Andhra Pradesh

Visakhapatnam-II

CC/366/2012

Doddi Mahalakshmi - Complainant(s)

Versus

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

P. Leelavathi

10 Jun 2015

ORDER

                  Reg. of the Complaint:06-11-2012                                                                                                                                      Date of Order:10-06-2015

BEFORE THE DISTRICT CONSUMERS FORUM-II

AT VISAKHAPATNAM

                   Present:

1.Sri H.ANANDHA 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

                                            

 

WEDNESDAY, THE 10^TH DAY OF JUNE, 2015

CONSUMER CASE NO.366/2012

 

BETWEEN:

Doddi Mahalakshmi w/o late Hema Ganeswara Rao,

@ Hema Ganesh, Hindu, aged 30 years,

R/at D.No.2-68, Thimmarajupeta Village,

Manugapaka Mandal, Visakhapatnam District.

…Complainant

AND:

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

Rep. by its Assistant General Manager,

Having its registered office at D.No.3-6-476,

3^rd floor, Anand Estates, Liberty Road,

Himayat Nagar, Hyderabad-29.

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

Rep. by its Divisional Manager,

Divisional office at D.No.1-83-27/1,

Plot No.M1-Sector-5, MVP Double Road,

MVP Colony, Visakhapatnam-17.

…Opposite Party

This case coming on 07-05-2015 for final hearing before us in the presence of SMT.P.LEELAVATHI, Advocate for the Complainant, and of                                     SRI A.VENKATESWARA RAO, Advocate for the 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.1,50,000/- with interest @ 24 % p. a., from the date of submission of claim form i.e., 09.05.2008 till the date of realization, Rs.50,000/- compensation and Rs.50,000/- towards damages with costs.
2. The case of the complainant in brief is that the husband of the complainant late Doddi Hema Ganeshwara Rao @ Hema Ganesh. During the life time took policy for an amount of Rs.1,50,000/-  from OPs vide policy No.LN 110700088226 dated 22-08-2007 and the complainant is the nominee to receive the benefits of the policy and the deceased has paid the first premium of Rs.5,000/- on 20-08-2007 and the date of proposal is 14-08-2007.
3. It is also their case that the insured-deceased met with dog bite on 08-10-2007 and immediately he was taken to Shri Shirdi Sai Hospital for treatment and he died on 15-10-2007 at their residence and the death was confirmed by the Grama Panchyat Authorities at Munagapaka Mandal, Visakhapatnam and the complainant intimated the death of the insured to the 1^st OP on 3-3-2008 and submitter her claim form along with original policy, death certificate, medical reports on 09-05-2008 but the 1^st OP repudiated the claim on 31-05-2008 stating that the insured was died due to pre-existing disease which they came to know that during their investigation by their senior officials. Hence, this complaint.
4. The case of the OP admitting a Policy with them and the complainant addressed a letter intimated his death and sending claim forms and thereafter conducted a regular investigation etc., by denying the other material averments. It is also the case of the OP that the Forum has no jurisdiction to entertain this case as the complainant does not come under the purview of the consumer. It is their further case that the complainant’s husband is having preexisting disease who obtained the policy  deceitfully by suppressing the real facts. Therefore, the complaint is liable to be dismissed.
5. To prove the case on behalf of the complainant, she field her affidavit and got marked Exhibits A1 to A11. On the other hand, on behalf of the OP, they filed their affidavit and got marked Exhibits B1 to B7.
6. Exhibit A1 is the First Premium Receipt, dated 20-08-2007, Exhibit A2 is the Shriram Plus Policy Schedule, dated 22-08-2007, Exhibit A3 is the prescription issued by the Shri Shirdi Sai hospital, Anakapalle, dated 08-10-2007, Exhibit A4 is the Medical Bill, dated 08-10-2007, Exhibit A5 is the Death Certificate, Exhibit A6 is the Intimation letter, dated 03-03-2008, Exhibit A7 is the Letter addressed by 1^st OP, dated 11-04-2008, Exhibit A8 is the Letter addressed by the complainant, dated 18-04-2008, Exhibit A9 is the Letter addressed by 1^st OP, dated 23-04-2008, Exhibit A10 is the Claim Form along with covering Letter, dated 09-05-2008 and Exhibit A11 is the Repudiation letter addressed by 1^st OP, dated 31-05-2008.
7. Exhibit B1 is the Intimation letter, dated 03-03-2008, Exhibit B2 is the Reminder No, dated 26-03-2008, Exhibit B3 is the Reminder Letter dated 11-04-2008, Exhibit B4 is the Investigation report dated, dated 24-05-2008, Exhibit B5 is the Bunch of Medical reports, Exhibit B6 is the Proposal Form dated 14-08-2007 and Exhibit B7 is the Repudiation Letter.
8. Both parties filed their written arguments.
9. Heard oral arguments from both sides.
10. Exhibit A1 is the premium receipt A2 is the Shriram Plan Schedule, A3 is the prescription issued by Shri Shirdi Sai Hospital and A4 is the Medical Bill and A5 is the death certificate. As seen from these Exhibits, it is clear that the complainant’s husband has taken a policy from the OPs on 22-08-2007 wherein the complainant was shown as nominee to receive the claim amount if her husband expires during the policy period and the sum assured covered under the policy is Rs.1,50,000/- and the complainant husband paid the first premium of Rs.5,000/- on 28-07-2007 and the date of proposal of the said policy is Rs.14-08-2007. According to the complainant, her husband met with dog bite and immediately, he was taken to Sri Shirdi Hospital and while taking treatment he died. To prove the same, she relied upon Exhibits A4 and A5 and thereafter, he addressed letters intimating the death to OP and on their request, she filed claim form along with necessary documents vide Exhibits A6 to A10 but finally they repudiated the claim of the complainant vide Exhibit A4 on the ground that the husband of the complainant was having pre existing disease as per their letter vide Exhibit B7. 
11. According to the complainant, her husband was not having any pre existing health problem at any time and he never suffered with any ailment and her husband has informed about his health condition to the agent of the OPs at the time of policy proposal and having satisfied with the said information, the OPs received premium amount from her husband and approved the policy but now only with a view to avoid the payment of claim amount, they have invented these allegations and that as the policy was in force at the time of his death of her husband, she is entitled for the insured amount. By drawing our attention, Exhibit B4 investigation Report and B5 Bunch of medical bills, the counsel for the Ops, tried to impress upon us that the deceased was under the treatment for the hypertension and PPH since 07-05-2007 but submitted the proposal form for the Policy on 14-08-2007 by suppressing these facts. On a careful perusal of  Exhibit B4 investigation report stated to have been issued by one G.Rama Murthy submitted that the deceased is having pre existing ailment. Admittedly, the said Rama Murthy has not filed his evidence affidavit as to how he got the information about the pre-existing disease of the deceased insured. According to his report based on the information of the 7 Hills Hospital, Visakhapatnam, he obtained  the history of the deceased. No evidence affidavit of 7 Hills Hospital Authority, Visakhapatnam is filed. Exhibit B5 relates to medical bills and medical reports. Perusal of them, it appears  that it is not in the name of D.Ganesh. The present insured name is late Doddi Hema Ganeswara Rao. It is also called as D.Ganesh no  proof is filed by the OP. Further, they have not obtained the affidavits of the same Hospital Authorities to show that these bills were issued by them and treated the said deceased and he was suffering with pre-existing disease.  In the absence of positive proof basing on Exhibit B4 and B5, it can not be held that the diseased was suffering with pre-existing disease and obtained the policy by suppressing pre-existing disease. Therefore, the contention of the learned counsel for the OP by suppressing the pre-existing disease, he obtained the policy has no legs to stand.

