Andhra Pradesh

Visakhapatnam-II

CC/196/2014

Smt Urukuti Lakshmi - Complainant(s)

Versus

AGEON Religare Life Insurance Company Limited - Opp.Party(s)

Adari Apparao

05 May 2015

ORDER

 Reg. of the Complaint: 30-06-2014

                                                                                                                                 Date of Order:05-05-2015

BEFORE THE DISTRICT CONSUMERS FORUM-II

AT VISAKHAPATNAM

                   Present:

1.Sri H.ANANDHA RAO, M.A., L.L.B.,

       President

2.Sri C.V.RAO, M.A., B.L.,

                                             Male Member

3.Smt.K.SAROJA, M.A., B.L.,

       Lady Member

                                            

 

TUESDAY, THE 05^TH DAY OF MAY, 2015

CONSUMER CASE NO.196/2014

 

BETWEEN:

Smt.Urukuti Lakshmi W/o Demudu (late),

Hindu, Aged 37 years, H.No.1-222, Venkatapuram,

Haripuram Post, Rambilli Mandal,

Visakhapatnam District-530046.

…Complainant

AND:

 

1.The General Manager,

Ageon Religare Life Insruance Co., Ltd.,

Building No.3, Third Floor, Unit No.1,

Nesco It Park, Western Express High Way,

Geregaon, (East), Mumbai-400 063.

 

2.The Branch Manager,

Ageon Religare Life Insurance Co., Ltd.,

4^th Floor, the Land Mark Building,

Beside Airtel, Waltair Uplands,

Visakhapatnam-03

…Opposite Parties

This case coming on 13-04-2015 for final hearing before us in the presence of SRI ADARI APPA RAO, Advocate for the Complainant, and of SMT.P.SAKUNTHULA, Advocate for the 2^nd Opposite Party, and of 1^st Opposite Party, being set exparte, and having stood over till this date for consideration, this Forum made the following.

 

 

 

ORDER

 (As per SMT.K.SAROJA, Honourable Lady Member on behalf of the Bench)

1. The case of the complainant in brief is that the complainant’s  husband obtained Insurance Policy bearing Policy No.120913611323 for an amount of Rs.2,50,000/- from the OPs. After due verification, OP issued policy on 7-9-2012, insured paid an amount of Rs.20,195/- towards first installment premium. The complainant was shown as the nominee in the said policy. The complainant’s husband suffered from severe chest pain and breathlessness and died on 15-11-2012. So he was shifted to Bhavani Clinic, Pedapadu for treatment. As per the advise of the Doctor of the Bhavani Clinic, the family members of the insured make arrangements to shift the insured to KGH for better treatment. But he died. The complainant came to know about the policy while she was searching for their land pass book on 17-09-2013. The complainant personally approached the 2^nd Op and intimated about the death of her husband and requested them to settle the claim amount on 17-09-2013. The 2^nd OP issued claim forms on 20-09-2013, the complainant personally approached the 2^nd OP and submitted the relevant documents. On 11-11-2013, the OP repudiated the claim of the complainant as the insured suppressed the material fact.  (The terms and conditions of the Policy are “plan offers 200% of sum assured along with accrued bonus in the unfortunate event of insured demise”). Hence, this complaint.  

a)  For an amount of Rs.5,00,000/- (Rs.2,50,000/- + Rs.2,50,000/-) (Rupees Five Lakhs only) along with benefits, together with interest @ 24% p.a, on it from the date of claiming the amount i..e, 17-09-2013 till its payment;

b)  For Compensation of Rs.50,000/- towards damages and mental agony, plan and suffering;

c)  For costs of the complaint; and

d)  For such other relief or reliefs as the Honourable Forum deems fit      and proper under the circumstances of the case.

 

2.       The 1^st Opposite Party did not appear before this Forum, hence, it was set exparte and remained exparte.

3.       The 2^nd OP, strongly resisted the claim of the complainant, by contending, as can be seen from its counter. The OP stated that the death of the life assured had occurred within the two years from the date of issuance of the policy.  The OP had conducted a statutory investigation. During the investigation, it was found that the details of the occupation and income stated by the life assured in the proposal form were false. As per the household card of the insured an annual income of life assured is Rs.12,000/- only.  At the time of obtaining the insurance policy, the insured declared as he was owner of the land.

