Andhra Pradesh
Visakhapatnam-II
CC/170/2012
Smt. Pentakota Venkatalaxmi - Complainant(s)
Versus
Reliance General Insurance Company Limited - Opp.Party(s)
Adari Apparao
17 Jun 2015
ORDER
Date of Registration of the Complaint:03-07.2012
Date of Order:17-06-2015
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
Tuesday, the 17th day of June 2015.
CONSUMER CASE No.170/2012
Between:-
Smt. Pentakota Venkatalaxmi, W/o (late)
Kananapparao, Hindu, aged 32 years,
D. No. 8-111, Gavarapeta Street, Thummapala,
Anakapalle Mandal, Visakhapatnam District,
Pin-531 032, presently come down to
Visakhapatnam.
….. Complainant
And:-
1.The General Manager, Reliance General Insurance
Company Limited., Anil Dhirubhai Ambani Group,
3rd Floor, Market Chambers IV, Nariman Point,
Mumbai-400 012.
2.The Branch Manager, Reliance General Insurance
Company Limited, 3rd Floor, Eswar Paradise,
Dwarakanagar Main Road, Visakhapatnam-530 016.
3.The Manager, UCO Bank, 10 B.T. Maharaja Sarani,
Kolkata-700001.
4.The Branch Manager, UCO Bank, N.T.R. Market Yard,
Anakapalle-531001.
… Opposite Parties
This case coming on 08.06.2015 for final hearing before us in the presence of Sri Adari Appa Rao, Advocate for the Complainant and Sri V. Parthasaradhi, Advocate for the Opposite Parties 1 and 2 and Sri S. Rama Moorthy Naidu, Advocate for the Opposite Parties 3 and 4 and having stood over till this date for consideration, this Forum made the following:
ORDER
(As per Sri. H. Ananda Rao, Honourable President, on behalf of the Bench)
1. This consumer complaint is filed by the Complainant against the Opposite Parties directing them to pay an amount of Rs.5,00,000/- (Rupees Five lakhs only) with interest @ 24% per annum from the date of claiming the amount till its payment, Rs.2,00,000/- (Rupees Two lakhs only) towards compensation with costs.
2. The case of the Complainant in brief is that her husband was an account holder in the 3rd & 4th Opposite Parties Bank at Anakapalle which was covered under the Group Insurance Policy bearing No.1529140000186 for an amount of Rs.5,00,000/- with the 1st and 2nd Opposite Parties company. The period of insurance covers from 7th March, 2008 to 6th March, 2009 and she is the nominee of the said policy.
3. The husband of the Complainant is a Electrician on 05.04.2008 he fallen from an Electrical pole and sustained grievous injury to his Spinal cord and he was immediately shifted to Simhadri Hospital, Visakhapatnam and admitted as in-patient in hospital, and treated in the said Hospital till 12.04.2008 and from there shifted to St. JOSEPH’S HOSPITAL on 17.04.2008. He discharged from hospital and subsequently being out patient, he took treatment and the Medical Board issued disability certificate subsequent to it he died on 06.09.2009. There-after in the month of October, 2008 the Complainant has submitted all the required documents for claiming insurance and as there is no response from the Opposite Parties, this complaint is filed.
4. The 1st Opposite Party filed counter denying the material averments of the complaint in contended the Complainant is not a Consumer as defined Under Section -2(d) of Consumer Protection Act and admitted about the issuance of the policy under certain terms and conditions.
5. That the Insurance policy between the insurer and the insured represents a contract between the party and the terms of the agreement have to be strictly construed to determine liability of the insurer. But when the terms of agreement are violated, the insurer is not liable to pay any claim to the Complainant. That it is a custodian of Public money and they are not liable to pay any claim if the same is not tenable. For these reasons, they are not liable to pay any amounts and pray for dismissal.
6. The Opposite Parties 3 and 4 filed their respective counters denying the material averments of the Complainant submitted that the Reliance General Insurance Company in the insurer to the Depositor and the entire burden is on the insurer to investigate. Accordingly basing on the investigations made by the 1st and 2nd Opposite Parties, they have settled the claim in favour of the Complainant for a sum of Rs.4,50,000/- and the same is credited in the Saving Bank Account No. 19570110006351 towards full and final settlement and the same is informed to this Forum on 02.05.2012 as such, if any claim more than the settled amount that it will be decided and settled by the 1st and 2nd Opposite Parties only. As such, they are not liable for any deficiency of service in settling the insurance claim amount for the death of the husband of the Complainant. Therefore, the complaint is dismissed against the Opposite Parties.
