Date of filing:16.6.2014.
Date of disposal:27.1.2015.
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM - II:
VIJAYAWADA, KRISHNA DISTRICT
Present: SMT N. TRIPURA SUNDARI, B. COM., B. L., PRESIDENT (FAC)
SRI S.SREERAM, B.COM., B.A., B.L., MEMBER
TUESDAY, THE 27th DAY OF JANUARY, 2015.
C.C.No.137 of 2014
Between:
Balagam Satyavathi, W/o (Late) Srinivasa Rao, Hindu, 48 years, Residing at Door No.6-7-6, Tirumallaiah Street, Tailorpet, Chittinagar, Vijayawada.
……Complainant.
AND
Sri Ram Life Insurance Company, Rep., by its Authorized Signatory, Ramky Selenium, Plot No.31 and 32, Beside Andhra Bank Training Centre, Gachi Bowli, Hyderabad.
.… Opposite Party.
This complaint coming on before the Forum for final hearing on 20.1.2015, in the presence of Sri P.Seshu Mohan, Advocate for complainant and Sri D.Rajasekhar. Advocate for opposite party and upon perusing the material available on record, this Forum delivers the following:
O R D E R
(Delivered by Hon’ble President (FAC) Smt N. Tripura Sundari)
This complaint is filed under Section 12 of the Consumer Protection Act, 1986.
The averments of the complaint are in brief:
1. The complainant’s husband obtained Shriram Ujjwal Life SP policy in the year 2011 by paying a single premium of Rs.1,80,000/-. As per the terms and conditions of the said policy in case of death of the policy holder the nominee is entitled to get sum assured + value of the units in unit account + top up sum assured along with top up fund value if payable. While so on 12.12.2011 due to heart failure the husband of the complainant died while crossing the road and due to such incident he had fallen into a drain. The complainant being a nominee under the said policy informed the death of the policy holder and submitted the claim form. On perusal of the same the opposite party paid part of the amount i.e., Rs.1,75,000/- relating to the units lying to his credit. Out of the said amount the opposite party appropriated Rs.60,000/- towards the pending instalments to the chit lying in the name of the complainant and paid the balance amount of Rs.1,15,000/-. In spite of repeated requests made by the complainant the opposite party failed to pay the other benefits under the said policy as per the terms and conditions of the policy. Subsequently the opposite party addressed a letter dated 10.8.2012 requesting the complainant to submit medical reports of her husband as he was suffering with epilepsy and due to which he died. The complainant approached the opposite party and informed that her husband was not suffering with any ailment as alleged by the opposite party and there was no medical reports. The complainant reiterated the said facts to the opposite party by giving her affidavit on 9.1.2013 as directed by the opposite party. Even then also the opposite party did not respond properly and failed to pay other benefits under the said policy inspite of repeated correspondence made by the complainant which amounts to clear deficiency in service on the part of the opposite party. Hence the complainant is constrained to file this complaint against the opposite party praying the Forum to direct the opposite party to pay Rs.1,98,000/- towards sum assured under the policy along with interest at 24% per annum to pay Rs.1,00,000/- towards damages for mental agony and to pay costs.
2. The version of the opposite party is in brief;
The opposite party denied all the allegations of the complaint and submitted that the complainant intimated that the policy holder died on 12.12.2011 and the opposite party handed over the concerned claim forms to the complainant who is the nominee under the said policy and requested her to fill the claim forms and submit along with other required documents for processing the claim. The complainant had submitted the claim form A and C and failed to submit the claim for B. As the claim form B was not received for processing the claim the opposite party had addressed reminder dated 9.6.2012, reminder No.1 dated 4.7.2012 and reminder No.2 dated 10.8.2012 calling the complainant for submitting the claim form ‘B’ and complete medical reports for the treatment taken by the deceased/life assured. Due to non submission of the claim form B the opposite party addressed a letter dated 12.1.2013 to the complainant informing that as non receipt of the claim form B the complainant is left with no option to repudiate the claim. The complainant had not filed a single document i.e., FIR, Post mortem report to substantiate that the deceased/life assured had died due to heart failure while he was crossing the road and fallen into drain. The complainant had failed to submit the claim form B which has to be filed by the Doctor stating the cause of death of the deceased/life assured. Hence non submission of the claim form B the claim could not be processed. If the complainant submits the claim form B along with medical reports as required for processing the claim under the policy. There is no deficiency in service on the part of the opposite party and prayed to dismiss the complaint with costs.
3. On behalf of the complainant she gave her affidavit and got marked Ex.A.1 to Ex.A.8. On behalf of the opposite party Sri E.Sridhar, Assistant General Manager cum Authorized Signatory gave his affidavit and got marked Ex.B.1 and Ex.B.2.
