Andhra Pradesh

Visakhapatnam-II

CC/284/2011

Adari Lakshmi - Complainant(s)

Versus

M/s Future Generali India Life Insurance Company Limited - Opp.Party(s)

M. Sivaramakrishna

02 Aug 2014

ORDER

                                              Date of Registration of the Complaint:05-08-2011

                                                                                                Date of Order:02-08-2014

BEFORE THE DISTRICT CONSUMERS FORUM-II AT

                             VISAKHAPATNAM

 

P  r  e  s  e  n  t:      

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

     President (FAC)  

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

                                    Male Member

 

                                 Saturday, the 2^nd day of August, 2014.

                                 CONSUMER CASE No.284/2011

Between:-

Smt. Adari Lakshmi, W/o Srinivasa Rao,

Hindu, aged 25 years, residing at 2-15-28,

Allavari Street, Anakapalli, Visakhapatnam

District.

….. Complainant

And:-

1.M/s. Future General India Life Insurance Co. Ltd.,

   Rep. by its Branch Manager, situated at 10-1-2,

   2^nd Floor, Land Mark, Plot No.3-2, 4-1/A, Waltair

   Uplands, Visakhapatnam.

2.M/s. Future Generali India Life Insurance Co. Ltd.,

   Rep. by its Authorized Signatory, situated at 001,

   Trade Plaza, Veer Savarkar Marg, Prabhadevi,

   Mumbai-400 025.

                                                                                          …  Opposite Parties  

                     

          This case coming on 04.07.2014 for final hearing before us in the presence of Sri M. Sri Siva Rama Krishna, Advocate for the Complainant and Sri D. Siva Prasad, Advocate for the 2^nd Opposite Party and the 1^st Opposite Party being exparte and having stood over till this date for consideration, this Forum made the following:

 

                                                ORDER

(As per the Honourable Male Member on behalf of the Bench)

 

1.       The Complainant asks the Forum to pass an order in her favour and against the Opposite Parties:  a) direct the Opposite Parties to pay an amount of Rs.78,000/- (Rupees Seventy Eight thousand only) being the death claim of the Complainant’s father Alla Sanyasi along with other benefits with interest @ 24% per annum from 05.05.2009 to till the date of realization; b) To pay an amount of Rs.50,000/- towards compensation for causing mental agony and physical strain caused by the Opposite Parties; c) To pay sum of Rs.25,000/- towards damages for deficiency of service caused by the Opposite Parties; d) To pay costs; and e) For such other relief or reliefs as the Forum deems fit and proper in the circumstances of the case.

 

2.       The 1^st Opposite Party did not resist the claim of the Complainant as it was set exparte and remained set exparte.

 

3.       The 2^nd Opposite Party strongly resisted the claim of the Complainant and asked the Forum to dismiss the complaint with costs.

 

   4.    The case of the Complainant, as can be seen from the complaint, is that the Complainant’s father Alla Sanyasi, S/o late Jagannadh had taken an Accidental Care Policy during his life time vide Policy No.00123708, dt.20.04.2009 for an amount of Rs.78,000/- and the Complainant’s name is mentioned as nominee in the policy.    On 05.05.2009 the Complainant’s father suddenly fell sick and immediately he was shifted to Andhra Pradesh Vaidhya Vidhana Parishath Hospital, Anakapalli and while undergoing treatment as an outpatient, he died due to heart attack on 05.05.2009 at his residence.    After the demise of her father, she immediately intimated the death to the Opposite Parties and subsequently sent the original policy copy, Death Certificate, Claim Form and treatment details on 08.07.2010.    After sending the Claim Form to the Opposite Parties, the Complainant requested the Opposite Parties officials many times to settle the death claim, but the Opposite Parties postponed the same on one pretext or the other and finally rejected her claim and sent a letter to the Complainant on 01.02.2011 with  baseless reasons.   Though the Opposite Parties had to settle the death claim of Alla Sanyasi, S/o Late Jagannadh and pay the claim amount of Rs.78,000/- with subsequent interest to the Complainant, the Opposite Parties did not choose to pay any amount.   The Complainant stated that the Opposite Parties failed to pay any amount to the Complainant and thus failed to render the services of the Opposite Parties and as such there is deficiency of service on the part of the Opposite Parties.   The Complainant further stated that as per the rules and regulations of the Opposite Parties the deceased Alla Sanyasi completed all formalities at the time of taking the policy.  The death of the Complainant’s father is an accidental death and she is entitled to receive the claim amount together with interest.   Hence, the Complainant.

 

4.       The Complainant filed an affidavit besides written arguments to support her claim.   Exs. A1 to A8 are marked for the Complainant.