7. To prove the case on behalf of the Complainant, she filed her affidavit and got marked as Exs.A1 to A21. On the other hand, on behalf of the Opposite Parties 1 and 4, they filed their evidence affidavits and got marked as Exs.B1 and B2.
8. Ex.A1 is the photo copy of Policy Document issued by the 4th Opposite Party in favour of the Complainant dated 07.03.2008. Ex.A2 is the original MRI Scan Report issued by the Vijaya Medical Centre to the deceased/insurer of the Complainant dated 06.04.2008. Ex.A3 is the original Discharge Summary issued by Simhadri Hospital, Visakhapatnam dated 05.04.2008. Ex.A4 is the original Discharge Summary issued by the St. Joseph’s Hospital, Maryland, Visakhapatnam in favour of the deceased/insurer dated 10.06.2008. Ex.A5 is the original Discharge Summary issued by the St. Joseph’s Hospital, Maryland, Visakhapatnam in favour of the deceased/insurer dated 17.04.2008. Ex.A6 is the original Medical Certificate in Respect of an Orthopaedically Handicapped Candidate and along with Certificate for the Persons with Disabilities issued by the Superintendent, District Medical Board in favour of the deceased/insurer dated 15.09.2008. Ex.A7 is the attested copy of Station- House General Dairy issued by Tahsildar, Anakapalle Mandal, Visakhapatnam dated 06.04.2008. Ex.A8 is the attested copy of Station- House General Dairy issued by Tahsildar, Anakapalle Mandal dated 07.04.2008. Ex.A9 is the attested copy of Statement of Insured given by the Complainant before this Station House Officer, Anakapalle PS dated 07.04.2008. Ex.A10 is the original Certificate issued by the S.I of Police, Anakapalle P.S. dated 29.08.2008. Ex.A11 is the Original Death Certificate of the insured/insurer issued by Panchayat Secretary, Thummapala dated 02.09.2010. Ex.A12 is the attested copy of Personal Accident Insurance Master Policy Tahsildar, Anakapalle Mandal in favour of the insured/insurer dated 05.10.2008. Ex.A13 is the photo copy of Requisition letter addressed by the Complainant to the 4th Opposite Party dated 10.03.2009. Ex.A14 is the photo copy of letter issued by the Complainant to the 4th Opposite Party dated 20.07.2009. Ex.A15 is the photo copy of letter addressed by the Complainant to the 4th Opposite Party dated 07.10.2009. Ex.A16 is the photo copy of letter addressed by the Complainant to the 4th Opposite Party dated 09.02.2010. Ex.A17 is the office copy of Registered Lawyer’s Notice issued by the Legal Advisor & Panel Advocate for Federal Bank Ltd., to the 1st and 4th Opposite Parties dated 17.04.2010. Ex.A18 is the Office copy of Requisition letter addressed by the Complainant to the 3rd Opposite Party dated 26.07.2011. Ex.A19 is the original Postal Receipts (2) two dated 29.07.2011. Ex.A20 is the original Postal Acknowledgement dated 29.07.2011. Ex.A21 is the Postal Acknowledgment dated 29.07.2011.
9. Ex.B1 is the photo copy of letter issued by the 4th Opposite Party to the Complainant dated 20.04.2012. Ex.B2 is the photo copy of Statement of Account issued by the 4th Opposite Party to the joint holder of the deceased/insurer and Complainant dated 20.04.2012.
10. Both parties filed their respective written arguments.
11. Heard oral arguments from both sides.
12. Now the point that arises for determination is:-
Whether there is any deficiency in service on the part of the Opposite Party and the Complainant is entitled for the reliefs asked for?
13. As seen from the written submissions made by the 3rd and 4th Opposite Parties, it is not in dispute that the Complainant’s husband was their account holder at Anakapalle, it is covered under Ex.A1 Group Insurance Policy for Rs.5,00,000/- and the insurer is the Opposite Parties 1 and 2 and the husband of the Complainant died due to fallen from Electrical pole on 06.09.2010 and there upon in the month of October, 2008 the Complainant has submitted all the required documents for claiming insurance and there is no response from the Opposite Parties which resulted filing this complaint.
