Andhra Pradesh

Visakhapatnam-II

cc/232/2013

Dasari Usha Rani - Complainant(s)

Versus

ICICI Prudential Life Insurance Company Limited - Opp.Party(s)

Veera Srinu

18 Nov 2014

ORDER

                                              Date of Registration of the Complaint:08-10-2013   

                                                                                                Date of Order:18-11-2014

BEFORE THE DISTRICT CONSUMERS FORUM-II AT

                             VISAKHAPATNAM

 

P  r  e  s  e  n  t:

1.  Sri H. Ananda Rao, M.A., L.L.B.,

     President           

2. Smt K. Saroja, M.A. B.L.,

     Lady Member 

                                3. Sri C.V. Rao, M.A., B.L.,

                                     Male Member

 

                         Tuesday, the 18^th day of November, 2014.

                             CONSUMER CASE No.232/2013

Between:-

Smt. Dasari Usha Rani, W/o (late) Dasari  Sankara Rao,

Hindu, aged 36 years, Eduruvanipalem, Near Gajuwaka

Dept. Visakhapatnam.

                                                                                        ….. Complainant

And:-

1.The Branch Manager, ICICI Prudential Life

   Insurance Company Limited, Door No.10-1-31,

   404-403, 3^rd Floor, Signature Towers, Traveler

   Bungalow Road, Siripuram, Visakhapatnam.

2.The Manager, ICICI Prudential Life Insurance

   Company Limited, Head Office, 1^st Floor, ICICI

   Purlife Towers, Opposite Tata Motor Showroom,

   Near Century Bazar, 1089, Appasaheb Marathe Marg.

   Pradhadevi, Mumbai-400025.

3.Grievance Redressal Committee (Chaired by External Member)

   ICICI Prudential Life Insurance Company Limited,

   Corporate Claims Cell, Ground Floor, Vinod Silk Mills

   Compound, Chakravarti Ashok Road, Kandivali (East),

   Mumbai-400101.

                                                                                           …  Opposite Parties

                     

This case coming on 30.10.2014 for final hearing before us in the presence of Sri     Veera Srinu, Advocate for the Complainant and the Opposite Parties 1 to 3 being 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 joined as a member in ICICI Prudential Life Insurance Company Limited on 08.07.2011 and paid Rs.50,000/- towards first premium.   The total sum assured amount is Rs.5,00,000/- after paying premium amount, the policy No.15730872 was allotted on 15.07.2011.   On 03.06.2012 the Complainant’s husband died.   Then the Complainant approached the Opposite Parties and requested them to settle the claim of the Complainant.   The Complainant approached the Opposite Party in the month of August, 2012 on that the Opposite Party stated the process is in progress.   On 18.10.2012 the Opposite Party sent a letter by repudiating the claim amount of the Complainant basing on the baseless allegations.   Then the Complainant issued a legal notice, dated 26.08.2013 all the Opposite Parties received the legal notice but the 3^rd Opposite Party gave a reply letter on 03.09.2013 stating that the claim is repudiated dated 08.10.2012.   Hence, this Complaint.

2.       a) To pay policy amount of Rs.5,00,000/- (Rupees five lakhs only) together with interest at the rate of 18% p.a. from the date of death (i.e., Sri (late) Dasari Sankara Rao) till the realization of the award amount to the nominee that is the Complainant.

          b) To pay Rs.50,000/- (Rupees Fifty thousand only) to the Complainant for the mental agony and hardship suffered by him for the deficiency of service done by the 1^st to 3^rd Opposite Parties

          c) To pay Rs.5,000/- towards costs of litigation; and

          d) For other relief or reliefs as the Forum may deems fit and proper in the circumstances of the case.     

 

3.       The Opposite Parties did not resist the claim of the Complainant as they were set exparte and remained exparte.

 

4.       At the time of enquiry, the Complainant filed affidavit as well as written arguments to support her contentions.  Exs.A1 to A9 are marked for the Complainant.

