Complaint filed on 15.02.2011

                                                                                                                                                             Compliant disposed on 27.02.2015 

                                                                                CONSUMER COMPLAINT NO.20 OF 2011

Between:-

Bomma Siddamma W/o. Late Parusharamulu, Age 35 years, Occu: House wife R/o. NandaramV/o. Husnabad Mandal of Karimnagar Dist.

                                                                                                                                                                      ... Complainant  

                                                AND

1. M/s. Shriram Life Insurance Company Ltd., R/by its Assistant General Manager, R/o. H.No.3-6-478, 3^rd Floor, Anand Estate, Liberty Road, Himayathnagar, Hyderabad.

2. The Branch Manager, Shriram Life Insurance Company Ltd., R/o. H.No.2-3-185, 1^st Floor, Ashirvad Complex, Kaman Raod, Karimnagar.

                                                                                                                                                                      … Opposite Parties

          This complaint is coming up before us for hearing on 31-10-2014, in the presence of Sri D.Nagaraju & Associate Advocates, counsel for complainant, Sri P.Ashok Advocate, counsel for opposite parties and on perusing the material papers on record, and having stood over for consideration till this day, the Forum passed the following:

::O R D E R::

          This complaint is filed under Sec 12 of C.P.Act, 1986 seeking direction to the opposite parties to settle the claim of complainant by paying Rs.1,00,000/- with interest @ 18% PA , Rs.20,000/- towards compensation and costs of the complaint and any other relief as deemed fit by the Forum. 

The brief averments of the complaint are:

1.       The husband of the complainant by name Bomma Parsharamulu during his life time had obtained a policy bearing no.LN 070900107747 from the opposite parties by paying Rs.10,000/-. The period of policy is for 15 years commencing from 23.09.2009 onwards. On 21.01.2010 the complainant’s husband died while undergoing treatment at MGM Hospital, Warangal. After death of her husband, the complainant being the nominee submitted the claim with relevant documents to the opposite party on 29.04.2010 which was acknowledged by opposite party no.2. After receipt of claim, the opposite parties sent a letter Dt: 5.6.2010 to the complainant demanding her to send Medical Report/Case Sheet from the M.G.M Hospital. Accordingly, she submitted Medical Report of policy holder issued by MGM Hospital Dt: 28.06.2010. But the opposite parties instead of settling claim again sent a letter Dt: 18.08.2010 demanding to send Medical Report/Case Sheet otherwise the claim will not be considered. Vexed with the attitude of opposite parties, the complainant got issued Legal Notice Dt: 03.09.2010 to the opposite parties demanding to settle the matter. After receipt of the same, the opposite party again demanded the Case Sheet through their reply Dt: 14.09.2010. Therefore, she obtained the attested copy of Case Sheet of her husband B.Parusharamulu under RTI Act from MGM Hospital Warangal and sent the same to opposite party no.1 along with a letter Dt: 03.11.2010 through her counsel. Even after receipt of the same, the opposite party neither sent reply nor settled the claim. The negligent and careless attitude of opposite party clearly amounts to deficiency in service, therefore filed this complaint.

2.       The opposite party no.1 & 2 filed their written version denying the averments made in the complaint and admitting the issuance of policy to Late Bomma Parusharamulu. The opposite party further submitted that as the complainant has not submitted the filled in claim forms along with relevant documents within stipulated period, they have issued Reminder Dt: 26.04.2010 to the nominee. Upon which the complainant submitted filled-in claim forms in the month of May, 2010. Basing on the investigation report, the company vide its letter 05.06.2010 has requested the nominee to forward the Case Sheet/Medical Record of life assured from M.G.M Hospital where he had taken treatment. But the complainant has not submitted the same. As such the claim of the complainant was closed vide its letter Dt: 18.08.2010 by the opposite party, however the company has informed the nominee that the claim will be reopened and will be processed upon receipt of required information as sought earlier. The complainant instead of following due procedure for processing the claim got issued a Legal Notice Dt: 03.09.2010. Finally on receipt of reply from opposite party, the complainant sent Medical Record of life assured obtained from MGM Hospital, Warangal. After careful perusal of Medical Record and Investigation Report, the opposite party repudiated the claim of the complainant and treated the matter as closed on the ground that the deceased life assured has concealed material facts with regard to his habits and health conditions while taking the policy. The deceased policy holder in order to get undue advantage of the policy benefits has malafidely suppressed the material facts at the time of taking the policy, thereby the contract has now become avoid and the opposite party is not liable to pay any amount against the above policy to the complainant. Therefore, prayed to dismiss the complaint with exemplary costs.

