Andhra Pradesh

Visakhapatnam-II

CC/306/2012

Kandregula Jogulamma - Complainant(s)

Versus

M/s Reliance Life Insurance Company Limited - Opp.Party(s)

P. Leelavathi

14 Jul 2015

ORDER

                  Reg. of the Complaint:10-03-2011

Date of remand:28-03-2014                                                                                                                                      

                                              Date of Order:14-07-2015

BEFORE THE DISTRICT CONSUMERS FORUM-II

AT VISAKHAPATNAM

                    Present:

1.Sri H.ANANDA 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 14^TH DAY OF JULY, 2015

CONSUMER CASE NO.306/2012

 

BETWEEN:

Kandregula Jogulamma w/o Suribabu,

Hindu, Aged 50 Years, R/at Patipalli Village,

Munagapaka Mandal, Visakhapatnam District.

…Complainant

AND:

1.M/s Reliance Life Insurance Co., Ltd.,

Rep. by its Regional Manager,

having its office at Reliance House,

6^th Floor, Headdows Road, Nungambakka,

Chennai-600 006.

 

2. M/s Reliance Life Insurance Co., Ltd.,

Rep. by its Branch Manager (Claims),

D.No.3-3-5, 1^st Floor, Woodpeta Ward,

Madugula Road, Anakapalle-530 001,

Visakhapatnam.

…Opposite Parties

 

This case coming on 01-07-2015 for final hearing before us in the presence of   SMT.P.LEELAVATRHI, Advocate for the Complainant, and of SRI SANAPALA KARUNA, Advocate for the 1^st and 2^nd Opposite Parties, and having stood over till this date for consideration, this Forum made the following.

 

ORDER

 (As per the Honourable President on behalf of the Bench)  

   

1. The Complainant filed the present complaint against the Opposite Parties, directing them to pay Rs.10,00,000 /- with interest @ 24% p.a, from the date of claim form  i.e., 12-02-2011 till the date of realization, Rs.1,00,000/- towards compensation and Rs.1,00,000/- damages with costs.
2. The case of the complainant in brief is that her son during his life time, obtained insurance policy which is valid for a period of 10 years commencing from 15-03-2010 and he died on 03-06-2010 due to stomach pain  and thereafter she submitted the claim form along with necessary documents to OPs but they have repudiated the claim on 30-07-2011 on the ground that her son suppressed the fact relating to his illness has to renal failure at the time of submission of proposal form. Hence, this complaint.
3. The case of the Opposite Party denying the material averments of the complaint is that admitting issuance of policy in favour of the insured  deceased and the complainant herein is the nominee contended that on receipt of death claim form from the complainant, investigation was conducted for the evolution of claim and during the investigation, it came to knowledge that the deceased life assured had suppressed material facts regarding his state of health he was suffering from renal failure from 30 days i.e., before signing the proposal form and he was referred to Anakapalle Government Hospital on 06-03-2010 and the documents reveal that on 06-03-2010, Deceased Life Assured  was admitted and it is an old case of renal and the DLA was suffering from the above mentioned disease at the time of signing the proposal form which is very much clear from the medical treatment record however the said fact was not disclosed by the deceased life assured. Thus according to OP by suppressing pre-existing medical history he has obtained policy.
4. To prove the case on behalf of the complainants, she field her affidavit and got marked Exhibits A1 to A8. On the other hand, on behalf of the OPs, filed their affidavit and got marked Exhibits B1 to B7.
5. Exhibit A1 is the Terms plan (Policy Schedule), dated 15-03-2010, Exhibit A2 is the Death Certificate , dated 23-07-2010, Exhibit A3 is the Letter addressed by the OPs, dated 30-07-2011, Exhibit A4 is the Registered reply notice issued by the complainant’s counsel, dated 07-09-2011, Exhibit A5 is the Acknowledgement form OP1, Exhibit A6 is the acknowledgement from OP2, Exhibit A7 is the Claim forms submitted  to the OPs, dated 12-02-2011 and Exhibit A8 is the courier receipts, dated 02-06-2011.                             
6. Exhibit B1 is the Policy Schedule, Exhibit B2 is the Proposal Form, Exhibit B3 is the Death Certificate, Exhibit B4 is the Claim Form A1, Exhibit B5 is the e-mail copy, Exhibit B6 is the outpatient ticket along with treatment particulars and Exhibit B7 is the Regd., letter.
7. Both Parties filed their written arguments.
8. Heard oral arguments from both sides.
9. Now the point for determination to be determined in this case is;

