILAW 910 (ORI)

Manager, Golden Trust Financial Services, Kolkata v. Padmini Behera

2014-12-31

R.N.BISWAL, SMARITA MOHANTY

body2014
ORDER : R.N. BISWAL, J. This appeal is directed against the order dated 30.11.2007 passed by the District Consumer Disputes Redressal Forum, Balasore (hereinafter referred to as District Forum) in C.D. Case No. 121 of 2005 holding the appellants and respondent No. 2 jointly and severally liable to pay respondent No. 1 the assured sum of Rs. 2,00,000/- and litigation cost of Rs. 500/- with interest at the rate of 6% per annum from the date of filing of the complaint till realization within one month of the order failing which interest at the rate of 9% per annum shall be chargeable on the aforesaid amount. Respondent No. 1 was the complainant, appellants were opposite party Nos. 2 and 3 respectively and respondent No. 2 was opposite party No.1 before the District Forum. The case of the complainant stated in brief is that while her husband Rabi Narayan Behera was working under Birla Tyres at Balasore, insured his life under Janata Personal Accident Insurance Scheme with opposite party Nos. 1 and 2 through opposite party No. 3 under policy No. 10030047019600092 for the period 8.6.2002 to 7.6.2017 and the sum assured was Rs. 2,00,000/-. While the said policy was in force, on 30.5.2004, he met with a vehicular accident and breathed his last. The matter was reported to Khantapada Police Station and accordingly, P.S. Case No. 101 of 2004 was registered and the dead body of the deceased was sent to District Headquarters Hospital, Balasore where autopsy over it was conducted. Complainant - nominee - wife of the life assured lost her mental equilibrium and after she was mentally stabled, she filed the claim form along with other documents with opposite party No. 3. In spite of several requests, opposite parties did not settle the claim and after long lapse of time, they closed her claim on 14.7.2005 as 'No Claim'. Hence, she filed the aforesaid Consumer Dispute with prayer to direct the opposite parties to settle the claim of Rs. 2,00,000/- along with interest at the rate of 12% per annum, pay compensation of Rs. 5,000/- and litigation expenses of Rs. 3,000/-. Hence, she filed the aforesaid Consumer Dispute with prayer to direct the opposite parties to settle the claim of Rs. 2,00,000/- along with interest at the rate of 12% per annum, pay compensation of Rs. 5,000/- and litigation expenses of Rs. 3,000/-. Opposite party No. 1 on being noticed appeared through his counsel and filed written version inter alia stating that after scrutiny of documents, it was ascertained that the claim was lodged at a very belated stage violating the policy condition and hence the claim was closed as 'No Claim' and prayed to dismiss the case. Opposite party Nos. 2 and 3 in their written version stated that the complainant is not a consumer under them and as such, the case was not maintainable so far they are concerned. The life of Rabi Narayan Behera the deceased policy holder, who was an employee of Birla Tyres was covered under insurance policy No. 100300/47/1/9600022/01/96/30081 for the period 8.6.2002 to 7.6.2017 and the sum assured was Rs. 2,00,000/-. He met with an accident on 30.5.2004 and breathed his last. On receipt of the claim form, opposite party No. 2 forwarded it to opposite party No. 1 on 6.12.2004, who closed the file on the ground of 'No claim'. Under such circumstances, they prayed to dismiss the case against them. After going through the pleadings of the parties, documents placed on record and hearing the counsel for the parties, the District Forum held that complainant submitted the claim application along with relevant documents which was acknowledged by opposite party No. 3 on 3.10.2004. As such, there was delay. It further held that due to latches on the part of the opposite parties, complainant should not suffer. Being aggrieved with the said order, the appellants preferred the present appeal as stated earlier. Learned counsel for the appellants submit that there is no partionship of 'consumer' and 'service provider' between respondent No. 1 and the appellants. It was specifically mentioned in the proposal form that for any insurance claim respondent No.2 - Insurance' Company would be solely liable and in no circumstances; the appellants would be liable to pay any amount. A memorandum of understanding entered into between the Golden Multi Services Club and respondent No. 2 authorises the appellants to collect premium from the members of the Club and to transmit the same to the latter on weekly basis. A memorandum of understanding entered into between the Golden Multi Services Club and respondent No. 2 authorises the appellants to collect premium from the members of the Club and to transmit the same to the latter on weekly basis. The settlement of claim has been vested mainly on respondent No. 2 Insurance Company and non-else. So according to the learned counsel for the appellants, the order passed by the District Forum suffers from gross illegality and as such, it warrants to be interfered with by this Commission. The claim has been repudiated on the ground of delay in noticing respondent No. 1 about the death of life assured; whereby policy condition No. 1 was violated. It is profitable to quote, the policy condition No. 1 of Insurance Policy, which reads as follows :- "Upon the happening of any event which may give rise to a claim under the policy this insured shall forthwith give notice hereof to the issuing Officer, i.e., Golden Multi Services Club, unless reasonable cause is shown; the insured should within one calendar month after the event which may give rise to a claim under the policy given written notice to the Company with full particulars of the claim". This relates to an injured life assured and not to a death case. In the present case in fact, the life assured died on vehicular accident on 30.5.2004. Respondent No. 1 sent the claim form along with relevant documents to the appellants, albeit on belated state. As per her case, after the death of her husband (life assured) she lost mental equilibrium and after she became mentally stabled, she sent the claim form along with the relevant documents to the appellants. So, even if the above quoted condition is presumed to be applicable to the present case, there was sufficient cause to notice respondent No. 2 about the death of life assured in a belated stage. It is found from the MOU executed between respondent No.2 Insurance Company and the appellants-Club that the Club will collect premium from the proposes and remit the same to Division-III of National Insurance Company Limited by consolidated cheque every week with list of insured persons. So the appellants - Club only facilitate its members to insure their life. It is found from the MOU executed between respondent No.2 Insurance Company and the appellants-Club that the Club will collect premium from the proposes and remit the same to Division-III of National Insurance Company Limited by consolidated cheque every week with list of insured persons. So the appellants - Club only facilitate its members to insure their life. There is no relationship of consumer and service providers between respondent No. 1 and the appellants: It has also been mentioned in the proposal form that for any insurance claim, the insurer would be solely liable and under no circumstances, the appellants - Club would have any liability in this aspect. Therefore, the appeal is allowed and the impugned order passed against the appellants is set aside. The entire award would be paid by respondent No. 2 to respondent No. 1. Parties to bear their cost. Records received from the District Forum, Balasore be sent back forthwith.