Date of registration:13.03.2014

     Date of order :27.11.2014

BEFORE THE DISTRICT CONSUMERS FORUM-I,

VISAKHAPATNAM : AP

PRESENT:  Smt K.V.R.Maheswari, B.A., B.L., LL.M.,

 Lady Member & FAC President

Sri V.V.L.Narasimha Rao, B.A., LL.M., PGDHR,

Member

Thursday, the 27^th day of November, 2014

Consumer Complaint No:87/2014

Between:    

Saragadam Ramana Babu S/o late Atchulu, Hindu, aged 51 years, residing at D.No.10-79-2, Middle Street, Munagapaka Village & Mandal, Visakhapatnam District.                                                …   Complainant

And:

1. Reliance Life Insurance Company Limited represented by Branch Manager, D.No.3-3-5, Madugula Road, Woodpeta Ward, Anakapalle.

2. Reliance Life Insurance Company Limited represented by Claims Manager, H Block, 1^st floor, Dhiribhai Ambani Knowledge City, Navi Mumbai, Maharashtra-400710.                                               …       Opposite Parties

This case is coming for final hearing on 26.11.2014 in the presence of Sri V.V.Bhaskar Kumar Advocate for the Complainant and of P.Sakuntala Advocate for Opposite Parties and having stood over till this date, the Forum delivered the following:

: O R D E R :

(As per Smt. K.V.R.Maheswari, Honourable President(FAC) on

behalf of the Bench)

1.       The case of the Complainant is that, the Complainant’s wife is Saragadam Devaki who took policy from 1^st opposite party bearing policy No.17445706, valid from 15.07.2010 to 15.07.2029 for an amount of Rs.2,10,000/- and the Complainant is nominee.  The 2^nd opposite party is registered office at Mumbai who look after claims.  While so, on 07.05.2011 suddenly the complainant’s wife i.e., life assured died due to heart attack and the same was informed to 1^st opposite party in writing about the death of life assured on 18.06.2011 and also submitted death certificate and policy copy.  The 1^st opposite party received all the documents and informed the complainant that the entire claim process is at Mumbai, hence all the documents send by the opposite party No.1 to the 2^nd opposite party.  The Complainant visited office of the 1^st opposite party several times and enquired about his wife’s claim amount and the 1^st opposite party informed that the claim is in process at 2^nd opposite party’s office and it required some more time.  The Complainant waited for some time but the opposite parties did not settle the claim amount and there is no proper reply also.  The Complainant stated that he is suffering from Paralysis since five months from the date of filing the complaint on right hand and right leg and he is unable to attend his nominal duties.  The opposite parties neither settle the claim amount nor issue any reply to the complainant.  Hence this complaint directing the opposite parties;

a)      to pay policy amount of Rs.2,10,000/- with 24% interest from the date of life assured.

b)      to pay Rs.75,000/- towards compensation besides costs.

2.       On the other hand, the opposite parties filed its counter and denied the allegations mentioned in the complaint and pleaded that it may be true that the life assured Saragadam Devaki has opted for Reliance Endowment Plan for a term of 20 years with yearly premium of Rs.11,508/- and that the sum assured of Rs.2,10,000/- vide policy No.17445706 but the complainant has not made any claim application or submitted any documents with the opposite parties, intimating the demise of life assured.  The Complainant has also not produced proof of the  same, hence there is no deficiency of service on the part of the opposite parties.  The nominee is required to intimate the death of the life assured to the claims department of the Insurance Company and on receiving the death intimation, the claims department send a list of forms or documents that needs to be submitted and on receipt of the complete documents, the insurance company decides the claim.  But here in this case the nominee i.e., the complainant has not complied with the required procedure, hence the opposite parties are not liable to pay him the policy proceeds.  The present complaint is frivolous, vexatious and unsustainable in law and is liable to be dismissed with compensatory costs to the opposite parties.

3.       At the time of enquiry, the Complainant filed evidence affidavit along with documents and written arguments.  Exhibits A1 to A3 are marked.  On the other side, the opposite parties filed their counter, evidence affidavit and written arguments.  No documents are marked on behalf of the opposite parties.  Heard both the counsels who reiterated their versions.

