Andhra Pradesh

Visakhapatnam-II

CC/374/2012

Yellapu Venkata Adibabu - Complainant(s)

Versus

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

Adari Appa Rao

02 Jul 2015

ORDER

                  Reg. of the Complaint:09-11-2012                                                                                                                                     Date of Order:02-07-2015

BEFORE THE DISTRICT CONSUMERS FORUM-II

AT VISAKHAPATNAM

                   Present:

1.Sri H.ANANDA RAO, M.A., L.L.B.,

       President

2.Sri C.V.RAO, M.A., B.L.,

                                             Male Member

3.Smt.K.SAROJA, M.A., B.L.,

       Lady Member

                                            

 

THURSDAY, THE 02^ND DAY OF JULY, 2015

CONSUMER CASE NO.374/2012

 

BETWEEN:

Sri Yeellapu Venkata Adibabu

S/o Appa Rao late, Hindu, aged 27 years,

D.NO.3-26, Madhyapeta, Thimmarajupeta Vilalge,

Munagapaka Mandal, Visakhapatnam District.

…Complainant

AND:

1. The Branch Manager, Reliance life Insurance Company,

Beside Ramachandra Theatre, Chodavaram Road,

Anakapalle, Visakhapatnam District.

2. The Regional Manager, Reliance Life Insurance Company Ltd.,

Sri Balaji Mangalagiri Complex, Siripuram, Visakhapatnam-03.

…Opposite Parties

 

This case coming on 09-06-2015 for final hearing before us in the presence of   Sri ADARI APPA RAO, Advocate for the Complainant, and of                                     SRI SANAPALA KARUNA & SMT.SAILAJA, Advocates for the 2^nd Opposite Parties, and of 1^st Opposite Party is being exparte, and having stood over till this date for consideration, this Forum made the following.

 

ORDER

 (As per the Honourable President on behalf of the Bench)                                                                              

 

1. The Complainant filed the present complaint against the Opposite Parties directing them to pay an amount of Rs.5,00,000/- with interest @ 24 % p.a., from the date of claiming the amount till its  payment, Rs.50,000/- towards compensation with costs.
2. The case of the complainant in brief is that his father Appa Rao during his life time obtained a Life Insurance Policy from Opposite party for a sum of Rs.5,00,000/- appointing him as the nominee and the insured suffered from Diarrhea on  10-03-2011. Therefore, shifted to Doctor BD Naidu Hospital, Visakhapatnam who prescribed some medicines on the same day night he died and  intimation of the death of the insured was intimated to OP and thereafter submitted their claim with necessary documents. However, OP repudiated the claim on the ground that non disclosure of the material facts about the health. Hence this complaint.
3. The case of the OP, by denying the material averments of the complaint admitted that the deceased Appa Rao has obtained Life Insurance Policy for Rs.5,00,000/-  and that he died on 15-02-2012. However, justified repudiation of the claim on the ground that Insurance Policy was obtained by concealing the material fact that the Deceased life insured hospitalized much prior to the signing of the proposal form and the said facts malafidely cancelled at the time of issuance of the policy i.e., for non disclosure  of material medical facts about health.
4. To prove the case on behalf of the complainant, he field his affidavit and got marked ExhibitA1 to A9. On the other hand, 2^nd OP filed his affidavit and got marked Exhibits B1 to B9.
5. Exhibit A1 is the Policy Document dated 23-08-2010,Exhibit A2 is the Treatment details, dated 10-03-2011, Exhibit A3 is the Death Certificate, dated 10-03-2011, Exhibit A4 is the Death intimation letter, dated 15-02-2012, Exhibit A5 is the Repudiation letter, dated 30-03-2012, Exhibit A6 is the Request letter, dated 28-04-2012, Exhibit A7 is the final repudiation letter dated 02-05-2012, Exhibit A8 is the Icon Krishi Hospital Letter, dated 05-12-2014 and Exhibit A9 is the Certificate of Registration of Icon Krishi Hospital.
6. Exhibit B1 is the Proposal Form along with documents, dated 12-08-2010, Exhibit B2 is the Policy Bond along with documents, dated 23-08-2010, Exhibit B3 is the Death Certificate, dated 24-03-2011, Exhibit B4 is the Death claim intimation17-02-2012, Exhibit B5 is the letter from the OPs, dated 17-02-2012, Exhibit B6 is the Investigation report, dated  07-03-2011, Exhibit B7 is the Investigation report, dated  07-03-2011, Exhibit B8 is the Repudiation Letter, dated 30-03-2012 and Exhibit B9 is the Letter correspondence between the OPs and the complainant, dated 30-03-2012, 28-04-2012 and 02-05-2012.
7. Both parties filed their written arguments.
8. Heard oral arguments from both sides.
9. Now the point for determination to be determined in this case is;

Whether there is any deficiency of service on the part of the OPs and the Complainant is entitled to any reliefs asked for?

