This case is coming for final hearing on 28.11.2014 in the presence of Sri M.Siva Rama Krishna Advocate for the Complainant and of Sri Sanapala Karuna & Smt.Sanapala Sailaja Advocates for Opposite Parties and having stood over till this date, the Forum delivered the following:

: O R D E R :

(As per Smt. K.V.R.Maheswari, Honourable President(FAC) on

behalf of the Bench)

1.       The case of the complainant is that his grand father Malla Yeruku Naidu S/o Chellayya took Reliance Life Traditional Investment Insurance Policy      /during his life time from 2^nd opposite party at Anakapalle vide policy No.17006182 on 28.05.2012 for an amount of Rs.86,250/- and the complainant’s name is mentioned as nominee in that policy.  While, so on 27.11.2012 the complainant’s father i.e., life assured died due to heart attack at his home, then, the complainant immediately intimated about the death of his father to 2^nd opposite party by way of letter on 27.12.2012 and the same was received by the opposite party, but failed to pay the policy amount to the complainant.  The complainant stated that he send the original policy, copy of death certificate and bank pass book  and ID proof to the opposite parties by way of letter on 27.12.2012.  But the opposite parties even after receipt of these documents, intentionally they failed to settle the claim amount which clearly shows the deficiency of service at the bank of the opposite party.  The life assured took the policy as per rules and regulations of opposite party, but after his death, even after submission of all necessary documents, the opposite parties not come forward to settle the issue, hence this complaint to direct the opposite parties;

a)      to pay a sum of Rs.86,250/- with interest at24% p.a. from 27.11.2012 to till the date of realization.

b)      to pay Rs.50,000/- towards compensation

c)       to pay Rs.25,000/- towards damages for deficiency of service besides costs.

2.       On the other hand, the opposite parties filed its counter BY denying all the allegations mentioned in the complaint and pleaded that the complaint is premature as the complainant himself failed to intimate or approach the opposite parties regarding his claim which require as per the terms and conditions of the policy, however the opposite parties can consider the death claim of the complainant subject to submission of signed claim forms along with requisite documents and further assist  the opposite party in order to decide the claim of the complainant.  The opposite parties admitted about the issuance of policy to Malla Yeruku Naidu i.e., DLA for an amount of Rs.86,250/- and the annual premium of Rs.11,500/- was to be paid.  The opposite parties stated that basing on the information provided in the proposal form and on receipt of premium, policy was issued to DLA and policy documents were dispatched to DLA and policy holder has right to reconsider his policy within 15 days after receipt of the documents, if he does not agree for the terms and conditions of the said policy.  After the death of DLA, the complainant should approach the opposite parties and file all the requisite documents viz., death claim forms etc., before the opposite parties which clearly mentioned in policy documents but the complainant failed to submit claim form along with relevant documents to the opposite parties and further failed to approach nearest branch of opposite parties and submit the necessary documents.  Hence, there is no deficiency of service on the part of the opposite parties and as a premature complaint; there is no cause of action.  However, the opposite parties can consider the death claim of the complainant as per the terms and conditions of the policy subject to, complainant provide completely filled and signed claim forms along with requisite documents and further assist opposite parties in order to decide the claim of complainant.  The complaint made by the complainant being devoid of merits, hence it is to be dismissed. 

3.       At the time of enquiry the complainant filed his evidence affidavit along with documents which are marked as Ex.A1 to A5.

4.       On the other hand, the opposite parties filed their counter, evidence affidavit along with documents which are marked as Exhibits B1 to B5 and the documents filed by the opposite parties are photo copies and to mark those documents as exhibits, the complainant represented no objection to mark those documents as exhibits, hence Forum marked them as Exhibits B1 to B5 on behalf of the opposite parties.  No written argument are filed by both the counsels, hence treated no written arguments for both of them.  Heard both the counsels who reiterated their versions.

5.       In view of the respective contentions, the point that would arise for determination is:-

Whether there is any deficiency in service on the part of the opposite parties, if so can the complainant entitle for the reliefs prayed for?

6.       Exhibit A1 is the policy schedule which clearly shows that the sum assured is Rs.86,250/- and the installment premium is Rs.11,500/- and the date of benefit of expiry is 28.05.2020 i.e., policy period is 10 years.  The date of commencement of policy is 28.05.2010 and the same was admitted by the opposite parties. Exhibit A2 is the copy of the letter issued by the complainant to the 2^nd opposite party on 27.11.2012 regarding the intimation about the death of his grand father i.e., life assured by enclosing the documents of original bond, original claim form, original death certificate, bank pass book, copy of ID proof.  Ex.A3 dated 27.12.2012 is the courier acknowledgment of the 2^nd opposite party.  In Ex.A3 i.e., acknowledgment of 2^nd opposite party clearly shows the signature and stamp of the 2^nd opposite party dated 27.12.2012.  Ex.A4 is the Death Certificate of the life assured.  Ex.A5 is the proposal form and the 3^rd page of Ex.A5 is the declaration of age of the life assured as 68 years.