4. Heard and perused.
5. Now the points that arise for consideration in this complaint are:
1. Whether there is any deficiency in service on the part of the opposite party
towards the complainant in not settling the claim of the complainant?
2. If so is the complainant entitled for any relief?
3. To what relief the complainant is entitled?
POINTS 1 AND 2:-
6. On perusing the material on hand the complainant’s husband obtained Shriram Ujjwal Life SP policy in the year 2011 by paying the single premium of Rs.1,80,000/- under Ex.A.2. As per the terms and conditions of the policy in case of death of policy holder the nominee is entitled for policy sum assured + value of the units in the unit account + top up sum assured along with top up fund value if any payable to the nominee. While so on 12.12.2011 due to heart failure the husband of the complainant died. Ex.A.1 death certificate issued by the Registrar of Births and Deaths, Municipal Corporation, Vijayawada evidences the same. The complainant being a nominee under the said policy informed the death of her husband and submitted claim form. On receiving the claim form the opposite party paid part of the amount i.e., Rs.1,75,000/- relating to the units lying in the account of the deceased/life assured. In spite of repeated requests made by the complainant under Ex.A.7 and Ex.A.8 the opposite party sent a letter Ex.B.2 dated 8.6.2012 stating that the opposite party had entrusted for investigation and received investigation report that the deceased/life assured was suffering with fits. Then the complainant addressed a letter to the opposite party and a copy to Consumer Affairs Department, Insurance Regulatory and Development Authority informing that her husband did not died due to fits, he died due to heart attack and there was no necessity for her husband to undergo any treatment for the said fits and she had submitted necessary papers including original policy bond and the cause of death is published in newspapers Ex.A.3. The opposite party received the same and sent reminders to the complainant dated 4.7.2012 and 10.8.2012 calling upon the complainant to submit all the required documents within two weeks from the date of receiving the reminder for settling the claim. The complainant sent her affidavit Ex.A.5 dated 9.1.2013 stating that her husband died on 12.12.2011 due to heart attack and falling in drainage on the road side. Therefore she did not consult any doctor. The husband of the complainant had not any medical problems before his death. Therefore she had not taken any medical certificates. The opposite party says that as the complainant failed to submit claim form B the opposite party sent repudiation of the claim letter dated 12.1.2013 under Ex.B.1.
7. On perusing the documents filed by the opposite party that there is no evidence to show that the deceased/life assured is suffering with fits (epilepsy) before his death and he died due to that problem. As there is no such problem to the deceased/life assured the complainant is not in a position to submit medical reports about her husband’s health relating to the said problem. The complainant submitted the original policy bond and death certificate of her husband. But the opposite party failed to settle the claim of the complainant as assured in the policy. Therefore there is deficiency in service on the part of the opposite party and the opposite party is liable to pay the assured amount to the complainant and the complainant is entitled to get the same. Accordingly these points are answered.
POINT No.3:-
8. In the result, the complaint is allowed in part and the opposite party is directed to pay the sum assured under the said policy i.e.,Rs.1,98,000/- with interest at the rate of 9% per annum from 1.1.2012 till realization and to pay costs of Rs.2,000/- to the complainant. Time for compliance one month. Rest of the claims of the complainant are dismissed.
Dictated to the Stenographer K.Sivaram Prasad, transcribed by him, corrected by me and pronounced by us in the open Forum, this the 27TH day of January, 2015.
PRESIDENT(FAC) MEMBER
Appendix of evidence
Witnesses examined
For the complainant: For the opposite parties:
P.W.1 B.Satyavathi D.W.1 E.Sridhar,
Complainant, Assistant General Manager
(by affidavit) cum Authorized Signatory of the opposite party (by affidavit)
Documents marked
On behalf of the complainant:
Ex.A.1 . . Photocopy of certificate of death.
Ex.A.2 . . Photocopy of Ulip Policy Schedule along with two letters.
Ex.A.3 . . Photocopy of Paper publication.
Ex.A.4 10.08.2012 Letter from the opposite party to the complainant.
Ex.A.5 09.01.2013 Photocopy of letter from the complainant to the opposite party.
Ex.A.6 . . Photocopy of letter from the complainant to the opposite party.
Ex.A.7 . . Photocopy of letter from the complainant to the opposite party.
Ex.A.8 . . Postal acknowledgement.
On behalf of the opposite parties:
Ex.B.1 . . Photocopies of Bunch of documents.
Ex.B.2 08.06.2012 Photocopy of letter from the opposite party to the complainant.
PRESIDENT(FAC)
