Date of filing : 24-05-2011
Date of Disposal: 03-09-2012
DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, ANANTAPUR.
PRESENT: - Sri T.Sundara Ramaiah, B.Com., B.L., President (FAC)
Sri S.Niranjan Babu, B.A., B.L.,Male Member
Smt. M.Sreelatha, B.A., B.L., Lady Member
Monday, the 3rd day of September, 2012
C.C.NO. 108/2011
Between:
Smt.D.Varalakshmi
W/o Late D.Ramakrishna
D.No.4-152, Vidyaranya Nagar
Papampeta
Anantapur . …. Complainant
Vs.
1. The Manager,
Shriram Life Insurance Co. Ltd.,
Opp: Judge Bungalow,
Aravinda Nagar
Anantapur.
2. The Regional Manager,
Shriram Life Insurance Co. Ltd.,
DBR Cardic, Opp: Krishna Reddy Hospital
Reddy and Reddy Colony,
Tirupathi
Chittoor District.
3. The Assistant Manager,
Shriram Life Insurance Co. Ltd.,
D.No.3-6-478, 3rd floor, Anand Estate
Liberty Road, Himayat Nagar,
Hyderabad. …. Opposite Parties
This case coming on this day for final hearing before us in the presence of Sri B.Harshavardhan Reddy and Sri J.Ravindra Babu, advocates for the complainant and Sri N.R.K.Mohan and Sri A.Suresh Kumar, advocates for opposite parties 1 to 3 and after perusing the material papers on record and after hearing the arguments of both sides, the Forum delivered the following:
O R D E R
Sri S.Niranjan Babu, Male Member: - This complaint has been filed by the complainant under section 12 of Consumer Protection Act, 1986 against the opposite parties 1 to 3 claiming a sum of Rs.7,50,000/- under the policy amount with interest @ 18% p.a. and Rs.50,000/- towards deficiency of service and Rs.1,00,000/- towards mental agony.
2. The brief facts of the complaint are that :- The complainant is the wife of late D.Ramakrishna and permanent resident of Anantapur. During the life time of the complainant’s husband, her husband has taken an Insurance Policy namely Sree Plus from the opposite party No.1 vide policy No.080800131856, which commenced from 11-08-2008 and term of the policy is for 15 years. The amount assured under the above said policy is Rs.7,50,000/- and the premium paid by the deceased is Rs.1,00,000/- for one year and for the said policy the deceased D.Ramakrishna made his wife as nominee.
3. Subsequently on 13-02-2009 the policyholder D.Ramakrishna died. After the death of the complainant’s husband, the complainant made a claim for the sum assured to the opposite parties. Later on 20-01-2010 the opposite party No.3 had sent a letter to the complainant that as she failed to produce the medical records of late D.Ramakrishna for the treatment said to have been taken at St.Johns Medical College Hospital, Bangalore to the opposite parties, therefore the opposite party No.3 had decided to close the claim and treat the matter as closed and however on receipt of the above required documents, the claim under the above policy will be reopened and processed accordingly.
4. Subsequently the complainant got issued a legal notice to the opposite parties on 12-04-2010 but there was no reply for the same. The opposite party No.3 had issued a reply notice dt.18-05-2010. The complainant herein is uneducated house-wife and when she was under shock of her husband’s death, the agent by name Narayana Reddy and another person came to her house and took her signatures on blank papers. The reply notice dt.18-05-2010 of the opposite party No.3 alleged that on a preliminary enquiry they came to know that the deceased during his life time had taken treatment inSt.Johns Medical College Hospital, Bangalore. To that letter, a letter has been addressed to the opposite parties through her advocate requesting to send the copy of the preliminary enquiry report, but the opposite party No.3 failed to furnish the same. This shows that the opposite party intentionally evading the process of the claim and caused deficiency of service and also caused lot of mental agony to the complainant.
5. The opposite party No.3 filed counter stating that the allegations made in the complaint are not fully true. The opposite party submits that late D.Ramakrishna during his life time has taken “ Sree Plus “ Policy bearing No.LN080800131856 for a sum assured Rs.7,50,000/- by paying Rs.1,00,000/- as premium on early mode. The said policy commenced from 11-08-2008 and the term is for 15 years. The deceased life assured has nominated his wife as nominee for the said policy.
