BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD.
CC 24 of 2012
Between:
Dayya Sony,
D/o. Late Dayya Kailash
H.No. 9-24, Subhash Nagar
Bheemgal, Nizamabad Dist. *** Complainant
And
1) Reliance Life Insurance Company
Anil Dhirubhai Ambani Group
A Reliance Capital Company
6th Floor, Reliance House
No. 6, Haddows Road
Nangambakkam, Chennai.
Rep. by Authorised Signatory
2) Reliance Life Insurance Company
Anil Dhirubhai Ambani Group
A Reliance Capital Company
Corporate Office : Midas Sahara Plaza
Andheri, Kurla Road, Andheri ( E )
Mumbai.
Rep. by Authorised Signatory
3) Reliance Life Insurance Company
Anil Dhirubhai Ambani Group
A Reliance Capital Company
Regd. Office: H-Block, 1st Floor
Dhurubai Ambani Knowledge City
Navi Mumbai-400 710
Maharashtra State
Rep. by Authorised Signatory
4) Reliance Life Insurance Company
Branch Office at Armoor
Karareddy, Nizamabad Dist.
Rep. by its Branch Manager. *** Opposite Parties
Counsel for the Complainant: M/s. Vakkanti Narasimha Rao
Counsel for the Opposite Party: None.
CORAM:
HON’BLE SRI JUSTICE D. APPA RAO, PRESIDENT
SMT. M. SHREESHA, MEMBER
&
SRI S. BHUJANGA RAO, MEMBER
WEDNESDAY, THE FOURTH DAY OF JULY TWO THOUSAND TWELVE
ORAL ORDER: (Per Hon’ble Sri Justice D. Appa Rao, President)
***
1) This is a complaint filed u/s 17 of the Consumer Protection Act claiming Rs. 19 lakhs covered under the policy with interest together with compensation and costs.
2) The case of the complainant in brief is that she is the nominee of her father Dayya Kailash under insurance policy for a sum of Rs. 19 lakhs for a period of 22 years commencing from 25.2.2010. While so, he died on 26.12.2010 at Supreetha Hospital, Kamareddy due to Acute Myocardial Infraction (AMI). Therefore she was entitled to Rs. 19 lakhs covered under the policy. She submitted claim form with all relevant documents through Op4. The opposite parties did neither repudiate the claim nor inform the stage. In fact they ought to have settled the claim within 60 days lest they were liable to pay interest. She got issued a legal notice through her counsel. Though they had received it they did not choose to give any reply. Again she got issued another notice through her counsel for which Op2 gave reply stating that it was repudiated on 31.5.2011 as the deceased had suppressed the ailment viz., renal failure and put on dialysis during January, 2009. Again she has given reply stating that her father had never taken treatment for renal failure nor put on dialysis. However, she has also sent photostat copy of case sheet of Supreetha Hospital, Kamareddy through her advocate with a request to send proof of receipt of repudiation letter though the same was received by the opposite parties it did not give any reply. Despite receipt of notice Op2 did not settle the claim. Non-settlement of claim amounts to deficiency in service, and unfair trade practise and therefore she filed the complaint claiming Rs. 19 lakhs covered under the policy with interest @ 24% p.a., together with compensation and costs.
3) Opposite parties 1 to 4 did not choose to contest the matter despite the fact that notice was served on them. Therefore they were set-exparte.
4) The complainant in proof of her case filed her affidavit evidence and got Exs. A1 to A19 marked.
5) The points that arise for consideration are :
i) Whether the opposite parties had issued policy for assured sum of Rs. 19 lakhs?
ii) Whether there was no suppression of ailment, and consequently the complainant was entitled to compensation?
iii) To what relief?
6) It is an undisputed fact that the complainant is the daughter of one Dayya Kailash. Her father had taken Special Term Plan (Regular) Policy Ex. A18 for a sum of Rs. 19 lakhs commencing from 25.2.2010 wherein she was made as nominee. It is also not in dispute that the insured died on 26.12.2010 evidenced under case sheet Ex. A1 maintained by Supreetha Hospital, Kamareddy, and Ex. A3 death certificate. The doctor has categorically stated that he died of Acute Myocardial Infraction (AMI) and respiratory arrest vide Ex. A4. The complainant after death of the deceased had submitted death claim intimation to the insurance company along with documents vide Ex. A6 and also by way of notice through her counsel Ex. A7 which the insurance company had received under Ex. A8 acknowledgement. In fact the insurance company gave reply to the legal notice dt. 6.2.2012 under Ex. A13 dt. 9.2.2012 stating:
“We state that a policy contract No. 16316435 was issued on 25.2.2010 in the name of the deceased late Dayya Kailash for the proposal received on 10.2.2010 under special term plan (regular) for the premium amount being Rs. 34,508/-, and the sum assured Rs. 19 lakhs.
