Per Smt T. Suneetha, Member:-

This complaint is filed U/s 12 of Consumer Protection Act, Seeking directions on opposite parties to  pay a sum of Rs.3,08,225/- (Rs.2,25,000/- amount of two policies, Rs.33,225/- of interest @ 12% p.a. from 29-03-2011 to  22-06-2012 and Rs.50,000/- as compensation).

2.   In brief the averments of the complaint are here under:

          The complainant is son of Late Mr.Kamepalli Lingaiah, who expired on29-03-11, during his life time took two insurance policies from the opposite party under policy Nos.100900113958 for Rs.1,50,000/- and policy no. 100900113961 for Rs.75,000/- on 21-08-2009.

        The complainant submitted the claim forms to the opposite parties office and approached all the opposite parties several times for the claim amount. But the opposite parties did not respond.  The complainant there after issued a legal notice to the opposite parties on 09-02-2012 for which the 2^nd opposite party sent a reply notice dated 15-02-2012 stating that they sent letters on 26-09-2011, 13-10-2011, 30-10-2011 and 28-11-11 and to submit the medical reports, case sheet of treatment taken for liver.  The complainant issued a legal notice dated 08-03-2012 but the opposite parties never replied for that letter.  The complainant’s father i.e. insured/deceased had never suffered any liver problem and never underwent any treatment in any hospital.  The conduct of the opposite parties in not settling the claim amounts to deficiency of service.  Therefore they are liable to compensate the complainant.  Thus the complaint.

3.      Opposite parties filed its version which is in brief as follows. 

          It is true that the late Kamepalli Lingaiah during his life time has taken two Shri Plus life insurance policies on 21-08-09 bearing No.LN100900113958 for a sum of Rs.1,50,000/- and premium payable at Rs.20,000/- for 15 years and under No. LN100900113961 for a sum of Rs.75,000/- premium payable at Rs.10,000/- for 15 years, nominating his son K.Yallamanda the complainant herein as nominee to receive the benefits under the above said policies. 

        The nominee has intimated the company about the death of the insured on 29-03-2011.  The investigator of opposite party conducted preliminary enquiry and found that the life assured was under treatment for jaundice and liver problems. On 18-05-2011 the investigator handed over claims forms to the nominee personally and requesting him to submit properly filled in claim forms to process the claim.  The opposite party has sent reminders 1 & 2 dated 13-10-11 and 31-10-11 and closing letter dated 28-11-11 stating that after receipt of the requirements the claim will be processed as per the terms and conditions of the policy.  The complainant has not cooperated with the opposite parties.  Finally the opposite party repudiated claim on 24-11-12. The Hon’ble Forum may dismiss the complaint with costs.      

4.      The 1^st and 3^rd opposite parties remained exparte on 08-10-2012. 

The complainant and 2^ndopposite party filed their respective affidavits. Exs.A-1 to A-10 were marked on behalf of the complainant.  Exs.B-1 to B-10 were marked on behalf of the 2^nd opposite party.    

5.      Now the points that arose for consideration in this          complaint are:      

1.  Whether the opposite parties committed deficiency of Service?

2.  To what relief the complainant is entitled to?

1. POINT NO.1:- The opposite party repudiated the claim of the complainant on the ground that the complainant suppressed the material fact that the insured underwent treatment for jaundice and liver problems.  The opposite party required medical reports of the insured for perusal.

The complainant contended that his father i.e insured died out of heart attack and he had not taken any treatment from any doctor for the above said problems.

        The Surveyor/Investigator report(Ex:B6) revealed that the daughter-in-law of the insured told that the insured took treatment from the herbal medicine man.  The cause of death is explained as such the insured after coming from fields consumed a glass of water and collapsed to death and was assumed by family members as heart attack. The habits, ailments and possibility of insured committing suicide are not established or assured. The death of the insured was not even certified by any Doctor. In those circumstances the burden of proving the allegations lies on the opposite parties which they failed to do. The opposite parties allegations are not supported by any documents.

        In absence of evidence the Forum would not have any reason to disbelieve the contention of the complainant. 

        In view of the above discussion the Forum comes to a considered opinion that the repudiation by the opposite party is not justified which amounted to deficiency of service on the part of opposite party. The point is answered in favour of the complainant.   

7.      POINT NO.2:-   Since there is deficiency of service on the part of opposite party, the opposite party is to compensate the complainant. 

8.     In the result, the complaint is        allowed in part as indicated below : 

        1. The opposite parties are directed to pay an amount of Rs.2,25,000/-

             towards two policy amounts to the complainant along with interest

            @ 9% p.a. from the date of closure of the claim i.e, 28-11-11 till the

             date of complaint i.e. 26-06-2012.

        2. The opposite parties are further directed to pay a sum of Rs.5,000/-

             towards compensation to the complainant. 

        3. The opposite parties are further directed to pay a sum of

               Rs.1,000/- towards cost of the complaint.    

        The above order shall be complied with in a period of six weeks from the date of receipt of the copy of this order, failing which the amounts ordered in item No. 2&3 shall carry interest @ 9% p.a. till realisation. 

Typed to my dictation by Junior Stenographer, corrected by us and pronounced in the open Forum dated this the 22^nd day of March, 2013.

MEMBER                                 MEMBER                                            PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite parties: -

                                                                                                         PRESIDENT     

NB:   The parties are required to collect the extra sets within a month after receipt of this order either personally or through their advocate as otherwise the extra sets shall be weeded out.