Andhra Pradesh

Visakhapatnam-II

CC/114/2014

Rakoti Ramanaji - Complainant(s)

Versus

Reliance General Insurance Company Limited - Opp.Party(s)

V.V. Bhaskar Kumar

26 Mar 2015

ORDER

                                              Date of Registration of the Complaint:03-04-2014 

                                                                                                Date of Order:26-03-2015

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

 

                         Thursday, the 26^th day of March, 2015.

                             CONSUMER CASE No.114/2014

Between:-

Rakoti Ramanaji, S/o Late Rakoti Peda Ramana,

Hindu, aged 25 years, Resident of Tumpala Village,

Tumapala Street, Anakapalle Mandal, Visakhapatnam

District.

                                                                                        ….. Complainant

And:-

Reliance General Insurance Company Limited,

Represented by its Branch Manager, 403, 3^rd Floor,

Eswar Paradise, Dwarakanagar Main Road,

Visakhapatnam.

                                                                                             …  Opposite Party

                     

This case coming on 12.03.2015 for final hearing before us in the presence of Sri V.V. Bhaskar Kumar, Advocate for the Complainant and Sri D. Siva Prasad, Advocate for the Opposite Party 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 father Peda Ramana obtained Personal Accident Insurance Policy from the Opposite Party Vide No. 1802722913000004 which is valid from 25.06.2012 to 24.06.2013, the insurance amount of Rs.10,00,000/- (Ten lakhs only).   The Complainant is nominee in insurance policy.   The Complainant’s father used to go to cattle of shed at threshing hut of Sontyana Nageswara Rao, Venkupalem Road, Tumapala village.   As usual on 24.08.2012 the Complainant’s father slept in the cattle shed for watching cattle’s.    On that night the Complainant’s father slept on cot in cattle shed by putting kerosene lamp and portable over besides his cot of mosquitoes.   At about 9.30 PM when caught fired the cattle shed accidentally, the flames raised and burned on his body and died.    On the next day i.e., on 25.08.2012 the Complainant lodged a report to Anakapalle Town Policy Station and about the death of his father due to burns, FIR was registered Under Section 174 Cr. P.C. (Death due to burns) in Crime No.190/12.   The Complainant’s father died due to burns at about 80%.   The Complainant could not trace out the policy in his house for some times.    After tracing out the policy, the Complainant informed to the Opposite Party about the death of his father and requested them for settlement of the claim.   The Complainant sent all the original documents as per their advice.   But the Opposite Party did not settle the claim or given any reply.   Hence, this Complaint.

2.       a) to direct the Opposite Party to pay the amount covered by policy No.1802722913000004 for Rs.10,00,000/- along with benefits thereon;

          b) Interest at 24% P.A. from the date of death of the deceased on 24.08.2012;

          c) to direct the Opposite Party to pay Rs.50,000/- for the deficiency of service and also for causing mental agony, pain and suffering;

          d) For the cost of the Petition Rs.20,000/-;    

          e) For such other relief or reliefs as the Forum may deems fit in the circumstances of the case.

 

3.       The Opposite Party strongly resisted the claim of the Complainant by contending, as can be seen from his counter.   After intimation from the Complainant, the Opposite Party demanded the Complainant to produce the relevant documents to process the claim of the Complainant, but the Complainant did not furnish the relevant documents to the Opposite Party either to process the claim or repudiated the claim as per their policy conditions.   The claim of the Complainant is not at all admissible as per the law and as per the express terms and conditions of the policy.   So, they have no liability to pay any reliefs asked by the Complainant.

 

 

 

4.       At the time of enquiry, both parties filed affidavit as well as written arguments to support their contention.   Exs.A1 to A10 are marked for the Complainant.  Ex.B1 to B5 are marked for the Opposite Party.  Heard both sides.  

 

 

5.       Ex.A1 is the Policy copy of Schedule for Personal Accident Policy (individual) issued by the Opposite Party in favour of the Complainant dated 25.06.2012.   Ex.A2 is the Death Certificate issued by the Panchayat Secretary, Thummapala dated 11.12.2012.   Ex.A3 is the attested copy of First Information Report No.190 dated 25.08.2012.   Ex.A4 is the attested copy of Inquest Report issued by the Anakapalle Police Station on 25.08.2012.    Ex.A5 is the attested copy of Post-Mortem Report issued by the Area Hospital, Anakapalle dated 25.08.2012.     Ex.A6 is the attested copy of Final Report issued by the Anakapalle P.S. dated 04.04.2013.   Ex.A7 is the photo copy of registered letter addressed by the Complainant to the Opposite Party dated 25.09.2013.   Ex.A8 is the photo copy of letter sent by the Complainant to the Opposite Party dated 01.11.2013.   Ex.A9 is the photo copy of Claim Form dated 01.11.2013.   Ex.A10 is the letter addressed by the Complainant to the Opposite Party dated 20.11.2013.

 

6.       Ex.B1 is the Schedule for Personal Accident Policy (individual) issued by the Opposite Party in favour of the Complainant dated 25.06.2012.   Ex.B2 is the Personal Accident Policy Wordings and terms and conditions issued by the Opposite Party.   Ex.B3 is the Office copy of Reminder letter issued by the Opposite Party to the Complainant dated 02.04.2014.   Ex.B4 is the office copy of 2^nd Reminder letter issued by the Opposite Party to the Complainant dated 17.04.2014.   Ex.B5 is the office copy of Reminder Cum Closure letter dated 2.5.2014 issued by the Opposite Party to the Complainant. 