14. Exs.A2 to A11 clearly goes to show the medical record of the insured and about his ultimate death. Ex.A12 is the Claim Form submitted to the 1st Opposite Party by the Complainant herein by enclosing the necessary documents. Ex.A13 is the letter addressed by the Complainant to the Branch Manager, UCO Bank of the 4th Opposite Party dated 10.03.2009 requesting him for settlement of insurance claim of her husband when there is no response Ex.A14 dated 20.07.2009. Exs.A15 and A16 were addressed by the Complainant for settling the insurance claim and finally she got issued a Registered Lawyer’s Notice to the Opposite Parties 1 and 4 dated 17.04.2010 for settlement of her insurance claim within a week, and account on 26.07.2011 vide Ex.A18 she addressed a letter through the 4th Opposite Party to the Assistant General Manager, UCO Bank, Head Office, Kolkata to settle the claim and arrange the insurance claim amounts and at last when there is no response, she filed the present complaint on 22.02.2012.
15. Ex.B1 addressed by the 4th Opposite Party to the Complainant herein informing that her claim is settled for Rs.4,50,000/- and credited the claim amount in their Saving Bank Account towards full and final settlement and requested to withdraw the Complainant. Ex.B2 is the account copy showing the credit of the aforesaid amount. Exs.B1 and B2 are filed by Advocate for the Opposite Parties 3 and 4 on 21.03.2014 along with memo. According to the Opposite Parties 1 and 2 after due investigation they settled the claim of Rs.4,50,000/-.
16. On scrutiny of the evidence let in by the Complainant, it is very clear that the Complainant’s husband obtained a Personal Accident Policy for an amount of Rs.5,00,000/- in case of the death. Exs.A2 to A11 clearly and categorically goes to show that the death of the insured is an accidental death, therefore, the Complainant is entitled for the said sum, but the Opposite Parties deposited Rs.4,50,000/- in the account towards full and final settlement after prolonged correspondence by the Complainant much less after filing this complaint that to without going any reasons, for the rest of the amount of the Rs.50,000/-. I do not understand how the Opposite Parties came to the conclusion for Rs.4,50,000/- when the policy Ex.A1 covers for Rs.5,00,000/- the insurance amount. There is nothing on record let in by the Opposite Parties what made them to conclude that the Complainant is entitled for Rs.4,50,000/- only in the absence of any link evidence by way of evidence affidavits of the concern. Therefore, we are of the considered view, that the Complainant is entitled for the entire amount of Rs.5,00,000/- i.e., the remaining Rs.50,000/- balance also.
17. The contention of the Complainant is that the Opposite Parties are liable to pay the balance amount of Rs.50,000/- along with interest for an amount of Rs.5,00,000/- from the date of claiming amount till its payment besides compensation and costs. It is evident as seen from the record for the first time in the month of October, 2008 the husband of the Complainant has submitted all the required documents to the Branch Manager, UCO Bank, Anakapalle, when there is no response, she submitted requisitions to 4th Opposite Party on 10.03.2009 and 20.07.2009 and when there is no response and in the meanwhile her husband died and the same was informed to the Opposite Parties on 07.10.2009 and again another requisitions of the sent 4th Opposite party dated 09.02.2010 but there is no response to those letters are referred as Exs.A12 to A16, finally Ex.A18 Registered Lawyer’s Notice was got issued by her on 17.04.2010 even then there is no response and again they requisition letter sent through the Opposite Parties 3 and 4 to the Assistant General Manager. These correspondences clearly and categorically goes to show the Opposite Parties intentionally avoided to pay the insurance amount to the Complainant for which is legally entitled clearly indicates to deficiency of service, further due to the irresponsible acts of the Opposite Parties, she sustained severe mental agony and hardship. For all these reasons, we are of the considered view, that the Complainant is entitled not only Rs.50,000/- i.e., the balance of the insurance amount with interest @ 9% p.a. from the date of claiming the amount till its realization, but also interest for Rs.4,50,000/- from the date of claiming i.e., from April 2009 on words till the same was credited to her account.
18. Now the question that comes up for consideration, at this stages of our discussion 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 in commercial in nature, but that does not and cannot mean to say that the Complainant is a licenced to claim interest @ 24% p.a. on Ex.A1. But at the same time, it is an 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. on Ex.A1 would better serve the ends of justice. Consequently, we proposed to fix at rate in question @ 9% p.a. on Ex.A1 in question. Accordingly interest is ordered.
19. Whether the Complainant is entitled for compensation of Rs.,2,00,000/- is to be considered. It appears as seen from the evidence of PW-1 that the Complainant was compelled to approach the Opposite Party and therefore experienced a lot of physical strain besides mental agony and financial loss. It is un-dispute fact that the Opposite Party did not refund the amount subscribed by the Complainant. Naturally that made 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 10,000/- would serve the ends of justice. We therefore, proposed to award compensation of Rs.10,000 /-, in the circumstances of the case on hand. Accordingly this point is answered.