 

5.       ExA1 is the ICICI Prudential Life Insurance Manual.   Ex.A2 is the Death Certificate issued by the Panchayat Secretary, Atchutapuram Mandalam.  Ex.A3 is the letter issued by the Opposite Parties in favour of the Complainant dated 18.10.2012.   Ex.A4 is the legal notice issued by the Complainant in favour of the Opposite Parties dated 26.08.2013.   Ex.A5 is another legal notice issued by the Complainant in favour of the Opposite Parties dated 02.09.2013.   Ex.A6 is the acknowledgement Card of the 1^st Opposite Party.  Ex.A7 is the acknowledgement Card of the 2^nd Opposite Party.  Ex.A8 is the acknowledgement of Insurance Ombudsman, Hyderabad.  Ex.A9 is the reply letter given by the Authorized Signatory of ICICI Prudential Life Insurance Company Limited   

 

6.       The fact shown from the document Ex.A3 reveals that the Complainant’s husband was joined as member in the 3^rd Opposite Party company and after paying premium of Rs.50,000/-, the 3^rd Opposite Party issued a policy in favour of the insured.   After verifying all columns the 3^rd Opposite Party issued the policy in favour of the insured.   

 

7.       The point that would arise for determination in the case is:-

Whether there is any deficiency in service on the part of the Opposite Parties.   Whether the Complainant is entitled to any reliefs asked for?

 

8.         After careful perusal of the case record, this Forum finds that the Complainant’s husband obtained the policy from the Opposite Parties by paying premium of Rs.50,000/- .  According to Ex.A9 the policy was issued after declarations made by the insured and issued the policy in favour of the insured/deceased.      The Opposite Parties repudiated the claim on the ground that the insured was undergone biopsy wherein he was diagnosed of Malignant Lesion of Left Humerus and was hospitalized on June, 27^th, 2011.   These mere allegations are not supported any documentary evidence to show that the insured was hospitalized on June 27^th, 2011.   Moreover, the Opposite Parties failed to file any treatment particulars of their allegations that the insured was hospitalized on June 27^th, 2011.   After declarations made by the insured, the Opposite Parties issued the Insurance Policy in favour of the insured/deceased.   As such, the repudiation on the basis of a false allegation amounts to deficiency in service on the part of the Opposite Parties.   Hence, the Complainant is entitled to insured amount with interest, some compensation and costs too.

 

9.       In the result, this Complaint is allowed directing the Opposite Parties 1 to 3: a) to pay an amount of Rs.5,00,000/- (Rupees Five lakhs only) with interest @ 9% p.a. from 18.10.2012 till the date of actual realization, to pay b) a compensation of Rs.50,000/- (Rupees Fifty thousand only) and c) Costs of Rs.2,000/- (Rupees two thousand only) to the Complainant.  Advocate fee is fixed at Rs.2,000/- (Rupees two thousand only).   Time for compliance, one month from the date of this order.

 

Dictated to the Steno, transcribed by him, corrected and pronounced by us in the Open Forum, this 18^th day of November, 2014.

 

Sd/-                                     Sd/-                                          Sd/-  

President                            Male Member                        Lady Member

                                     

 

APPENDIX OF EVIDENCE

For the Complainant:-

NO.	DATE	DESCRIPTIONOFTHEDOCUMENTS	REMARKS
Ex.A01		ICICI Prudential Life Insurance manual.	Original
Ex.A02	03.062012	Death Certificate issued by the PanchayatSecretary, Atchutapuram Mandalam.	Original
Ex.A03	18.10.2012	Letter issued by the Opposite Parties in favour of the Complainant.	Original
Ex.A04	26.08.2013	Legal Notice issued by the Complainant’s to the Opposite Parties	Office copy
Ex.A05	02.09.2013	Legal Notice issued by the Complainant’s to the Opposite Parties	Office copy
Ex.A06	03.09.2013	Acknowledgement of 1st OP.	Original
Ex.A07	29.08.2-13	Acknowledgment 2nd OP.	Original
Ex.A08	29.08.2013	Acknowledgment of Insurance Ombudsman, Hyderabad.	Original
Ex.A09	03.09.2013	Reply letter with cover given by the Authorized signatory of ICICI Prudential Life Insurance Company Limited.	Office copy

For the Opposite Parties:-

                                       

                                        -Nil-

 

 

Sd/-                                Sd/-                                          Sd/-                                         

President                       Male Member                                               Lady Member