We respond to the fact pertaining to the death of the life assured, and claim made in this behalf by stating that the concerns raised by your client has already been replied through our letter dt. 31.5.2011 wherein we have repudiated the claim.
We further state that we had conducted an investigation into the matter and also perused the medial reports in this regard. On the basis of which, we have found that the deceased was diagnosed for renal failure and put on dialysis during January, 2009.
Further, we would also like to bring to your kind notice that questions 29 & 31 pertaining to medical history were also answered as ‘negative’ in the proposal thereby concealing to disclose the material fact.”
On receipt of it, the complainant again got issued a notice through her counsel under Ex. A14 dt. 13.2.2012 mentioning that she did not receive any repudiation letter, and denied that he was diagnosed for renal failure and put on dialysis during January, 2009. It may be stated herein that despite denial of the said fact, the insurance company did not mention as to what exactly the investigation was, and where the deceased had undergone dialysis. Obviously, knowing full well that it cannot prove the said fact no reply was given nor the matter was contested when notices were received in the complaint filed by the complainant. The insurance company intends to somehow repudiate the claim on the ground of pre-existing ailment. It did not have any evidence to controvert the medical record submitted by the complainant in this regard. Therefore, we hold that there was neither suppression of ailment nor any ground for dis-entitlement of the claim. The documentary evidence shows that he died of AMI. He was not suffering from renal failure, not there was any pre-existing ailment. The complainant being nominee entitled to the amount. Since the repudiation was unjust, the complainant is also entitled to compensation towards mental agony which we quantify at Rs. 25,000/- taking the amount into consideration. The complainant is also entitled to interest @ 9% p.a.
7) In the result the complaint is allowed directing the opposite parties (insurance company) to pay Rs. 19 lakhs with interest @ 9% p.a., from the date of claim viz., 17.3.2011 till the date of realization together with compensation of Rs. 25,000/-, and costs of Rs. 10,000/-. Time for compliance four weeks.
1) _______________________________
PRESIDENT
2) ________________________________
MEMBER
3) ________________________________
MEMBER
APPENDIX OF EVIDENCE
WITNESSES EXAMINED FOR
COMPLAINANT OPPOSITE PARTIES
None None
Documents marked for complainant:
Ex A-1 Cash sheet Xerox copy of Supreetha Hospital, Kamareddy
Dt : 25.12.2010
Ex A-2 Cash sheet death certificate of Supreetha Hospital, Kamareddy
Dt : 26.12.2010
Ex A-3 Death certificate Xerox copy of Panchayathraj depart, Bheemgal
NZBD Dist.dt: 4.1.2011
Ex A-4 Claim Form B-Medical Attendance Certificate Xerox copy dt : 17.3.2011 Dr. B.Ravinder Reddy
Ex A-5 Claim Submission acknowledgement of R4 dt : 18.3.2011
Ex A-6 Death claim intimation Xerox copy of R4 dt 21.3.2011
Ex A-7 office copy of legal notice of Akula Suresh, ADv, dt 23.8.2011
Ex A-8 postal acknowledgement card duly served the notice on OP1 dt 12.9.2011
Ex A-9 Un-served postal cover of R2 dt 25.8.2011
Ex A-10 office copy of legal notice dt 6.2.2012
Ex A-11 speed post receipts 4 nos. dt 6.2.2012
Ex A-12 Track result downloaded from internet (4 nos) dt : 9.2.2012
Ex A-13 copy of reply dt : 9.2.2012
Ex A-14 office of rejoinder dt : 13.2.2012
Ex A-15 speed post receipt dt : 13.2.2012
ExA-16 Track result downloaded from internet dt : 17.2.2012
Ex A-17 Policy contact no. 16316435 (Xerox ) dt : 25.2.2010
Ex A-18 Policy (Schedule)
Ex A-19 1st Premium payment receipt dt : 25.2.2010
DOCUMENTS MARKED FOR OPS: Nil
1) _______________________________
PRESIDENT
2) ________________________________
MEMBER
3) ________________________________
MEMBER
04/07/2012
*pnr
UP LOAD – O.K
