Date of filing: 28.11.2017 Date of Order : 14.08.2018
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM ::
KADAPA Y.S.R DISTRICT
PRESENT SRI V.C. GUNNAIAH, B.Com., M.L., PRESIDENT
SMT. K. SIREESHA, B.L., LADY MEMBER
TUESDAY THE 14th DAY OF AUGUST, 2018
CONSUMER COMPLAINT No. 95 / 2017
M. Swarup Kumar Reddy, S/o Late M. Sudhakar Reddy,
aged 21 years, R/at D.No. 5/67, Sankarapuram,
Peddasettipalli, Proddatur, YSR District,A.P. ….Complainant.
Vs.
1. Muthoot Finance Limited, Rep. by its
Branch Manager, Proddatur Branch,
Opp. to BVS Theatre, Rajiv Circle,
Proddatur town, YSR district, A.P.
2. Shriram Life Insurance Co. Ltd., Rep. by its
Regional Manager, Claims Department,
5th Floor, Ramky Selenium, Gachibowli,
Hyderabad – 500 032. ….. Opposite parties.
This complaint coming for final hearing on 01-08-2018 in the presence of Sri G. Trivikram Singh, Advocate for complainant and Sri M. Sudhakar Babjee, Advocate for O.P.2 and O.P. 1 called absent and set exparte on 07.3.2018 and upon perusing the material papers on record, the Forum made the following:-
O R D E R
(Per Sri V.C. Gunnaiah, President),
1. The complainant filed this complaint under section 12 of Consumer Protection Act, 1986 (for short herein after called as C.P. Act) to direct the opposite parties to pay insurance amount of Rs. 2,00,000/- with interest at 24% p.a. from 28-12-2016 i.e. date of death of his father (insured) till date of realization for the policy bearing No. GP011410000266, to pay Rs. 50,000/- as compensation for physical and mental strain and to pay Rs. 5,000/- towards costs of the complaint.
2. The brief averments of the complaint are as follows:-
The complainant’s father Mopuru Sudhakar Reddy during his life time availed Gold Loan of Rs. 12,000/- by handing over the gold ring of 8 gms as security from O.P.1 on 04.10.2016. At the time of availing gold loan O.P.1 had taken insurance coverage to the complainant’s father and collected Rs. 2,164/- from him and remitted the same to O.P.2 and O.P.2 issued insurance master policy No. GP011410000266 showing O.P.1 as master holder and complainant’s father Mopuru Sudhakar Reddy as member. The above said policy covers the member’s death or any other event when the policy was inforce. Complainant is the nominee to the said policy by his father. In case of death of the member of the group insurance policy his nominee would be paid Rs. 2,00,000/- the sum assured.
3. While so on 28.12.2014 the insured Mopuru Sudhakar Reddy died. The complainant being the nominee approached O.P.1 and requested him to process his claim to O.P.2 as they are interlinked and master policy was issued in the name of O.P.1. On the advice of O.P.1 the complainant has submitted claim form along with required documents to forward the same to O.P.2. But there was no response either from O.P.1 or O.P.2 in spite of the complainant approached number of times opposite parties not responded. Though the claim of complainant is genuine, till date their claim was not settled. Thus the services of opposite parties are deficient in nature and they are liable to settled the claim and pay Rs. 2,00,000/- together with interest but not paid. On 23.10.2017 the complainant issued legal notice to opposite parties calling upon them to pay the insured amount. O.P.2 issued reply on 03.11.2017 with all false allegations. Hence, the complaint for the above reliefs.
4. Notices were issued to opposite parties 1 & 2 and both of them served notices. O.P.1 remained exparte and not participated in the proceedings.
5. O.P. No.2 filed written version admitting the availment of loan of Rs. 12,000/- by the complainant’s father from O.P.1 by handing over his gold ring as security on 04.10.2016 and took insurance coverage by paying Rs. 2,164/- and O.P.1 remitted the amount to him under master policy showing O.P.1 as master policy holder and the said policy covers the members death for an amount of Rs. 2,00,000/- and the complainant was nominee to the said policy issued by O.P.2. He further admits that on 28.12.2016 the insured had died but O.P.2 denied the other allegations that the claim is genuine and not settled the same etc. It is further averred on the intimation of death of Mopuru Sudhakar Reddy by master policy holder this O.P conducted regular investigation into the claim and the documentary evidence secured by them revealed that as per medical records dt. 10.4.2016 the deceased was suffering from H/o of Diabetes and Hypertension for the last six months. This fact was not disclosed by M. Sudhakar Reddy at the time of applying for insurance policy to the specific questionnaire in declaration of good health form (DGH). In the said declaration form he had not correctly disclosed his health condition. Hence, the contract become void and unforceable and not legally binding. Therefore, the claim under the above policy was repudiated vide letter dt. 22.6.2017 due to concealment of pre-existing ailment by the deceased life assured as he suppressed material facts. Hence, the complaint is not maintainable and the same is liable to be dismissed with exemplary costs.
6. No oral evidence has been let in by the parties. But on behalf of complainant his affidavit is filed and got marked Ex. A1 to A4. Affidavit of opposite parties not filed and no documents are marked on their behalf. No written arguments are filed by the parties.
