SBI Life Insurance Company Limited V/S Gorie Nagamani - Consumer Court Case

Andhra Pradesh

Visakhapatnam-II

CC/74/2012

Gorie Nagamani - Complainant(s)

Versus

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

Adari Apparao

16 Jun 2015

ORDER

Reg. of the Complaint:09-03-2012 Date of Order:16-06-2015

BEFORE THE DISTRICT CONSUMERS FORUM-II

AT VISAKHAPATNAM

Present:

1.Sri H.ANANDHA 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

TUESDAY, THE 16^TH DAY OF JUNE, 2015

CONSUMER CASE NO.74/2012

BETWEEN:

Gorle Nagamani W/o late Appa Rao, Hindu, aged 29 years,

D.No.19-48-5, Kotaveedhi, Chodavaram, Visakhapatnam District,

Presently came down to Visakhapatnam.

…Complainant

AND:

1.The Divisional Manager, SBI Life Insurance Co., Limited,

Corporate Office, Turner Morrison Building, G.N.Vaidya Marg,

Mumbai-400 023.

2.The Branch Manager, SBI Life Insurance Co., Ltd.,

Visakhapatnam Branch-II, 4^th Floor, Sai Trade Centre,

2^nd Lane, Dwarakangar, Visakhapatnam-530016.

…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 of SRI K.SAILESH PRASAD, Advocate for the Opposite Parties, 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)

The Complainant filed this complaint against the OPs, directing them to pay an amount of Rs.9,00,000/-, (Rs.6,00,000/- + Rs.3,00,000/-) together with interest @ 24 % p.a., from the date of claiming the amount till its payment, a compensation and Rs.50,000/- and costs.
The case of the complainant in brief is that the husband of the complaint i.e., Gorle Appa Rao, during his life time had subscribed a Life Insurance Policy from the OPs i.e., SBI Shield Insurance Policy for an amount of Rs.6,00,000/- for level cover and Rs.3,00,000/- for the accidental benefit vide policy No.16002958303 dated 06-09-2006 and her husband had accidentally fallen from stairs at their residence on 10-11-2006 and has sustained head injury and immediately shifted to KGH Visakhapatnam and after treatment by the Medical Officer, her husband was shifted to their residence on 25-11-2006, he died due to the shock and fear from the said accident and by the time of the death of her husband, she has no knowledge about the existence of the policy in the name of her husband as such she could not take steps such as lodging of complaint before the police to enable them to send the dead body for inquest nor she informed the OPs about his death.
Though she traced the policy documents in the month of May, 2008 while she was trying to clean the cupboard and came to know that her husband has subscribed Insurance Policy from the OPs and has nominated her as a nominee and as such, she immediately informed the OP about the death of the insured by way of letter dated 20-05-2008 through courier requesting them to settle the claim amount and that she sent the originals of Policy Document, Medical Record and Death Certificate along with requisition letter and they are in possession of the OPs. on 18-07-2008, the 1^st OP sent a claim form and further more information and at that time of receipt of the claim form, she was suffering from deprivation on account of sudden demise of her husband in the month of December 2008 one person approached her with claim form and he himself introduced as an agent of OPs and obtained her signatures on the claim form and also took a letter from her which was drafted as per the agent dictates as the said agent said her that the insurance amount will be paid early. If the letter is drafted as per her dictate. That the at the time of writing letter and singing the claim form, she would not in a position neither verify the contents of the letter nor show the same to any other person. Subsequently, her cuisine approached her and stated that he will pursue the matter with the OPs and took documents and later her cousin stated that he will take legal opinion by taking certain signatures.
That her cousin has left to Bangalore and there is no information about her claim, she filed PLAC 179/09 on the file of permanent Lokadalath Bench, Visakhapatnam and on coming to know on the same cause of action C.C.No.127/09 was pending before the District Consumer Forum-I at Visakhapatnam wherein the OP filed counter and on that she approached Consumer Forum No.1 and verified C.C. and filed not press memo and thereupon, it was dismissed. At that time of verification of documents, she was surprised to find that the claim form contained wrong particulars relating to her husband’s Date of Death infact she was shown in the claim form that her husband died on 25-06-2006 instead of 25-11-2006. That the date of death of her husband can be clearly ascertained from the death certificate issued by the Panchayat Authorities. That on 13-07-2009, she submitted to the OP by way of letter through Registered Post but claim was not settled, hence this complaint.
The case of OP, denying all the allegations put forth by the complainant in her complaint except which are specifically admitted herein. Most of the averments made in the complaint filed by the complainant are not true and correct and the complainant is put to strict proof of the same. The complaint is not maintainable either on facts or under law and the same is liable to be dismissed.
That the Provision of Law under which the complainant filed this complaint, has no application to the facts of the case on hand and on this ground alone, the complaint is liable to be rejected.
At the time of taking the above policy, the deceased life assured was supplied with the proposal form and requested to fill the same with regard to his health condition pre-health problems, if any, habits, age occupation family history etc., As per questionnaire of the proposal form, this OP has accepted the risk of his life and thereby issued the said policy in good faith.
The complainant involves larger issues which are to be thoroughly investigated and enquired into and only Civil Courts are competent to try the same because the proceedings before a District Consumer forum are summary in nature.
That the diseased Appa Rao was the Holder of Policy of 16002958303 with a date of commencement of Policy as 20-09-2006 reported to have died on 25-11-2006. The case is found to be prima facie highly suspicious as the date of death intimated initially by the nominee complaint is 25-06-2006 whereas the date of death as per death certificate is 25-11-2006. The annexures B and C state that Date of Death to be 25-06-2006 while death certificate states that the date of death of to be 25-11-20006 the policy was issued in between these two days if the date of death was 25-06-2006, there is no concluded contract as on the date of death because the proposal was dated 06-09-2006 thus if the date of death was 25-06-2006, the insured was obtained policy fraudulently after the death of the deceased Appa Rao. Further the Outpatient ticket produced by the complainant was denied by the Hospital Authorities orally which shows the register No. as 335493 while the extract from the record shows 3335493 belongs to someone else does not relates to Deceased Appa Rao. Therefore, the original hospital treatment papers or the discharge summary in original policy documents etc., called for to examine the case in detail.

