Andhra Pradesh

Visakhapatnam-II

CC/380/2011

Smt. Sirasapalli Lakshmi - Complainant(s)

Versus

M/s Star Health and Allied Insurance Company Limited - Opp.Party(s)

M Sivaramakrishna

02 Dec 2014

ORDER

                                              Date of Registration of the Complaint:27-09-2011 

                                                                                                Date of Order:02-12-2014

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 2^nd day of December, 2014.

                             CONSUMER CASE No.380/2011

Between:-

Smt. Sirasapalli Lakshmi, W/o late Chandra Rao,

Hindu, aged 37 years, residing at D.No.27-3-230/1,

Official Colony, Chinagantyada, Gajuwaka,

Visakhapatnam-26.

                                                                                        ….. Complainant

And:-

1.M/s. Star Health and Allied Insurance Co., Ltd.,

   Rep. by its Authorized Signatory, No.1,

   New Tank Road, Valluvar, Kottam High Road,

   Nungambakkam,  Chennai-34.

2.M/s. Star Health and Allied Insurance Co., Ltd.,

   Rep. by its Authorized Signatory, D.No.12-4-16,

   1^st Floor, Srirama Complex, Pudimadaka,

   Anakapalli, Visakhapatnam District.

                                                                                         …  Opposite Parties

                     

This case coming on 21.11.2014 for final hearing before us in the presence of Sri        M. Sivaramakrishna, Advocate for the Complainant and Sri K.A. Prakash, Advocate for the Opposite Parties 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 obtained an Accidental Care Policy during his life vide Policy No. P/131314/02/2007/000202, dated 17.03.2007 for an amount of Rs.3,00,000/- wherein the Complainant mentioned as nominee in the policy.  On 06.11.2007 the Complainant’s husband accidentally fallen from height from the building and sustained head injury.   Immediately, he was shifted to Sita Rama Nursing Home, Maharanipeta, Visakhapatnam in semi conscious stage and died on 09.11.2007 while undergoing treatment.  Then the Complainant intimated the same to the Opposite Party.   Subsequently, the Opposite sent a reminder letter on 24.03.2011 for which the Complainant send original policy copy Death Certificate, Claim Form and treatment details on 04.04.2011 to the Opposite Parties for settlement of her claim.   Inspite of many requests made by the Complainant, the Opposite Parties did not settle the claim till now.   Hence, this Complaint.

 

2.       a) Direct the Opposite Parties to pay an amount of Rs.3,00,000/- (Rupees Three lakhs only) being the death claim of the Complainant’s husband Sirasapalli Chandra Rao along with other benefits with interest @ 24% p.a. from 09.11.2007 to till the date of realization,

          b) To pay an amount of Rs50,000/- 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 other relief or reliefs as the Forum may deems fit and proper in the circumstances of the case. 

 

3.       Counter filed by the 2^nd Opposite Party and adoption memo filed by the 1^st Opposite Party. The Opposite Parties strongly resisted the claim of the Complainant by contending, as seen from their counter.   Receiving the Complainant request the Opposite Parties informed the Complainant to furnish all the required documents for settlement of the claim dated 24.03.2011 and 11.07.2011, but the Complainant did not send the required documents to the Opposite Parties.   Moreover, the Complainant put the claim after laps of 4 years in the year, 2011.   So, they have no liability to pay any reliefs asked by the Complainant.

 

4.       At the time of enquiry, both parties are filed affidavits as well as written arguments to support their contentions.  Exs.A1 to A6 are marked for the Complainant.   Ex.B1 to B4 are marked for the Opposite Parties.   Heard both sides.

 

5.       ExA1 is the Policy Schedule for period of insurance from 17.03.2007 to 16.03.2008.   Ex.A2 is the treatment particulars of deceased at Sri Sita Rama Nursing Home.   Ex.A3 is the Death Certificate issued by the GVMC.  Ex.A4 is the Reminder Letter from the Opposite Parties dated 24.03.2011.   Ex.A5 is the letter issued by the Complainant to the 2^nd Opposite Party dated 4.4.2011.  Ex.A6 is the Courier Receipt. 

