Date of Filing: 28/07/2011
Date of Order: 12/09/2011
BEFORE THE I ADDITIONAL DISTRICT CONSUMER DISPUTES REDRESSAL FORUM SESHADRIPURAM BANGALORE - 20
Dated: 12th DAY OF SEPTEMBER 2011
PRESENT
SRI.H.V.RAMACHANDRA RAO,B.SC.,B.L., PRESIDENT
SMT.NIVEDITHA .J, B.SC.,LLB., MEMBER
COMPLAINT NO. 1394 OF 2011
Smt. Vedavathi N.S,
W/o. Girish N.B,
Aged About 23 years,
R/at: No.20, 5th Cross, KSRTC Layout,
Mahdeshwara Nagara, Bangalore-91.
(Rep. by Advocate Sri.Nagaraj Jain) Complainant.
-V/s-
(1) Reliance Life Insurance
Level 1, Midas Wing, Sahar Plaza Complex,
Andhreri-Kurla Road, Andheri (East),
Mumbai-400 059.
Rep. by its Manager.
(2) Reliance Life Insurance,
Branch Office at No.2940/E-5,
GG Arcade 3rd Floor Service Road,
West of Chord Road, Opp. To Maruti Mandir,
Vijayanagara, Bangalore-40.
Rep. by its Branch Manager.
(Rep. by Advocate Sri.G.B.Kulkarni) Opposite parties.
BY SRI.H.V.RAMACHANDRA RAO, PRESIDENT
ORDER
The brief antecedents that lead to the filing of the complainant made Under Section 12 of the Consumer Protection Act, seeking direction to the opposite parties to pay a sum of Rs.3,65,220/-, are necessary:-
Smt. Renukamma the mother of the complainant had insured with the opposite parties “Reliance Super Invest Assure Plan” for a period of 15 years on a yearly premium of Rs.15,000/- + Rs.112/- for Rider benefit. The sum assured was Rs.3,00,000/- and ACC Death and TPD Benefit Rider for Rs.1,00,000/-. The policy commenced from 30.09.2009 which should mature on 30.09.2024. On 02.01.2011 the mother was admitted to the Institute of Nephro Urology at Victoria Hospital Bangalore due to her Kidney problem, on the same day she died. The complainant who is the nominee of the above said policy made laid claim before the opposite parties. The opposite party had repudiated the claim alleging suppression of material facts. The mother of the complainant never had any illness earlier to her death. The allegations to the contrary to the repudiation letter is an untenable one.
2. In this case the notice to the opposite parties was served, who engaged the service of an advocate on 29.08.2011 and took time to file the version. Subsequently neither the advocate nor the opposite parties were present nor filed the version nor contested the matter. Hence the complainant has filed his affidavit. Heard the complainant since the counsel for the opposite parties and the opposite parties were absent.
3. The points that arise for our consideration are:-
- Whether repudiation of the insurance claim by the opposite party is an unfair trade practice/deficiency in service?
- What order?
4. Our findings on the above points are:-
Point (A):In the Positive
Point (B):As per the final order
For the following:-
REASONS
POINT (A) to (B):-
5. Reading the compliant in conjunction with the affidavit and documents on record, it is established that the mother of the complainant by name Smt. Renukamma had obtained an insurance policy from the opposite party in the year 2009. The premium was Rs.15,000/- per year + Rs.112/- for Rider benefit. The maturity value is Rs.3,00,000/-. It is also established that on 02.01.2011 the deceased was taken to Institute of Nephro Urology at Victoria Hospital, Bangalore. On that day after treatment she died. In this regard the complainant made a claim with the opposite party as she is the legal class-I heir as well as the nominee under the law. It is also an admitted fact that the opposite party has repudiated the claim on 15.03.2011 contending that from the medical reports submitted by the complainant, the deceased was suffering with chronic Kidney diseases with hypertension and anemia from 17.12.2008 to 24.12.2008 and this was not disclosed hence they have repudiated the claim. Hence let us see what is the medical records that was given to the opposite party and how it has analyzed.
6. On 02.01.2011 the deceased was taken to Institute of Nephro Urology at Victoria Hospital, Bangalore. The history that has been given reads thus:-
That is to say the deceased was having hypertension since about 3 years and was having some problem with urology from 28.12.2010 and not of any kidney diseases since three years. Hence the contention of the opposite party that the diseased was suffering from kidney disease in the year 2008, she has suppressed the same in 2009 when she took the policy is nothing but an unfair trade practice. The opposite party never stated in the repudiation letter that, it had conducted any investigation from an independent investigating agency and came to know that, the deceased was admitted to any other hospital or took treatment for kidney problem elsewhere in the year 2008 earlier to the date of taking the policy. There is no such averment in the repudiation letter. Merely picking holes in the documents of the complainant the opposite party is trying to deny the claim of the complainant which is nothing but an unfair trade practice. None of the allegation are challenged by the opposite party nor denied by the opposite party. In the repudiation letter the opposite party has simply placed its denial on the document of the complainant which is stated supra i.e., misreading the document the medical record. Hence under these circumstances we hold the above points accordingly and proceed to pass the following:-
ORDER
1. The complaint is Allowed-in-part.
2. The opposite party is directed to pay to the complainant sum of Rs.3,00,000/- together with interest thereon at the rate of 12% per annum from 02.01.2011 until payment within 30 days from the date of this order.
3. The opposite party is also directed to pay to the complainant a sum of Rs.2,000/- as costs of this litigation.
4. The opposite party is directed to send the amounts as ordered at Serial Nos. 2 & 3 above to the complainant through DD by registered post acknowledgment due and submit the compliance report to this Forum with necessary documents within 45 days from the date of this order.
5. Return the extra sets filed by the parties to the concerned as under Regulation 20(3) of the Consumer’s Protection Regulation 2005.
6. Send a copy of this order to both the parties free of costs, immediately.
(Dictated to the Stenographer, transcribed and typed by him, corrected and then pronounced by us in the Open Forum on this the 12th Day of September 2011)
MEMBER PRESIDENT