 

5.       On the other hand, the 2^nd Opposite Party besides denying all the averments put forward in the complaint, mainly contended, as can be seen from its counter, that the Opposite Party Company had always intimated the Complainant that hers is an early claim as even as per the admission of the Complainant the policy holder died due to illness within 14 days from the date of obtaining the policy.   Therefore, the deceased suppressed the health  condition and obtained the policy from the Opposite Party.   The claim submitted by the Complainant is an attempt to defraud the company as the entire contract was based on fraud, medical non disclosure and suppression of material facts and hence the contract was voidable at the option of the Opposite Parties Company.   The Complainant seriously prejudiced the interest of the other genuine policy holders of the company.    The claim of the Complainant is not at all tenable under law as per the policy conditions and provisions of the act.    Therefore, the repudiation of the claim or non-payment of the claim of the Complainant not at all amounts to deficiency of service on the part of the 2^nd Opposite Party; the 2^nd Opposite Party is not liable to pay the amount as claimed or prayed by the Complainant.

 

6.       The 2^nd Opposite Party filed an affidavit besides written arguments to buttress its contention.       Exs.B1 and Ex.B2 are marked for the 2^nd Opposite Party.

 

7.       The matter has been heard on behalf of the Complainant as well as the 2^nd Opposite Party.         

 

8.         After careful perusal of the case record, this Forum finds that there is outright deficiency of service on the part of the Opposite Parties 1 and 2.   The 2^nd Opposite Party’s contention that the deceased-insured Sri Alla Sanyasi was suffering from chronic illness by the date of obtaining the policy is totally baseless.    The 2^nd Opposite Party miserably failed to present before this Forum even an iota of evidence to show that the deceased-insured ever suffered from any disease prior to his death.   Ex.B2 “Investigation Report” prepared by a Standard Investigation Agency, Zubair & Co., clearly shows that the Opposite Parties contacted the Arogya Sree Department and all most all the important Nursing Homes at Anakapalli to get any adverse information from those hospitals about the health of the deceased-insured Alla Sanyasi.    But the report itself stated unequivocally that the investigation failed to get even an iota of information about the ill-health of the deceased-insured Alla Sanyasi before he took the insurance policy in question.   As such, the Opposite Parties should have given the policy amount to the Complainant, the daughter-nominee of the deceased-insured Alla Sanyasi, as soon as she put forward her claim to them on 25.01.2010 itself.   But the Opposite Parties illegally repudiated the claim on 01.02.2011.   So, the Complainant is entitled to get the death claim of Rs.78,000/- with interest from 25.01.2010 till the date of actual realization.   Moreover, as the deficiency of service on the part of the Opposite Parties should have caused much physical hardship and mental agony to the Complainant, she is entitled to suitable compensation.   Moreover, as the Complainant is forced to file this complaint because of the deficiency of service on the part of the Opposite Parties, she is entitled to costs of this complaint too.   

 

9.       In the result, this Forum directs the Opposite Parties 1 and 2: to pay 1) the death claim amount of Rs.78,000/- (Rupees Seventy eight thousand only) with interest @ 9% p.a. from 25.01.2010 till the date of actual realization, 2) a compensation of Rs.10,000/- (Rupees Ten thousand only) and 3) Costs of Rs.2,000/- (Rupees two thousand only) to the Complainant.  Time for compliance, one month.

     Dictated to the Steno, transcribed by him, corrected and pronounced by us in the Open Forum, this the 2^nd day of August, 2014.

Sd/-                                                                                     Sd/-

President                                                                          Male Member

 

 

 

                             APPENDIX OF EVIDENCE

For the Complainant:-

NO.	DATE	DESCRIPTIONOFTHEDOCUMENTS	REMARKS
Ex.A1	20.04.2009	Insurance Policy	Photo copy
Ex.A2	25,01.2010	Letter sent by the Complainant to 2nd OP	Photo copy
Ex.A3	25.01.2010	On dot Courier receipt	Original
Ex.A4	08.07.2010	Letter sent by the Complainant to 1st OP	Photo copy
Ex.A5	09.07.2010	On dot Courier receipt	Original
Ex.A6	25.06.2009	Death Certificate	Original
Ex.A7	01.02,2011	Death Claim rejection letter issued by the Ops to Complainant	Original
Ex.A8	05.05.2009	OP Chit	Original

For the Opposite Parties:-                                  

NO.	DATE	DESCRIPTIONOFTHEDOCUMENTS	REMARKS
Ex.B1	31.07.2010	Investigation Report	Original
Ex.B2	20.04.2009	Insurance Policy Copy	Original

 

Sd/-                                                                                     Sd/-

President                                                                                Male Member