4.       At the time of enquiry, both parties filed their Evidence Affidavits as well as written arguments to support their contentions. Exhibits A1 to A12 are marked for the complainant and Exhibit B1 to B5 are marked for the OP.  Heard both sides.

Exhibit A1 is the Policy Bond dated 07-09-2012, Exhibit A2 is the Death Certificate, dated 15-11-2012, Exhibit A3 Death Claim intimation letter, dated 17-09-2013, Exhibit A4 Treatment Details, dated 12-09-2013, Exhibit A5 is the Repudiation letter dated 11-11-2013, Exhibit A6 is the Reconsideration letter  dated 18-11-2013, Exhibit A7 is the Payment Receipt in the name of Investigator dated 16-12-2013, Exhibit A8 is the Affidavit of the Complainant, dated 17-12-2013, Exhibit A9 is the Income Proof certificate issued by VRO, Exhibit A10 is the Policy Conditions, Exhibit A11 is the Pattadar Pass Book, Exhibit A12 is the Title Deed Pass Book.

Exhibit B1 is the Proposal Form, dated 03-09-2012, Exhibit B2 is the Policy Bond, dated 07-09-2012, Exhibit B3 is the Repudiation Letter, dated 11-11-2013 Exhibit B4 is the Household card and Exhibit B5 is the Job Cards Holders Information.

5.       The point that would arise for determination is:

Whether there is any deficiency of service on the part of the OPs? If so, Whether the Complainant is entitled to the   reliefs asked for?

 

6.       After careful perusal of the case record, this forum finds that the insured had land of Ac.2.20.cts according to Exhibit A11 and A12. The OP did not file any investigation report and also affidavit. According to their investigator the insured has no land and also he is not having that much of annual income as he shown at the time of the proposal form. But mere denial does not suffice. The OP fails to file any piece of evidence to show that the complainant’s husband did not have any land. They stated that the insured suppressed the material fact,  but they failed to rebut the complainant’s evidence. At the time of taking insurance policy, the insured has paid premium of Rs.20,195/- which shows that the insured has such income to pay premium of Rs.20,000/- per annum.  We hold that there is deficiency in service on the part of the OP. Hence, the complainant is entitled to the insured amount with interest, some compensation and costs too.

7.       In the result, this complainant is allowed directing the Opposite Parties 1 and 2 to pay insured amount of Rs.5,00,000/- (Rupees Five Lakhs only) (Rs.2,50,000/- + Rs.2,50,000/-) with interest 9% p.a., from 11-11-2013 till the date of actual realization, a compensation of Rs.50,000/- (Rupees fifty thousand only) and costs of Rs.2,500/-(Rupees Two thousand and five hundred only) to the complainant.   Time for compliance one month from the date of this order.

Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open Forum, on this the 05^th day of May, 2015.                                                   (TGR)

 

 

Sd/-                                                                 Sd/-                                                 Sd/-

M.MEMBER                                                     PRESIDENT                                                L.MEMBER  

 

APPENDIX OF EVIDENCE

Exhibits Marked for the Complainant:        

Exhibits	Date	Description	Remarks
A-1	03-09-2012	Proposal Form	Photocopy
A-2		Policy Bond	Photocopy
A-3		Repudiation Letter	Photocopy
A-4	12-09-2013	Treatment Details	Photoocpy
A-5	11-11-2013	Repudiation Letter	Original
A-6	18-11-20013	Reconsideratioin letter	Photocopy
A-7	16-12-2013	Payment Receipt in the name of the Investigator	Original
A-8	17-12-2013	Affidavit	Photocopy
A-9	17-12-2013	Income Proof Certificate issued by the VRO	Photocopy
A-10		Policy Conditions	Photocopy
A-11		Pattadar Pass Book	Photocopy
A-12		Title Deed Pass Book	Photocopy

 

Exhibits Marked on behalf of the OPs:  

Exhibits	Date	Description	Remarks
B-1	03-09-2012	Proposal Form	Photocopy
B-2	07-09-2012	Policy Bond	Photocopy
B-3	11-11-2013	Repudiation letter	Photocopy
B-4		House hold card	Photocopy
B-5		Job Card’s Holders Information	Photocopy

 

 

Sd/-                                                                 Sd/-                                                 Sd/-

M.MEMBER                                                     PRESIDENT                                                L.MEMBER