3.       The complainant filed Proof Affidavit reiterating the averments made in the complaint and the documents filed by her are marked as Ex.A1 to A7. The opposite party no.1 & 2 filed Evidence Affidavit and the documents filed on their behalf are marked as Ex.B1 to B19.

4.       Now the point for consideration is whether there is any deficiency of service on the part of opposite parties? If so, to what relief the complainant is entitled?

POINT:

5.       This case is pertaining to entitled claim on the death of the complainant’s husband from the opposite party. The deceased had obtained SHRI PLUS Policy from the opposite parties on payment of Rs.10,000/- towards annual premium and term of the policy is 15 years commenced on 23.09.2009. This policy was made through the opposite party’s agent Mr.T.Ramu bearing agent code A0008743. The said policy carried a sum assured of Rs.1,00,000/-, whereas, the deceased died on 21.01.2010 while undergoing treatment at MGM Hospital, Warangal. Ex.A1 is a letter Dt: 26.04.2010 addressed to the opposite parties informing about the death of the deceased and requested to settle the claim i.e., entitled benefits on occurrence of the death of the policy holder. Ex.B6 Dt: 03.02.2010 received by the opposite party shows that the intimation about the death of the deceased has been communicated to the opposite parties by the wife of the deceased. Ex.B7 is the Death Certificate which confirms the date of death as 21.01.2010 at MGM Hospital, Warangal. Since the death occurred very shortly, the opposite party investigated into the case and confirmed that the deceased had been suffering from various health problems which he could not disclosed at the time of obtaining the policy. So the detailed investigation report on the death claim is presented in the form of Ex.B9. Ex.B2 shows that the opposite parties have closed the claim of the policy of the life assured as the complainant failed to produce Medical Reports and Case Sheets which are mandatory to claim the death benefits from the opposite parties. Ex.A3 is the Legal Notice Dt: 03.09.2010 issued to the opposite parties for settlement of the claim within 15 days. The opposite parties sent reply Dt: 14.09.2010 stating that the Medical Reports and Case Sheets were not submitted despite reminders to the complainant and also stated that during the preliminary enquiry conducted by the opposite parties it was found that the life assured had been suffering from severe Pedal Edema due to Alcoholism and Hyper Tension and he was admitted at MGM Hospital, Warangal before his death for the treatment.

6.       The Forum obtained the complete medical record along with copies of Case Sheet from the MGM Hospital, Warangal Ex.C1 regarding the health profile and treatment of her husband/deceased. During the proceedings of the case Dr.Gururaj Asst. Professor of medicine working at MGM Hospital, Warangal who had been requested to give evidence about the health profile of the deceased. The said doctor deposed before the Forum on 19.06.2013 and in his deposition he said that the deceased was admitted to the hospital on 17.01.2010 at 11.30 PM with the complaint of fits, fever and loss of consciousness. Later on it was known that the deceased was Diabetic and Hyper Tension patient and the deceased was on irregular treatment for a period of considerable time and he died on 21.01.2010 while undergoing treatment in the hospital. In support of his deposition Ex.B1 containing 37 sheets has been marked which gives the complete medical history of the deceased. Ultimately from this medical history it is inferred that the deceased has been suffering from Diabetic and Hyper Tension and at the time of admission into the hospital he was having low blood glucose level that was recorded as 50mg/dl which shows that low sugar and also it is noted that the deceased was a known Alcoholic and smoker. So the medical record is undisputed. Here it is pertaining to mention that at the time of obtaining a policy the agent of the opposite party Mr.T.Ramu who has certified in the proposal form of the policy which is marked as Ex.B3, wherein at the end of the proposal form under the sub heading agent’s recommendation, the agent certified as “I have verified the information given in the proposal by discreet enquiries and find the information true to the best of my knowledge and belief. I am of the opinion that the Life proposed for insurance is insurable. I recommend the proposal for acceptance”. He has signed with date 14.09.2009. So the agent has to be blamed for making a wrong recommendation to the opposite parties. The contention of the opposite parties that had they known the various health problems of the policy holder that he would not have given a policy to the deceased cannot be accepted. Because from the proposal form it is mentioned the educational qualifications of the deceased as only 7^th class and under the column the medical history it is mentioned as good health and if you check hand writing on the proposal form, it is agent’s writing only, the proposer has signed in vernacular language i.e., in Telugu. So for making a policy in this case, it is totally the responsibility of the agent of the opposite party only. Therefore, Forum opines that the policy holder cannot be faulted for non-disclosure of the health profile of the deceased. But the agent has to be made responsible for furnishing wrong information and duly certified in the proposal form of the opposite parties. Hence the opposite party attracts vicarious liability. Therefore, the complainant deserves the death benefits on the policy of her deceased husband. The point is answered against opposite parties and the complainant proved her case.