4.       In view of the respective contentions, the point that would arise for determination is:-

Whether there is any deficiency in service on the part of the opposite parties, if so can the complainant entitle for the reliefs prayed for?

5.       As per Ex.A1 i.e., policy copy dated 15.07.2010 shows that Smt.Saragadam Devaki i.e., policy holder by paying the installment premium of Rs.11,505.29p.s. for a term of 20 years is evidenced.  Ex.A2 is the death certificate of life assured and Ex.A3 is the letter issued by the complainant to 1^st opposite party on 18.06.2011.

6.       The version of the complainant is that after the death of her wife he intimated the same to 1^st opposite party and on assurance given by the 1^st opposite party he is on the fond hope that the 2^nd opposite party will process the claim and waited for some time, but the opposite parties failed to settle the claim amount.  In Ex.A3, the Complainant clearly mentioned that the photo copy of the policy and death certificate is enclosed with that letter and requested for settlement of claim amount.

7.       The version of the opposite parties in its affidavit that the complainant not made any claim application and not submitted any documents regarding the death of life assured.  In Ravneet Singh Bagga Vs. KLM Royal Dutch Airlines 2000(1) SCC 66 stated that “the deficiency in service cannot be alleged without attributing fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance which is required to be performed by a person in pursuance of a contract or otherwise in relation to any service”. In another case “Export Credit Guarantee Corporation of India Ltd., Vs. Garg Sons International 2013(1)SCALE 410 held that “while construing the terms of the contract of insurance, the court must give paramount importance to the terms used in the said contract.  In the present case, the opposite parties have not violated any terms and conditions of the said policy”.  The complainant does not disclose any cause of action against the opposite parties and hence in the absence of any cause of action against the opposite parties, there is no complaint against him.

8.       The main plea of the opposite parties is that the complainant has not made any claim application or not intimated the death of life assured, hence there is no deficiency of service on the part of the opposite parties.  But in our view Ex.A3 i.e., letter issued by the complainant on 18.06.2011 regarding the settlement of claim amount, he sent photo copies of death certificate and policy copy.  It may be true that the complainant issued that letter in ordinary post and roamed around the offices of the opposite parties, but the opposite parties not come forward to settle the claim amount.  As such, the opposite parties are liable to settle the claim amount if those claims are genuine ones. 

9.       Regarding the relief prayed by the complainant about the compensation of Rs.75,000/- for the deficiency of service on the part of the opposite parties, the Forum observed that the complainant being a nominee he failed to submit the original policy bond and necessary documents to the opposite parties. Simply he issued a letter to the opposite parties regarding death of her wife and sent photo copies of documents.  At the time of hearing the counsel of complainant stated that the 1^st opposite party itself asked him to submit photo copies of documents and after that they will ask for originals, hence, the complainant submitted the photo copies for documents.  What ever it may be without submitting original documents for submission of claim the opposite parties cannot settle the claim amount.  Hence, the complainant is not entitled for the compensation of Rs.75,000/- as there is no negligence on the part of the opposite parties, because the complainant not submitted original policy bond and required documents.

10.     But in our view, being a nominee of the policy holder, the complainant has right to get the claim amount if it is genuine one, hence, after submitting the necessary documents by the complainant to the opposite parties, the opposite parties are liable to settle the claim amount within 3 months.

11.     Accordingly, this point is answered, holding that the opposite parties are liable to settle the claim amount within three months after getting necessary documents from the complainant within 15 days from the date of receipt of order. 

12.     In the result, the complaint is partly allowed directing both the opposite parties to settle the claim amount on receipt of necessary documents from the complainant within three months.  The complainant is also directed to submit all necessary documents to the opposite parties within 15 days from the date of receipt of order. No order as to compensation and costs.

  Dictated to the Shorthand Writer, transcribed by her, corrected and pronounced by us in the open Forum on this the 27^th day of November, 2014.

    Sd/-                                                                       Sd/-

Member                                                                 President (FAC)

                                                                   District Consumer Forum-I 

                                                                             Visakhapatnam

APPENDIX OF EVIDENCE

Exhibits Marked for the Complainant:

Exhibits Marked for the Opposite Parties:

NIL

    Sd/-                                                                       Sd/-

Member                                                                  President (FAC)

                                                                   District Consumer Forum-I

                                                                             Visakhapatnam

//VSSKL//