6. In fact at the time of taking the policy, the opposite party has supplied proposal form and requested the life assured to fill all the columns with correct details. Basing on the information provided by the life assured, the opposite party has accepted the risk on his life and thereby issued a policy in good faith. Subsequently the nominee has intimated the opposite party that her husband died on 13-02-2009 due to fever. Immediately the opposite party on 02-04-2009 through its private investigator by name G.Rama Murthy has personally handed-over the claim forms to the nominee and requested her to submit the filled in claim forms alongwith relevant documents to process the death claim. Simultaneously the investigator has conducted his preliminary enquiry into the death claim and found that the deceased life assured was a severe alcoholic and smoker and he had been on treatment since 2005 at Perar Hospital, Badanapalli and St.John Medical College Hospital, Bangalore. The opposite party further submits that a letter was addressed to the complainant on 01-06-2009 requesting her to submit the filled in claim forms alongwith medical records of the treatment taken by the life assured. Upon which nominee has submitted filled in claim forms A, B & C in the month of June, 2009. After perusal of the investigation report and claim forms, the opposite party has sent request letter dt.19-12-2009 requesting the complainant to forward case sheet and medical records of the deceased life assured for the treatment taken at St.Johns Medical College Hospital, Bangalore. But the complainant has not submitted the required medical records. Hence the opposite party has no other go except to close the claim vide its letter dt.20-01-2010. However the opposite party informed the complainant that the claim will be reopened and will be processed upon receipt of the required information as sought for. The opposite party further submits that the complainant without following due procedure for processing the claim got issued a legal notice dt.12-04-2010 for which the opposite party has given suitable reply dt.18-05-2010 stating that upon receipt of required documents, the claim will be reopened and processed accordingly. But as the complainant did not turn up and submit the required documents till date and filed the present complaint with false allegations. Further the opposite party submits that the opposite party has not yet taken any decision either admitting or rejecting the death benefits under the said policy and further the opposite party is waiting for the required documents to process the claim as such the complaint is pre-matured one. As there is no deficiency of service, the complaint is liable to be dismissed.
7. The opposite parties 1 & 2 filed a memo adopting the counter filed on behalf of the opposite party No.3.
8. Basing on the above pleadings, the points that arise for consideration are:-
1. Whether the opposite parties 1 to 3 have committed any deficiency of service?
2. To what relief?
9. To prove the case of the complainant, the evidence on affidavit of the complainant has been filed and marked Exs.A1 to A11 documents. On behalf of the opposite parties, the opposite party No.3 filed evidence on affidavit and marked Ex.B1 to B14 documents.
10. Heard both sides.
11. POINT NO. 1 - It is an admitted fact that the deceased D.Ramakrishna has taken Insurance Policy bearing No.LN080800131856 on 11-08-2008 under plan Sree Plus by paying a sum of Rs.1,00,000/- as first premium and the sum assured is Rs.7.50 lakhs. The term of the policy is for 15 years and there is no dispute with regard to nominee also who is none other than the complainant herein. On 13-02-2009 the complainant’s husband died and the same was informed to the opposite parties by the complainant. After the death of her husband, while she was under shock the agent by name Narayana Reddy and another went to the complainant’s house and obtained signatures of the complainant on blank papers. Later the opposite parties have sent the claim forms through Mr.G.Rama Murthy who is a Private Investigator. Subsequently the complainant handed over the filled in claim forms alongwith necessary documents to the opposite parties. Thereafter a letter was sent by the opposite parties on 20-01-2010 stating that if the complainant fails to submit the medical records of late D.Ramakrishna for the treatment said to have been taken at St.John Medical College Hospital, Bangalore to the opposite parties, hence they have decided to close the claim and treat the matte as closed and however on receipt of the above requirements the claim under the policy will be reopened and processed accordingly.
12. After receiving the said letter, the complainant got issued a legal notice on 12-05-2010 for which the opposite party No.3 issued a reply notice dt.18-05-2010 with all false allegations. Further the opposite party No.3 stated that on enquiry by their private investigation agent by name G.Rama Murthy, they came to know that the deceased was a regular alcoholic and smoker and that he had been on treatment since 2005 at Perar Hospital, Badanapalli and St.John Medical College Hospital, Bangalore . But the opposite parties have not filed any document to prove that the deceased was aalcoholic and that he took treatment at the above said hospitals. The opposite parties did not file even the affidavit of Mr.G.Rama Murthy a Private Investigator on whose recommendations the claim was said to be closed. This shows that the opposite parties have not fulfilled their part of liability to prove that the deceased has taken treatment at the said hospitals.