10. That too prove the accidental death, the complainant should prove the same by submitting FIR, PM, inquest report etc.., but failed to submit the same and as such benefit under the policy is not at admissible which clearly is mentioned in the Policy Bond under condition no.11 schedule III. For all these reasons, complaint filed by the Complainant is liable to be dismissed.

11. To prove the case, the complainant filed her affidavit and got marked Exhibit A1 to A13. On the other hand, on behalf of the OP, the officer concerned filed his affidavit and got marked Exhibits B1 to B10.

12. Exhibits A1 is the Death Claim Intimation Letter dated 20-05-2008, Exhibit A2 is the Courier Receipt, dated 20-05-2008, Exhibit A3 is the Death Certificate, dated 30-11-2006, Exhibit A4 is the Treatment Details, dated 10-11-2006, Exhibit A5 is the Letter sent by the 1^st OP, dated 18-07-2008, Exhibit A6 is the letter send to the 1^st Op, dated 13-07-2009, Exhibit A7 is the Postal Receipt, dated 14-07-2009, Exhibit A8 is the Reminder letter sent to the OPs, dated 19-11-2009, Exhibit A9 is the Acknowledgement, dated 23-11-2009, Exhibit A10 is the letter submitted to the 2^nd OP, dated 09-12-2009, Exhibit A11 is the letter submitted to the 2^nd OP dated 04-01-2010, Exhibit A12 is the Order copy issued by the Chairman, Permanent Lok Adalath, dated 19-09-2011 and Exhibit A13 is the Postal Receipts, dated 19-11-2009.

13. Exhibit B1 is the office copy of Policy Bond, Exhibit B2 is the copy of the claim form dated 31-12-2008, Exhibit B3 is the Death Certificate dated 30-11-2006, Exhibit B4 is the letter dated 31-12-2008, Exhibit B5 is the Cop of the outpatient ticket, Exhibit B6 is the copy of letter dated 24-02-2009, Exhibit B7 is the copy of letter of complainant, dated 09-12-2009, Exhibit B8 is the Copy of Claim form dated 08-12-2009, Exhibit B9 is the copy of attested outpatient ticket and Exhibit B10 is the copy of letter dated 15-12-2009.

14. Both parties filed their written arguments.

15. Heard oral arguments from both sides.

16. 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?