12.     The contention of the OP is that the deceased died due to dog bite is unbelievable as no one will die due to dog bite within one week and further submitted that the death caused due to pre existing disease, can be ascertained only in the PM and in the present case, there is no FIR AND P.M Report. On perusal of record much less the affidavit averments of the complaint and A5 death certificate issued by the competent authority clearly shows that the complaint died due to dog bite and as on that date the policy was In force and immediately the complainant applied for policy amount and claim form but due to non settlement of the claim amount, the complainant approached this form. For all these reasons, we are of the view that the acts of the Ops, in non settlement of claim of the complainant, comes under definition of deficiency of service.  Therefore, the complaint is entitled for Policy amount as sought.

13.     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 and A2 is commercial in nature, but that does not and cannot mean to say that the Complainant is licensed to claim interest @ 24% p.a.  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. on Ex.A-10 dated 09-05-2008 in question.   Accordingly interest is ordered.

14.     Whether the Complainant is entitled for compensation of Rs.50,000/- 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 settle the claim amount covered under the said policy 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 15,000/- would serve the ends of justice.   We therefore, proposed to award compensation of Rs.15,000 /-,  in the circumstances of the case on hand. Accordingly this point is answered.

15.     Before parting our discussion, it is incumbent and imperative  on our part to consider the costs of litigation.   The Complainant ought not have to approach this Forum had her claim for payment of Rs.1,50,000/- 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.

 

16.     In the light of our discussion, referred supra, the complainant is entitled to receive the sum of Rs.1,50,000/-  with interest for the said sum @ 9% only from 09-05-2008, compensation of Rs.15,000/- and costs of Rs.2,500/-.

17.     In the result, this complaint is allowed in part, directing the OPs to pay an amount of Rs.1,50,000/-  (Rupees one lakh fifteen thousand only) with interest @ 9%  p.a., from 09-05-2008 from the date of claim form till the date of realization, a compensation of Rs.15,000/- (Rupees Fifteen Thousand only) and Rs.2,500/- (Rupees Two Thousand and five hundred only) towards costs. 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  10^th day of June, 2015.                                   

   Sd/-                                                Sd/-                                          Sd/-

LADY MEMBER                            MALE MEMBER                        PRESIDENT       

 

APPENDIX OF EVIDENCE

  For the Complainant:-

Exhibits	Date	Description	Remarks
A1	20-08-2007	First premium Receipt	Photocopy
A2	22-08-2007	Shriram Plus Policy Schedule	Photocopy
A3	08-10-2007	Prescription issued by Shri Shirdi Sai Hospital, Anakapalle	Photocopy
A4	08-10-2007	Medical Bill	Photocopy
A5		Death Certificate	Original
A6	03-03-2008	Intimation Letter	Original
A7	11-04-2008	Letter addressed by the 1st OP	Original
A8	18-04-2008	Letter addressed by the Complainant	Photocopy
A9	23-04-2008	Letter addressed by the 1st OP	Original
A10	09-05-2008	Claim form along with covering letter	Photocopy
A11	31-05-2008	Repudiation letter addressed by 1st OP	Original

For the Opposite Parties:-  

Exhibits	Date	Description	Remarks
B1	03-03-2008	Intimation Letter	Photocopy
B2	26-03-2008	Reminder	Photocopy
B3	11-04-2008	Reminder Letter	Photocopy
B4	24-05-2008	Investigation report	Photocopy
B5	-	Bunch of Medical Reports	Photocopy
B6	14-08-2007	Proposal form	Photocopy
B7	31-05-2008	Repudiation letter	Photocopy

   Sd/-                                                Sd/-                                Sd/-

LADY MEMBER                             MALE MEMBER                         PRESIDENT