 

7.       The fact shown from Ex.A1 shows that the Complainant’s father obtained Insurance Policy for a sum of Rs.10,00,000/- and the Complainant was shown as nominee.   The policy was valid from 25.06.2012 to 24.06.2013, and the policy was taken for Personal Accident benefits.   As per Ex.A3, Ex.A4, Ex.A5, Ex.A6 and Ex.A8  reveals that the Complainant’s father died due to burns accidently in the hut on 24.08.2012.  

 

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 Party.   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 accidental death of the insured/deceased.   The Opposite Party did not settle the claim of the Complainant as sufficient documents were not furnished by the Complainant for settlement of the claim.   According to their terms and conditions the documents are necessary for processing the claim.   Moreover, they stated that there is delay in intimating the death of the insured/deceased by the Complainant.   Even after receiving the original documents from the Complainant, the Opposite Party did not settle the claim nor repudiate the claim till now.

 

          The Complainant relied upon the decision of the National Consumer Dispute Redressal Commission, New Delhi held in RP. NO.2852/13  National Insurance Company Limited Vs. B. Venkataswamy, wherein it was held  “we solely agree with the significant observations made by the State Commission pertaining to delay in making the claim that the insurance company, cannot repudiate the claim, which is repudiated as follows:  In this regard it is fruitful to take note of the circular Ref: IRDA/HLTH/MISC/CIR/216/09/2011 DATED 20.09.2011 issued by the Insurance Regulatory & Development Authority pertaining to delay in claim intimation/documents submission with respect to:

All life insurance contracts and

All non-life individual and group insurance contracts.

Re: Delay in claim intimation/documents submission with respect to

1. All life insurance contracts and
2. All Non-life individual and group insurance contracts

The Authority has been receiving several Complaints that claims are being rejected on the ground of delayed submission of intimation and documents.

     The current contractual obligation imposing the condition that the claims shall be intimated to the insurer, with prescribed documents within a specified number of days, is necessary for insurers for effecting various post-claim activities, like investigation, loss assessment, provisioning, claim settlement etc.    However, this condition should not prevent settlement of genuine claims, particularly, when there is delay in intimation or in submission of documents, due to unavoidable circumstances”.    So, the Complainant’s claim cannot be rejected by the Opposite Party on the ground of delay intimation.   In the present complaint, the Opposite Party did not repudiate the claim nor settle the claim of the Complainant till now.   It shows their negligent attitude, deficiency in service and coupled with unfair trade practice on the part of the Opposite Party.    Hence, the Complainant is entitled to insurance amount with some interest compensation and costs too.

 

10.     In the result, this Complaint is allowed directing the Opposite Party: a) to pay an amount of Rs.10,00,000/- (Rupees Ten lakhs only) with interest @ 9% p.a. from 25.09.2013 till the date of actual realization, b) a compensation of Rs.50,000/- (Rupees Fifty thousand only) and 3) Costs of Rs.5,000/- (Rupees five thousand only) to the Complainant.   Time for compliance, one month from the date of this order.

 

Dictated to the Steno, transcribed by him, corrected and pronounced by us in the Open Forum, this 26^th day of March, 2015.

      Sd/-                                    Sd/-                                      Sd/-

President                            Male Member                      Lady Member

                                     

APPENDIX OF EVIDENCE

For the Complainant:-

NO.	DATE	DESCRIPTIONOFTHEDOCUMENTS	REMARKS
Ex.A01	25.06.2012	Policy copy of Schedule for Personal Accident Policy (individuals) issued by the OP in favour of the Complainant	Original
Ex.A02	11.12.2012	Death Certificate issued by the Panchayat Secretary, Thummapala	Original
Ex.A03	25.08.2012	First Information Report No.190	Attested copy
Ex.A04	25.08.2012	Inquest Report issued by the Anakapalle Police Station	Attested copy
Ex.A05	25.08.2012	Attested copy Post-Mortem Report issued by the Area Hospital, Anakapalle	Attested copy
Ex.A06	04.04.2013	Final Report issued by the Anakapalle P.S.	Attested copy
Ex.A07	25.09.2013	Registered letter addressed by the Complainant to the OP	Photo copy
Ex.A08	01.11.2013	Letter sent by the Complainant to the OP	Photo copy
Ex.A09	01.11.2013	Claim Form	Photo copy
Ex.A10	20.11.2013	Letter addressed by the Complainant to the OP	Photo copy

For the Opposite Party:-               

                  

NO.	DATE	DESCRIPTIONOFTHEDOCUMENTS	REMARKS
Ex.B01	25.06.2012	Policy copy of Schedule for Personal Accident Policy (individuals) issued by the OP in favour of the Complainant	Original
Ex.B02		Personal Accident Policy Wordings and terms and conditions issued by the OP	Original
Ex.B03	02.04.2014	Reminder letter issued by the OP to the Complainant	Office copy
Ex.B04	17.04.2014	2nd Reminder letter issued by the OP to the Complainant	Office copy
Ex.B05	02.05.2014	Reminder Cum Closure letter issued by the OP to the Complainant	Office copy

 

 

      Sd/-                               Sd/-                                                 Sd/-

President                       Male Member                                             Lady Member