 

6.       Ex.B1 is the Policy Schedule and Proposal Form.   Ex.B2 is the final reminder letter dated 11.07.2011.   Ex.B3 is the Accident Care Individual Insurance Policy along with terms and conditions.   Ex.B4 is the letter final reminder dated 11.07.2011.

 

7.       The fact shown from the document Ex.A4 reveals that the Opposite Parties issued a reminder dated 24.03.2011 to the Complainant stating that in order to process the claim you are requested to submit the following documents in original 1) Death Certificate and Panchanama, 2) FIR and MLC, 3) Post-Mortem Report, 4) Original Policy and 5) Coroners Report/Police Inquest Report.

 

          As per the letter of the Complainant dated 4.4.2011 reveals that the Complainant sent the original documents of the Death Certificate and Policy Bond and treatment particulars of the deceased to the Opposite Parties for settlement of claim.

          As per final reminder by the Opposite Parties dated 11.07.2011 as the required documents did not send by the Complainant for settlement of the claim within 15 days of receipt of this letter the claim as closed.

 

8.       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?

 

9.         After careful perusal of the case record, this Forum finds that there is no dispute regarding the insurance policy.   The insured/deceased died in the year, 2007 and the claim made by the Complainant with the Opposite Parties is in the year, 2011.   As per the intimation given by the Complainant, the Opposite Parties informed the Complainant through letters dated 24.03.2011 and 11.07.2011 requesting the Complainant to send the original documents as follows: 1) Death Certificate and Panchanama, 2) FIR and MLC, 3) Post Mortem Report, 4) Original Policy Certificate and 5) Coroners Report/Police Inquest Report.    But the Complainant sent the documents of Doctor Certificate Policy Bond and original Death Certificate to the Opposite Parties.   As per the terms and conditions of the policy the claimant has to send as per general conditions of the policy 3(A) insured person has to produce bills/Vouchers/Discharge Summary, Death Certificate, Viscera Sample Report/Forensic Science Laboratory Report, First Information Report, PM Report, Legal Haier Certificate, Succession Certificate and such other documents as may be required for processing the claim.   In the present complaint, the Complainant failed to produce the necessary documents, such as PM Report, FIR, Inquest Report to the Opposite Parties.   She did not produce the said documents before this Forum also.   The Complainant filed a citation of the Hon’ble High Court of A.P. held in Krapa Vidyavathi and others v/s Life Insurance Corporation of India, Machilipatnam and others, but the facts are different from the present case.   Hence, the claim put forward by the Complainant is untenable and the Complaint is liable to be dismissed.

 

9.       In the result, this Complaint is dismissed.

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

 

 Sd/-                                        Sd/-                                         Sd/-  

President                            Male Member                      Lady Member

                                     

 

APPENDIX OF EVIDENCE

For the Complainant:-

NO.	DATE	DESCRIPTIONOFTHEDOCUMENTS	REMARKS
Ex.A01	17.03.2007	Accident Care Policy Schedule-Indivudual	Photo copy
Ex.A02	06.11.2007	Medical Prescription issued by the Sri Sita Rama Nursing Home, Vsp	Photo copy
Ex.A03	09.11.2007	Death Certificate of Sirasapalli Chandra Rao	Original
Ex.A04	24.03.2011	Reminder letter sent by the 2nd OP to the Complainant	Original
Ex.A05	04.04.2011	Letter addressed by the Complainant to the 2nd OP.	Office copy
Ex.A06	04.04.2011	Courier Receipt	Original

For the Opposite Parties:-                                    

                                       

NO.	DATE	DESCRIPTIONOFTHEDOCUMENTS	REMARKS
Ex.B01	17.03.2007	Accident Care Policy Schedule-Individual	Original
Ex.B02	11.07.2011	Final Reminder letter issued by the 1st OP to Complainant.	Photo copy
Ex.B03		Accident Care Individual Insurance Policy and terms and conditions	Original
Ex.B04	11.07.2011	Reminder letter sent by the 2nd OP to the Complainant	Original

 

  Sd/-                              Sd/-                                                 Sd/-                                                    

President                       Male Member                                             Lady Member