17. The first limb of argument of the counsel for the complaint is that her husband had accidentally fallen from stairs at their residence on 10-11-2006 and sustained head injury and immediately he was shifted to local hospital at Chodavaram later KGH, Visakhapatnam and after treatment her husband was shifted to their residence on 25-11-2006 and he died due to shock and fear from the said accident. To prove the same, she relied upon Exhibit A4 OP Chit of KGH with Register No.335493 dated 10-11-2006 and Exhibit A3 death certificate issued by Panchyat Secretary. According to OP, the complaint involves larger issues i.e., Prima Facie the death of the deceased husband of the complainant is highly suspicious and the hospital out-patient ticket was denied by them therefore, they are to be thoroughly investigated and enquired into, as such, only the Civil Courts are competent to sue such cases against the proceedings before the District Consumer Forum are summary in nature and relied upon a decision reported in Life Insurance Corporation of India vs. Surender Kaur and Others (Civil Appeal No.5334/06 SLP(9) No.7865-7866 of 2005.

18. The complaint at para 3A stated that the husband of the complainant during his life time had subscribed a life Insurance Policy from OP for an amount of Rs.6,00,000/- for lever cover and Rs.3,00,000/- for the accidental benefit vide Exhibit B1. Now, we are dealing with the point relates to accidental benefit. Exhibit B1 is the Policy under condition no.11 Schedule III clearly goes to show that in order to prove the accidental death, the complainant should prove the same by submission of FIR Post Mortem Report and Panchanama Certificate along with the hospital reports etc. In the instant case, the complainant except Exhibit A4 OP chit did not submit the other relevant documents as contemplated under the Policy. The record goes to show at the first instance, the insured was admitted in Government Hospital, Chodavaram and later shifted to KGH where underwent treatment for a period of 10 days and later came to house where he died. Admittedly, the complainant has not filed either medical record, or certificate from the medical officer concern or atleast their affidavits to prove the aforementioned facts. If really the insured was admitted at first instance in Chodavaram Hospital and later treated in KGH for a period of 10 days the relevant medical record is available but unfortunately for the reasons best know to the complainant, she did not chose to file them. Exhibit B6 is the letter dated 24-02-2009 addressed by OP to the complainant on receipt of original claim form to submit the Hospital Treatment Papers or Discharge Summary in original to consider the admissibility of the claim. Exhibit B10 is the another letter addressed by OP December, 15^th 2009. After receipt of the Original Claim Form, Death Certificate etc., from the complaint, reminded them to submit the Hospital Treatment Papers or the Discharge Summary in original to consider the admissibility or otherwise of the claim but for the reasons best known to the complainant, they have not submitted the relevant documents nor give any explanation with reasons what made them not to submit those documents.

19. The complainant relied upon OP Chit showing the Registration No.335493 while the extract from the records show filed by OP that it belongs to someone else and it is not belongs to the insured. Inspite of communicating by addressing letters to the complainant, the complainant failed to submit hospital treatment papers or the discharge summary original to consider the admissibility or otherwise of the claim. Having regard to all these facts and circumstances, we are of the considered view that the complainant failed to substantiate his case that the death of the insured is an accidental death. Therefore, the complaint is not entitled to the amount claimed under the head of accidental benefit vide Exhibit B1 Policy for an amount of Rs.3,00,000/-.

20. The last contention of the complainant is that the case is found to be prima facie highly suspicious as the date of death intimated initially by the nominee of complainant is 25-06-2006 whereas the date of death as per the death certificate is 25-11-2006. On the other hand, according to the complainant, the signatures of the complainant at the time of verification of documents before the District Consumer Forum No.I Visakhapatnam by the OPs, she was surprised to find that the claim Form contained wrong particulars relating to her husband’s date of death. Infact, it was shown in the claim form that her husband died on 25-06-2006 instead of 25-11-2006 and her further case is date of death of her husband has to be ascertained by the death certificate issued by Panchyat Authorities only is Exhibit A3, i.e., Panchyat Secretary, Gram Panchyat, Chodavaram. It is the contention of the complainant at the time of receipt of the claim form, she was suffering from depression on account of sudden demise of her husband and in the month of December 2008 , the agent of OP personally approached with Claim Form by introducing himself as the agent of OP and obtained her signatures in the claim form and took letter from her which was drafted as per the agent dictation and at that time, she was not in a position to neither verify the contents of the said letter or show the same to any other person . In lieu of the plea taken by the complainant much importance need not be given to Exhibit B4 and due importance has to be given to A3 which is issued by the competent authority. On scrutiny of record with exhibits marked on behalf of the complainant, the contention of the OP that the case is found prima facie highly suspicious is incorrect. The complainant in support of her case filed her affidavit and the death certificate. On scrutiny of them, it is to be held that the diseased insured died on 25-11-2006 only and thereby proved her case.