7.       In the result the complaint is allowed and the opposite parties are directed to pay the complainant jointly and severally a sum of Rs. 1,00,000/- towards death benefits covered under the policy with interest @ 9% p.a. from the date of filing the complaint i.e., 15.02.2011 and compensation of Rs.15,000/- including costs of the litigation. Time for compliance is 30 days.     

Dictated to Stenographer and transcribed by her and after correction the orders pronounced by us in the open court this the 27^th day of February, 2015.

MEMBER                                                                               PRESIDENT(FAC)

NO ORAL EVIDENCE HAS BEEN ADDUCED ON EITHER SIDE

FOR COMPLAINANT:                       

1. Ex.A1 is the photo copy of acknowledgment of representation submitted to opposite parties by the complainant Dt: 26.04.2010.
2. Ex.A2 is the photo copy of letter from opposite parties (OP No.1) addressed to the complainant Dt: 18.08.2010 in respect of closing of claim.
3. Ex.A3 is the office copy of Legal Notice issued by counsel for complainant addressed to opposite parties Dt: 03.09.2010.
4. Ex.A4 is the copy of Reply from opposite parties (OP1) addressed to the counsel for complainant Dt: 14.09.2010.
5. Ex.A5 is the photo copy of Medical Certificate issued by Superintendent of MGM Hospital, Warangal Dt: 28.06.2010.
6. Ex.A6 contains two postal receipts Dt: 03.09.2010.
7. Ex.A7 is the acknowledgment card Dt:09.09.2010.

FOR OPPOSITE PARTY:

1. Ex.B1 is the photo copy of Case Sheet of deceased policy holder.
2. Ex.B2 is the Medical Attendant’s Certificate in Claim Form – B of deceased policy holder Dt: 23.04.2010.
3. Ex.B3 original copy of Proposal Form Dt: 14.09.2009.
4. Ex.B4 is the original policy document issued by opposite parties Dt: 23.09.2009.
5. Ex.B5 is the original copy of Policy Schedule issued by opposite parties Dt: 23.09.2009.
6. Ex.B6 is the original copy of representation submitted to opposite parties by the complainant Dt: 03.02.2010 (with no acknowledgment).
7. Ex.B7 is the original copy of Death Certificate of deceased policy holder issued by Warangal Muncipal Corporation Dt: 30.03.2010 (DOD 21.01.2010).
8. Ex.B8 is the original copy of declaration submitted to opposite parties by the complainant Dt: 23.03.2010.   
9. Ex.B9 is coloured photo copy of Investigation Report (3 sheets) of Death Claim Dt: 24.03.2010.
10. Ex.B10 is the original letter of Reminder-I issued to complainant by the opposite parties Dt: 26.04.2010.
11. Ex.B11 is the original letter from opposite parties addressed to complainant Dt: 05.06.2010.
12. Ex.B12 is the original letter of Reminder-I issued to complainant by the opposite parties Dt: 06.07.2010.
13. Ex.B13 is the original letter from opposite parties addressed to complainant Dt: 18.08.2010.
14. Ex.B14 & A3 are one and the same documents.
15. Ex.B15 is the postal acknowledgment card addressed to OP/Hyd.
16. Ex.B16 & A4 are one and the same documents.
17. Ex.B17 is the original copy of letter forwarding the Case Sheet of deceased to the opposite parties Dt: 03.11.2010.
18. Ex.B18 is the acknowledgment card addressed to OP/Hyd.
19. Ex.B19 is the photo copy of Under Certificate of Posting Dt: 19.12.2010 of Claims Department of opposite parties.

The record of deceased policy holder obtained by the Forum from the MGM Hospital Warangal is marked as Ex.C1 Dt: 21.05.2013.

Sd/-                                                                                          Sd/-

                  MEMBER                                                                            PRESIDENT(FAC)