    10. It is evident as seen from record, the OP repudiated the claim of the complainant on the ground that the insurance was obtained by the deceased by concealing or non disclosure of the material medical facts of the health (suppression of material facts). To prove the same the burden lies heavily on the OP. In order to prove the same, Exhibit B6 and B7 i.e., investigation report is filed along with affidavit of the investigator which goes to show that they have collected discharge card issued by Krishi Trust Hospital, Visakhapatnam and it goes to show the life assured admitted in the hospital at Yelamanchali did not take any medication etc., but they have not field any record evidencing he was treated in the hospital for Cerebrovascular Accident during the month of January, 2009 under which the claim was repudiated. In the absence of such proof, it cannot be held that the Life Assured was hospitalized and treated for Cerebrovascular Accident. Thus, it can be held that OP has failed to onus the said fact by adducing evidence i.e., either by examination of the treating doctor or by producing the original record of the treatment.

    11. On considering the rival contentions and perusal of the record indisputably, the OP has repudiated the claim of the complainant on the ground that insurance was obtained by the deceased by concealing the fact that he was hospitalized and treated for Cerebrovascular accident. Onus of proving the above ground of repudiation of insurance claim, lies on OP but they failed to prove the same. Even the original record has not been produced to prove the contention of the OP. Since the OP has failed to produce the evidence to establish the ground for repudiation of the claim,  we are of the considered view that the OP failed to establish the ground under which they have repudiated the acts of the OP clearly indicates that there is a deficiency of service on their part. Therefore, the complaint is entitled for the relief as sought for an amount of Rs.5,00,0000/- with interest 9% p.a., from the date of May, 2012 i.e., after receiving a repudiation letter from OP, compensation of Rs.25,000/- and costs of Rs.2,500/-.

12.Now the question that comes up for consideration, at this stage of our discussion is, 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 commercial in nature, but that does not and cannot mean to say that the Complainant is licensed to claim interest @ 24% p.a. from the date of claim.  But at the same time, it is 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. would better serve the ends of justice.    Consequently, we proposed to fix the rate of interest @ 9% p.a. on Ex.A 1 dated 02-05-2012 i.e., Repudiation letter in question.   Accordingly interest is ordered.

13.Whether the Complainant is entitled for compensation of Rs.50,000/- is to be considered.   It appears as seen from the evidence of Complainant that the Complainant was compelled to approach the Opposite Parties and therefore experienced a lot of physical strain besides mental agony and financial loss. It is an un-disputed fact that the Opposite Parties did not pay the sum assured to the complainant.   Naturally, that might 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 25,000/- would serve the ends of justice.   We therefore, proposed to award compensation of Rs.25,000 /-,  in the circumstances of the case on hand. Accordingly this point is answered.

14.Before parting our discussion, it is incumbent and imperative on our part to consider the costs of litigation.    The Complainants ought         not have to approach this Forum had his claim for payment of Rs.5,00,000/- 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 costs 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.

15.In the light of our discussion, referred supra, the complainant is entitled to receive the sum of Rs.5,00,000/-  with interest for the said sum @ 9% only from 02-05-2012, compensation of Rs.25,000/- and costs of Rs.2,500/-.

16.In the result, this complaint is allowed in the part directing the opposite parties to pay an amount of Rs.5,00,000/- (Rupees Five Lakhs only) with subsequent interest @ 9% p.a, from 02-05-2012, ill the date of realization, Rs.25,000/- (Rupees Twenty Five Thousand only) towards compensation and Rs.2,500/- (Rupees Two thousand and five hundred only) towards costs to the complainant. Time for compliance, one month from the date of this order.

Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open Forum, on this the 02^nd day of July, 2015.       

 

Sd/-                                          Sd/-                                          Sd/-                           

LADY MEMBER                            MALE MEMBER                        PRESIDENT  

 

APPENDIX OF EVIDENCE

  For the Complainant:-

Exhibits	Date	Description	Remarks
A1	23-08-2010	Policy Document	Photocopy
A2	10-03-2011	Treatment details of Dr.B.D.Naidu	Photocopy
A3	10-03-2011	Death Certificate	Original
A4	15-02-2012	Death Intimation letter	Photocopy
A5	30-03-2012	Repudiation letter	Original
A6	28-04-2012	Request letter	Photocopy
A7	02-05-2012	Final Repudiation Letter	Original
A8	05-12-2014	Letter of Icon Krishi Hospital	Original
A9		Registration Certificate of the Icon Krishi Hospital	Photocopy

For the Opposite Parties:-                                                 

Exhibits	Date	Description	Remarks
B1	12-08-2010	Proposal form  along with documents	Original
B2	23-08-2010	Policy Bond along with Documents	Original
B3	24-03-2011	Death Certificate	Original
B4	17-02-2012	Death claim intimation and form A & B	Original
B5	17-02-2012	Letter from OP	Office copy
B6	07-03-2012	Investigation Report	Original
B7	07-03-2012	Investigation Report	Original
B8	30-03-2012	Repudiation Letter	Office copy
B9	30-03-2012 28-04-2012 02-05-2012	Letter correspondence between the complainant and the OPs	Photocopies

           

Sd/-                                                  Sd/-                                        Sd/-

LADY MEMBER                            MALE MEMBER                        PRESIDENT