20. 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 his claim for refund of the sum of Rs.,500,000/- 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 claims for cost 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.
21. In the result, the Complaint is allowed in part directing the Opposite Parties to pay interest for Rs.5,00,000/- (Rupees Five lakhs only) from April, 2009 till Rs.4,50,000/- (Rupees Four Lakhs and fifty thousand only) was credited to the account of the Complainant and her husband bearing A/c No.19570110006351and further directed to pay an amount of Rs.50,000/- (Rupees fifty thousand only) with interest @ 9% p.a. from 20.04.2012 till the date of realization, Rs.10,000/- (Rupees Ten thousand only) towards compensation and Rs.2,500/- (Rupees Two thousand and five hundred only) towards costs. Time for compliance, one month.
Dictated to the Steno, transcribed by him, corrected and pronounced by us in the Open Forum, this the 17th day of June, 2015.
Sd/- Sd/- Sd/-
Male Member Lady Member President
APPENDIX OF EVIDENCE
For the Complainant:-
NO. | DATE | DESCRIPTIONOFTHEDOCUMENTS | REMARKS |
Ex.A01 | 07.03.2008 | Policy Document issued by the 4th OP in favour of the Complainant | Photo copy |
Ex.A02 | 06.04.2008 | MRI Scan Report issued by the Vijaya Medical Centre to the deceased/insured | Original |
Ex.A03 | 05.04.2008 | Discharge Summary issued by Simhadri Hospital, VSP | Original |
Ex.A04 | 10.06.2008 | Discharge Summary issued by the St. Joseph’s Hospital, Maryland, VSP in favour of the deceased/insured | Original |
Ex.A05 | 17.04.2008 | Discharge Summary issued by the St. Joseph’s Hospital, Maryland, VSP in favour of the deceased/insured | Original |
Ex.A06 | 15.09.2008 | Medical Certificate in Respect of an Orthopaedically Handicapped Candidate and along with Certificate for the Persons with Disabilities issued by the Superintendent, District Medical Board in favour of the deceased/insured | Original |
Ex.A07 | 06.04.2008 | Station House General Dairy issued by Tahsildar, Anakapalle Mandal, VSP | Attested copy |
Ex.A08 | 07.04.2008 | Station-House General Dairy issued by Tahsildar, Anakapalle Mandal | Attested copy |
Ex.A09 | 07.04.2008 | Statement of Insured given by the Complainant before this Station House Officer, Anakapalle P.S | Attested copy |
Ex.A10 | 29.08.2008 | Certificate issued by the S.I of Police, Anakapalle P.S | Original |
Ex.A11 | 02.09.2010 | Death Certificate of the insured/deceased issued by Panchayat Secretary, Thummapala | Original |
Ex.A12 | 05.10.2008 | Personal Accident Insurance Master Policy, Tahsildar, Anakapalle Mandal in favour of the Insured/insurer | Attested copy |
Ex.A13 | 10.03.2009 | Requisition letter addressed by the Complainant to the 4th OP | Photo copy |
Ex.A14 | 20.07.2009 | Letter issued by the Complainant to the 4th OP | Photo copy |
Ex.A15 | 07.10.2009 | Letter addressed by the Complainant to the 4th OP | Photo copy |
Ex.A16 | 09.02.2010 | Letter addressed by the Complainant to the 4th OP | Photo copy |
Ex.A17 | 17.04.2010 | Registered Lawyer’s Notice issued by the Legal Advisor & Panel Advocate for Federal Bank Ltd., to the 1 and 4 Ops | Office copy |
Ex.A18 | 26.07.2011 | Requisition letter addressed by the Complainant to the 3rd OP | Office copy |
Ex.A19 | 29.07.2011 | Postal Receipts (2) two | Original |
Ex.A20 | 29.07.2011 | Postal Acknowledgement | Original |
Ex.A21 | 29.07.2011 | Postal Acknowledgement | Original |
For the Opposite Parties:-
Ex.B01 | 20.04.2012 | Letter issued by the 4th OP to the Complainant | Photo copy |
Ex.B02 | 20.04.2012 | Statement of Account issued by the 4th OP to the Joint holder of the decedased/insuerer and the Complainant | Photo copy |
Sd/- Sd/- Sd/-
Male Member Lady Member President
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