7.       The version of the complainant is that even after intimation given by him regarding the death of his grandfather i.e., DLA to the opposite parties by sending all necessary original documents, but the opposite parties neither settled nor repudiate the claim amount.  But pleaded that they neither received any death intimation or any documents from the complainant, hence they could not settle the claim amount.  That too as per the policy terms and conditions which are mentioned clearly in policy documents regarding the procedure of filing the claim as per the last page of Ex.B5.  Ex.B2 is the letter issued by the opposite parties to life assured regarding the issuance of policy to Malla Yeruku Naidu.  Ex.B1 is the proposal form.  Ex.B3 is the declaration of age of DLA.  Ex.B4 is the Format for attestation of ID proof and address proof by Gazetted Officer dated 14.05.2010 which is the form of identity and residence proof for the purpose of Reliance Life Insurance Company Limited to M.Yeruku Naidu i.e., DLA and the age and residence address was mentioned and the same was attested by Gazetted officer. Ex.B5 is the consent by life insured to opposite parties to pay extra premium for age etc., where in it clearly mentioned that life assured agreed to pay age extra premium incurred at Rs.1.5p.s per Rs.1,000/- and this premium is applicable based on Non standard age proof submitted.

8.       Thus, the opposite parties main contention is that they did not receive any death intimation or necessary documents from the complainant, hence they could not settle the claim.  But in its counter as well as in oral arguments it is stated that they will consider the death claim of the complainant as per the terms and conditions of the policy subject to complainant provide completely filled and signed claim forms along with requisite documents.

9.       After careful analysation of the complaint, counter and with related documents and oral versions made by both parties, the Forum is of the firm opinion that Ex.A2 is the crucial documents to show the deficiency of service on the part of the opposite parties.  After issuance of letter by the complainant i.e., Ex.A2 and even after receipt of that letter along with original documents and the opposite parties acknowledged the same which is evidenced by Ex.A3, but failed, either to settle the claim amount or to repudiate it.  Hence, it is the bounden duty of the insurance company that after receipt of necessary documents along with claim form by the nominee i.e., the complainant it has to look into the matter and settle the claim, if it is as per their terms and conditions.  But they simply kept quite nearly 13 months after submission of documents by the complainant to the opposite parties.  Hence, the opposite parties have to settle the claim amount of Rs.86,250/-.  The Forum is of the view that even after filing the complaint i.e., the complaint filed on 12.07.2013 the opposite parties did not come forward to settle the issue by searching the original documents in their office which were already submitted by the complainant to the opposite parties.  Hence, on receipt of the original documents also, the opposite parties kept silent, hence it is not a premature complaint as per Ex.A2 which clearly shows that the complainant submitted all the documents to the opposite parties on 27.12.2012.  Hence, here the deficiency of service on the part of the opposite parties is clearly established, hence the opposite parties are liable to pay the compensation of Rs.8,000/-. 

10.     The interest claimed by the complainant on the claim amount is 24% p.a. from 27.11.2012, but in our view allowing interest from the date of submission of documents by the complainant i.e., 27.12.2012 is just and reasonable.  The other relief regarding the damages for deficiency of service caused by the opposite parties is rejected, as already the compensation of Rs.8,000/- was awarded towards deficiency in service as well as mental agony to the complainant caused by the opposite parties.

          Accordingly, this point is answered.

11.     In the result, the complaint is allowed directing both the opposite parties to pay an amount of Rs.86,250/- with 9% interest per annum from 27.12.2012 till the date of realization to the complainant.  The opposite parties are further directed to pay Rs.8,000/- towards compensation besides costs of Rs.2,000/-. Time for compliance three months.

  Dictated to the Shorthand Writer, transcribed by her, corrected and pronounced by us in the open Forum on this the 4^th day of December, 2014.

      Sd/-                                                                                                 Sd/-

Member                                                                 President (FAC)

                                                                   District Consumer Forum-I 

                                                                             Visakhapatnam

APPENDIX OF EVIDENCE

Exhibits Marked for the Complainant:

Exhibits Marked for the Opposite Parties:

       Sd/-                                                                                                Sd/-

Member                                                                  President (FAC)

                                                                   District Consumer Forum-I

                                                                             Visakhapatnam

//VSSKL//