21. Exhibits marked on behalf of the complainant i..e, Exhibit A5 to A10 clearly goes to show that in spite of claim made by her, the OP failed to respond to settled her claim in one way or other. The act of OPs in this regard is clear that there is a deficiency of service on their part. Therefore, the complaint is entitled to for a sum of Rs.6,00,000/- only in respect of insurance policy amount for level cover with interest from the date of registration of the complainant i.e., 9 % p.a., The record shows during the year 2008 when the complainant sought for insurance amount, the OP requested certain documents by addressing a letter but till one year there is no response from the complainant. At this stage, it is relevant for me to note that the complainant filed pre-litigation before the permanent Lok Adalath and filed C.C. before District Consumer Forum No.1, Visakhapatnam and after filing counter, they have not pressed the C.C. on the ground that she has not given instruction to file the complaint and by not pressing the same in the year 2009 and after not pressing the PLAC in 2011 this complaint is filed in the year 2012. Having record to all these facts and circumstances, we are unable to come to a conclusion that on whose fault the claim was not settled during the said period. Therefore, we are constrained to give interest from the date of complaint only but not earlier thereto.

22. 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. B1 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 intimation i.e., 20-05-2008. 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. from the date of registration. Accordingly interest is ordered.

23. 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 refund the advance amount paid by 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 30,000 /- would serve the ends of justice. We therefore, proposed to award compensation of Rs.30,000 /-, in the circumstances of the case on hand. Accordingly this point is answered.

24. 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.6,00,000/- 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.

25. In the light of our discussion, referred supra, the complainant is entitled to receive the sum of Rs.6,00,000/- with interest for the said sum @ 9% from the date of registration of the complainant, compensation of Rs.30,000 /- and costs of Rs.2,500/-.

26. In the result, this complaint is allowed in part, directing the OP to pay an amount of Rs.6,00,000/- (Rupees Six Lakhs only) with interest @ 9% p.a., from the date of registration of the complainant i.e., 09-03-2012 till the date of realization, a compensation of Rs.30,000/- (Rupees Thirty Thousand only) and Rs.2,500/- (Rupees Two Thousand and five hundred only) towards costs. 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 16^th day of June, 2015.

Sd/- Sd/- Sd/-

LADY MEMBER MALE MEMBER PRESIDENT

APPENDIX OF EVIDENCE

For the Complainant:-

1.Exhibits A1 is the Copy of Death Claim Intimation Letter dated 20-05-2008

2.Exhibit A2 is copy of the Courier Receipt, dated 20-05-2008

3.Exhibit A3 is the Original Death Certificate, dated 30-11-2006

4.Exhibit A4 is the Original Treatment Details, dated 10-11-2006

5.Exhibit A5 is the Original Letter sent by the 1^st OP, dated 18-07-2008

6.Exhibit A6 is the Copy of letter send to the 1^st Op, dated 13-07-2009

7.Exhibit A7 is the Original Postal Receipt, dated 14-07-2009

8.Exhibit A8 is the Copy of Reminder letter sent to the OPs, dated 19-11-2009

9.Exhibit A9 is the Original Acknowledgement, dated 23-11-2009

10.Exhibit A10 is the Original Letter submitted to the 2^nd OP, dated 09-12-2009

11.Exhibit A11 is the Original letter submitted to the 2^nd OP dated 04-01-2010

12.Exhibit A12 is the Original Order copy issued by the Chairman, Permanent Lok

Adalath, dated 19-09-2011

13.Exhibit A13 is the Original Postal Receipts, dated 19-11-2009.

For the Opposite Parties:-

1.Exhibit B1 is the Office Copy of Policy Bond

2.Exhibit B2 is the Copy of the claim form dated 31-12-2008

3.Exhibit B3 is the Copy of Death Certificate dated 30-11-2006

4.Exhibit B4 is the Letter dated 31-12-2008

5.Exhibit B5 is the Copy of the outpatient ticket

6.Exhibit B6 is the Copy of letter dated 24-02-2009

7.Exhibit B7 is the copy of letter of complainant, dated 09-12-2009

8.Exhibit B8 is the Copy of Claim form dated 08-12-2009

9.Exhibit B9 is the copy of attested outpatient ticket

10.Exhibit b10 is the copy of letter dated 15-12-2009.