13. As per the version of the complainant, the deceased D.Ramakrishna died in her house only and that he had not taken any treatment as stated by the opposite parties. The burden of proof lies on the opposite parties to show that the deceased has taken treatment at St.Johns Hospital, Bangalore by producing the medical records of the deceased alongwith the affidavit of the doctor, who treated the deceased. But no such document or affidavit of the doctor is filed to substantiate their version that the deceased has taken treatment prior to his death. Simply saying that the deceased was an alcoholic and chain smoker is not sufficient to escape from the liability and when the complainant issued a legal notice to settle her claim, the opposite parties gave reply notice asking her to produce the medical records of her deceased husband in order to process the claim. This shows that the opposite parties want to escape from the liability of paying the claim. As the opposite parties failed to settle the death claim of the complainant by simply saying that the deceased has taken treatment at St.Johns Hospital, Bangalore and asking the complainant to furnish the medical records of her husband in order to process the claim shows their carelessness and escapism and thereby caused deficiency of service for which the opposite parties are also liable. In the above circumstances, we are of the view that the opposite parties are liable to pay the death claim of the complainant’s husband.
14. POINT NO.2 – In the result the complaint is allowed by directing the opposite parties 1 to 3 jointly and severally liable to pay to the complainant a sum of Rs.7,50,000/- with interest @ 12% p.a. from the date of death till the date of payment and further the opposite parties are also directed to pay a sum of Rs.5,000/- towards deficiency of service and also Rs.2,000/- towards costs of the complaint within one month from the date of this order.
Dictated to the Steno, transcribed by him, corrected and pronounced by us in open Forum, this the 3rd day of September, 2012.
Sd/- Sd/- Sd/-
MALE MEMBER LADY MEMBER PRESIDENT (FAC)
DISTRICT CONSUMER FORUM DISTRICT CONSUMER FORUM DISTRICT CONSUMER FORUM
ANANTAPUR ANANTAPUR ANANTAPUR
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
ON BEHALF OF THE COMPLAINANT: ON BEHALF OF THE OPPOISITE PARTIES
- NIL - - NIL -
EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT
Ex.A1 - Photo copy of First Premium Receipt dt.11-08-2008 issued by the opposite party
No.1 in favour of the deceased D.Ramakrishna.
Ex.A2 - Photo copy of Death Certificate relating to deceased D.Ramakrishna issued by the
Panchayat Secretary, A.Narayanapuram.
Ex.A3 - Letter dt.20-01-2001 issued by the opposite party No.3 to the complainant.
Ex.A4 - Office copy of legal notice dt.12-05-2010 got issued by the complainant to the
Opposite parties.
Ex.A5 – Postal Receipts.
Ex.A6 - Postal acknowledgements signed by the opposite parties.
Ex.A7 - Reply notice dt.18-05-2010 got issued by the opposite party No.3 to the counsel for the
Complainant.
Ex.A8 - Office copy of legal notice dt.01-11-2010 got issued by the complainant to the
Opposite party No.3
Ex.A9 - Postal Receipt.
Ex.A10 – Letter of the counsel for the complainant dt.06-12-2010 addressed to the
Superintendent of Post Offices, Anantapur.
Ex.A11 - Letter dt.22.12.2010 sent by the Superintendent of Post Offices, Anantapur.
EXHIBITS MARKED ON BEHALF OF THE OPPOSITE PARTIES
Ex.B1 - Photo copy of Proposal form relating to deceased D.Ramakrishna submitted to the
Opposite party No.1.
Ex.B2 - Photo copy of policy relating to deceased D.Ramakrishna issued by the
Opposite parties.
Ex.B3 - Photo copy of First Premium Receipt dt.11-08-2008 issued by the opposite party
No.1 in favour of the deceased D.Ramakrishna.
Ex.B4 - Photo copy of document relating to deceased D.Ramakrishna issued by the opposite
parties.
Ex.B5 - Photo copy of letter sent by the complainant to the opposite parties.
Ex.B6 - Photo copy of Death Certificate relating to deceased D.Ramakrishna issued by the
Panchayat Secretary, A.Narayanapuram
Ex.B7 - Photo copy of letter dt.02-04-2009 sent by the complainant to the Insurance
Investigator.
Ex.B8 - Photo copy of letter dt.01-06-2009 sent by the opposite party No.3 to the complainant.
Ex.B9 - Photo copy of letter dt.19-12-2009 sent by the opposite party No.3 to the complainant.
Ex.B10 - Photo copy of letter dt.20-01-2010 sent by the opposite party No.3 to the complainant.
Ex.B11 - Office copy of legal notice dt.12-04-2010 got issued by the complainant to the
Opposite parties.
Ex.B12 – Photo copy of reply notice dt.18-05-2010 issued by the opposite party No.3 to the
Counsel for the complainant.
Ex.B13 - Photo copy of Postal Receipt.
Ex.B14 - Photo copy of Postal acknowledgemnt singed by the 1st opposite party.
Sd/- Sd/- Sd/-
MALE MEMBER LADY MEMBER PRESIDENT (FAC)
DISTRICT CONSUMER FORUM DISTRICT CONSUMER FORUM DISTRICT CONSUMER FORUM
ANANTAPUR ANANTAPUR ANANTAPUR