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

10. As seen from the contentions of both sides much less the onus of proving concealment was on the OP  undisputedly the OP has repudiated the claim of the complainant on the ground that insurance was obtained by the deceased insured by concealing the fact that he was suffering renal. The onus of proving the above ground for repudiation of insurance claim lies heavily on the OP. The Op in order to prove the concealment of previous ailment on the part of the deceased relying upon the photocopy of B6 out-patient ticket allegedly issued by the Government Hospital with relevant treatment etc., if  this Exhibit B6 is taken to be proved, then the life assured was admitted in the above noted hospital on 6-3-2010 and expired on the same day at 5.30.p.m., and at the time of admission, he gave the history to some extent. The core question however is whether the OP has proved the above Exhibit B6 and linked it with the complainant herein.
11. On a perusal of record, we find that the concerned doctor who allegedly treated the insured on 6-3-2010 and relied that the patient was admitted with the history of renal from the last several days was not examined by the OPs.  To prove the photocopy of Exhibit B6 relied upon by OPs,  no affidavit of the said person has filed nor even original record alleged to have been given by the Government  Hospital has not been produced to prove the Exhibit B6 which obviously is a secondary evidence. Thus, OP has failed to produce evidence to show the ground for repudiation of claim.
12. The OP further relied upon the report of the Investigating Officer Zabbir and Co., and it is marked as Exhibit B5 unfortunately, the OPs failed to file the affidavit of the Investigating Officer who investigated and on basing on whose report the claim of the complainant was repudiated.  Exhibit B5 is a also photocopy; what happened to the original is not known. The Investigation Officer who collected the aforesaid document from the Medical Officer admittedly is not examined. In our opinion, in order to prove the case set up by OP, it is incumbent upon the insurance company to file affidavit of either the Medical Officer or atleast of the investigator who allegedly collected the afore said prescription from him. That having not been done, it would be difficult to say Insurance Company  has been able to discharge onus placed on it to prove that the insured has suppressed the material information with respect to the health condition while taking the insurance cover. On a careful scrutiny of the evidence let in by both sides, we are of the considered view that  the acts of the OPs in repudiation of claim of the complainant without any valid reasons, amounts to clear deficiency of service on their part. Therefore, the complaint is entitled for the insured amount.

12. Now the question that comes up for consideration, at this stage of our discussion is, what is the rate of interest for which the Complainant is entitled.   The rate of interest claimed by the Complainant is 24% p.a.  This rate of interest claimed by the Complainant appears to be excessive, of course, it is a fact that the transaction covered by Ex.A1 is commercial in nature, but that does not and cannot mean to say that the Complainant is licensed to claim interest @ 24% p.a. from the date of the death of the deceased husband of the complainant.  But at the same time, it is imperative on our part to award a reasonable interest.   Having regard to all these facts and circumstances, we sincerely feel having considered the case on hand awarding of interest @ 9% p.a. would better serve the ends of justice.    Consequently, we proposed to fix the rate of interest @ 9% p.a.,             26-09-2012 i.e., from the date of registration of the complaint.   Accordingly interest is ordered.

13. Whether the Complainant is entitled for compensation of Rs.1,00,000/- is to be considered.   It appears as seen from the evidence of Complainant that the Complainant was compelled to approach the Opposite Parties and therefore experienced a lot of physical strain besides mental agony and financial loss. It is an un-disputed fact that the Opposite Parties did not pay the sum assured to the complainant.   Naturally, that might have put the Complainant to suffer some mental agony besides physical stress and strain.   In this view of the matter, we sincerely feel that it is a fit case to award compensation.   But that does not and cannot mean to say that the Complainant claim for compensation is acceptable.    Having regard to all these facts and circumstances, we are of the considered opinion, award of compensation of 50,000/- would serve the ends of justice.   We therefore, proposed to award compensation of Rs.50,000 /-,  in the circumstances of the case on hand. Accordingly this point is answered.

14. Before parting our discussion, it is incumbent and imperative on our part to consider         the costs of litigation.    The Complainants ought not have to approach this Forum had his claim for payment of Rs.10,00,000/- or reliefs sought for have been honored by the Opposite Parties within a reasonable time and in view of the matter, the Complainant’s claim for costs deserves to be allowed.   In our considered and unanimous opinion awarding a sum of Rs.2,500/- as costs would appropriate and reasonable.   Accordingly costs are awarded.

15. In the light of our discussion, referred supra, the complainant is entitled to receive the sum of Rs.10,00,000/-  with interest for the said sum @ 9% only from 10-03-2011, compensation of Rs.50,000/- and costs of Rs.2,500/-.

16. In the result, this complaint is allowed in part directing the opposite parties to pay an amount of Rs.10,00,000/- (Rupees Ten lakhs only) with subsequent interest @ 9% p.a., from 26-09-2012, till the date of realization, Rs.50,000/- (Rupees Fifty Thousand only) towards compensation and Rs.2,500/- (Rupees Two thousand and five hundred only) towards costs 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 14^th day of July, 2015.      

Sd/-                                                               Sd/-                                                     Sd/-

LADY MEMBER                              MALE MEMBER                       PRESIDENT  

    

APPENDIX OF EVIDENCE

  For the Complainant:-

Exhibits	Date	Description	Remarks
A1	15-03-2010	Terms Plan (Policy Schedule)	Photocopy
A2	23-07-2010	Death Certificate	Original
A3	30-07-2011	Letter addressed by the OPs	Original
A4	07-09-2011	Registered reply notice issued by the complainant’s counsel	Office copy
A5		Acknowledgement from OP1	Original
A6	09-09-2011	Acknowledgement from OP2	Original
A7	12-02-2011	Claim forms submitted to the OPs	Photocopy
A8	02-06-2011	Courier Receipts	Original

For the Opposite Parties:-            

Exhibits	Date	Description	Remarks
B1		Policy schedule	Photocopy
B2		Proposal form	Photocopy
B3		Death Certificate	Photocopy
B4		Claim form A1	Photocopy
B5		e-mail copy	Photocopy
B6		Out-patient ticket along with treatment particulars	Photocopy
B7		Registered letter	Photocopy

 

Sd/-                                                                           Sd/-                                       Sd/-

LADY MEMBER                              MALE MEMBER                       PRESIDENT