7. Heard arguments on both sides and perused the material on record.
8. On the basis of the above pleadings the following points are arise for determination.
- Whether is there any deficiency of service on the part of opposite parties as pleaded by the complainant in settling his insurance claim?
- Whether the complainant is entitled for the reliefs against Opposite parties, if so what extent?
- To what relief ?
9. Point Nos. i and ii: These two points are connected to each other, hence, they are discussed together for the sake of convenience and better understanding.
10. The admitted facts in this case are the complainant is the nominee for the life assured Mopuru Sudhakar Reddy. The said Mopuru Sudhakar Reddy availed Gold loan of Rs. 12,000/- by handing over 8 gms. Gold ring to O.P.1 on 04.10.2016 and he had also availed insurance personal coverage by paying Rs. 2,164/- through O.P.1 to O.P.2 under master policy bearing No. GP011410000266 issued by O.P.2. O.P.1 is the master policy holder whereas complainants father Mopuru Sudhakar Reddy is member under the said policy and the said policy covers one year from 04.10.2016 and the sum assured in the event of death is Rs. 2,00,000/- to the nominee. It is further admitted fact on 28.12.2016 the insured died and the complainant being nominee under the policy claimed the amount of Rs. 2,00,000/- by submitting all relevant documents through O.P.1 but O.P.2 repudiated the claim stating that the insured suppressed material facts viz., his previous health condition of diabetes and hypertension.
11. Learned counsel for complainant contended that O.P.2 repudiated the claim on the ground that the insured Mopuru Sudhakar Reddy suffered with diabetes and hypertension prior to 04.10.2016 but not filed any records to prove the same and claim was repudiated without any valid reason and O.P.1 has not taken any interest in settling the claim through O.P.2 and not responded even to the legal notice. So deficiency in service on their part is established and both are liable to pay the insured amount apart from the amount claimed for mental agony and costs.
12. Learned counsel for O.P.2 submitting that the insured suppressed that he was suffering from diabetes and hypertension prior to taking master policy under Ex. A1, so the claim was rightly repudiated for the reasons mentioned in Ex. A4 reply notice no deficiency in service on their part. Hence, the complaint is liable to be dismissed.
13. O.P.2 contended that the insured Mopuru Sudhakar Reddy prior to taking policy under Ex. A1 was suffering with diabetes and hypertension and their investigation revealed as per document dt. 10.4.2016 the same was revealed but O.P.2 has not filed any record much less the document dt. 10.4.2016 to establish that the insured Mopuru Sudhakar Reddy was suffering with diabetes and hypertension and was taking treatment in any hospital. So O.P.2 failed to prove that the insured Mopuru Sudhakar Reddy, father of the complainant was suffering with any sort of disease much less diabetes and hypertension prior to taking of policy under Ex. A1. Ex. A2 is the death certificate filed by the complainant to show that the insured Mopuru Sudhakar Reddy died on 28.12.2016 since the complainant is the nominee of the policy under Ex. A1 to the insured Mopuru Sudhakar Reddy the complainant can claim the benefits under the policy and is entitled to file this complaint and the complaint is maintainable. Since, the policy under Ex.A1 was inforce on the date of death of deceased and the repudiation of the claim of complainant by opposite parties is baseless and unreasonable. We hold there is deficiency in service on the part of the opposite parties and the complainant is entitled for the sum assured of Rs. 2,00,000/- from opposite parties, apart from Rs. 10,000/- towards mental agony and Rs. 5,000/-towards costs of the complaint. Accordingly, points i & ii are answered in favour of the complainant and against the opposite parties 1 & 2.
14. Point No. iii:- In the result, the complaint is allowed directing the opposite parties 1 & 2 to pay Rs. 2,00,000/- (Rupees two lakhs only) to the complainant towards policy bearing No. GP011410000266 and shall also pay Rs. 10,000/-(Rupees ten thousand only) towards mental agony and Rs. 5,000/- (Rupees five thousand only) towards costs of the complaint, within 45 days from the date of receipt of this order, failing which the above amounts shall carry interest at 9% p.a. till realization.
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open forum, this the 14h day of August 2018.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses examined
For complainant : NIL For opposite party : Nil
Exhibits marked on behalf of the Complainant :-
Ex. A1 Attested copy of certificate of insurance issued by O.P.,NO.2 under master policy No. GP011410000266 showing O.P-NO.1 as a mater policy holder and indicating the complainant’s father Late Mopuru Sudhakar Reddy, as a Member,.
Ex.A2 P/c of Death Certificate Mopuru Sudhakar Reddy .
Ex.A3 Legal Notice Dated 23-10-2017 issued by the complainant through his counsel to pp parties with two postal receipts.
Ex.A4 Reply notice dt.03-11-2017.
Exhibits marked on behalf of the Opposite parties :–
MEMBER PRESIDENT
Copy to
- Sri G. Trivikram Singh, Advocate for complainant.
- Sri M. Sudhakar Babji, Advocate for O.P.2
- Muthoot Finance Limited, Rep. by its
Branch Manager, Proddatur Branch,
Opp. To BVS Theatre, Rajiv Circle,
Proddatur town, YSR district, A.P.
B.V.P
