This complaint coming up before us for hearing on 24-05-12               in the presence of Sri N. Srinivasa Rao, advocate for complainant and of  Sri P. Kirshore, advocate for 2^nd opposite party, 1^st opposite party remained absent and set exparte, upon perusing the material on record and having stood over till this day for consideration this Forum made the following:-

O R D E R

Per Sri A. Hazarath Rao,  President:-

        The complainant filed this complaint under section 12 of the Consumer Protection Act seeking Rs.2,51,370/- from the opposite parties; Rs.25,000/- towards mental agony and for costs.

2.   In brief the averments of the complaint are these:

        One Baladugu Peraiah father of the complainant obtained                   Sri Raksha participating policy bearing No.NP100700064711 for Rs.3,00,000/-. The policy is valid from 28-03-07 to 27-03-22.                  The complainant is a nominee under the said policy.   The insured died on 17-12-09 due to chest pain.  The opposite parties have to pay accident rider benefits to the nominee as the insured died during the continuance of the said policy.   The complainant on 06-02-10 submitted claim form.   The opposite parties on 30-09-10 sought further information from the complainant.   Inspite of furnishing information the opposite parties failed to settle the claim.   The complainant on 07-04-11 got issued a notice through advocate.   Thereafter, the opposite parties paid Rs.5,50,000/- only by way of cheque instead of Rs.6,31,000/- plus interest.   The complainant received the cheque sent by the opposite parties under protest.   The opposite parties not settling the claim as per terms and conditions of the policy amounted to deficiency of service.    The conduct of the opposite parties in not settling the claim caused mental agony and hardship to the complainant.   The complaint therefore be allowed.

3.      The 1^st opposite party filed memo adopting the version of the 2^nd opposite party and their contention in brief is thus:

        The opposite parties after receipt of relevant papers from the complainant settled the claim at Rs.5,50,000/- even though the nominee of the life assured is not entitled to additional benefits as per terms of the policy.  The complainant is not entitled to any interest from 06-02-10 as there was correspondence among the parties.   The complainant received Rs.5,50,000/- in full and final settlement of the claim.   The complaint therefore may be dismissed.

4.   Exs.A-1 to A-10 and Exs.B-1 to B-4 on behalf of the complainant and opposite parties were marked.

5.     Now the points that arose for consideration in this complaint are:

1. Whether the opposite parties committed deficiency of service?
2. Whether the complainant is entitled to compensation and if so to what amount?
3. To what relief?

6.    Admitted facts in this case are these:

1. The opposite parties issued Sri Raksha (participating) policy in favour of Baladugu Peraiah for Rs.3,00,000/- (Ex.A-1).
2. The insured died on 17-12-09 (Ex.A-2).
3. The insured paid premiums till his death.
4. The complainant was the nominee under the said policy.
5. The complainant submitted claim form (Ex.A-3, A-4,  A-7, A-8 and A-9)
6.  The opposite parties gave cheque for Rs.5,50,000/-          (Ex.A-6) to the complainant.

7.  POINT No.1:-    The opposite parties did not file the terms and conditions of Sri Raksha participating policy.   The opposite parties collected the premium of Rs.32,888/- i.e., Rs.32,063/- towards basic cover, Rs.375/- (accident rider), Rs.450/- (FIB rider).  In Ex.A-1 the opposite parties mentioned maturity benefits, death benefits and rider benefits as detailed infra:

Maturity benefits: Rs.3,00,000/- plus vested bonus payable                                          on 28-03-22.

Death benefits:    Double SA plus vested bonus if death occurs at                               any time during the premium term.

                         Rs.3,00,000/- if death occurs at any time                                        after the premium paying term.

Rider benefits:    Rs.3,00,000/- payable if death is due to                                          accident as defined in the policy conditions.

        FIB Rider:  Rs.3,00,000/- payable as defined in                        the policy conditions.

8.   Medical attendance certificate was issued by the Medical Officer, Government Hospital, Vinukonda, Guntur district (Ex.A-3) stating that Baladugu Peraiah died in Government Hospital, Vinukonda due to AIGINA Pectoris and shock.   It can therefore be said that the insured met with natural death on 17-12-09 during the continuance of the policy.   There is nothing in Ex.A-1 disentitling the nominee to claim death benefits as contended by the opposite parties. 

9.  The opposite parties relied on Ex.B-1 letter said to have been written by the complainant on 21-07-11.  In Ex.B-1 it was mentioned that in the claim form the doctor mentioned the insured as alcoholic, smoker.  Both these words did not find place in claim form-B               (Ex.A-3).   In Ex.B-1 the amount was not mentioned in words.  But there was an over writing in Ex.B-1.   After overwriting it appears to us as Rs.5,80,000/-.   Ex.B-3 is a copy of receipt for Rs.5,50,000/- said to have been issued by the complainant.   The said receipt cannot be believed as the date was not properly mentioned in it.  Under those circumstances, the contention of the complainant that he received Rs.5,50,000/- towards claim under protest is having considerable force.   Ex.B-2 letter dated 28-07-11 was silent so as to how they arrived Rs.5,18,500/- as exgratia. Ex.A-10 declaration/indemnity bond did not contain the signature of the opposite parties. Ex.A-10 cannot be relied being a self explanatory.       

10.  The opposite parties deposited a cheque dated 28-02-12 in favour of the complainant for Rs.81,500/- drawn on HDFC Bank (Ex.B-4).    The 1^st opposite party sent Ex.A-9 to the Claims                  In-charge, Hyderabad on 08-07-10.  For the reasons best known to them the opposite parties issued cheque for Rs.5,50,000/- (to the complainant) on 25-07-11 (Ex.A-6).   Thus there was enormous delay even in payment of Rs.5,50,000/-.   Ex.B-2 letter was silent as already observed how they arrived at Rs.5,18,500/-.   Under those circumstances, the reduction of amount by Rs.81,500/- by the opposite parties is not justifiable and amounted to deficiency of service.   Therefore, we opine that the complainant is entitled to Rs.6,00,000/- plus vested bonus of Rs.31,500/-.

11.  The opposite parties have to settle the claim of any insured or nominee within a reasonable time.   In this case the complainant submitted his claim form answering the objections raised by the opposite parties on 06-07-10.   The reasonable period in this case according to us can be upto 31-07-10.   Therefore, the opposite parties are liable to pay reasonable interest.    We therefore answer this point against the opposite parties.

12.  POINT No.2:-   The conduct and attitude of the opposite parties certainly caused embarrassment and mental agony to the complainant.   The complainant claimed Rs.25,000/- as damages.  Considering the conduct and attitude of opposite parties awarding Rs.10,000/- as damages will meet ends of justice.   We therefore answer this point accordingly in favour of the complainant.

13. POINT No.3:-   In view of above findings, in the result the complaint is partly allowed

1. Directing the opposite parties to pay interest @9% p.a., on Rs.6,31,500/- from 01-08-10 to 25-07-11 and on Rs.81,500/- from 26-07-11 to 24-05-12.
2. The opposite parties are directed to pay Rs.10,000/- (Rupees ten thousand only) as damages.
3. The opposite parties are directed to pay Rs.1000/- (Rupees one thousand only) towards costs.
4. The complainant is at liberty to obtain the cheque for Rs.81,500/- from the Forum.
5. The amount so ordered above shall be paid within a period of six weeks from the date of receipt of the copy of the order.

          Typed to my dictation by Junior Steno, corrected by me and pronounced in the open Forum dated this the 28th day of May, 2012.

MEMBER                                             MEMBER                                             PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite parties :  

                                                                                           PRESIDENT