Andhra Pradesh

Visakhapatnam

CC/347/2012

CHADARAM KUMARI - Complainant(s)

Versus

STAR HEALTH AND ALLIED INSURANCE COMPANY LTD. - Opp.Party(s)

M.SIVA RAMA KRISHNA

28 Nov 2014

ORDER

     Date of registration:17.10.2012

     Date of order :28.11.2014

 

BEFORE THE DISTRICT CONSUMERS FORUM-I,

VISAKHAPATNAM : AP

 

PRESENT:  Smt K.V.R.Maheswari, B.A., B.L., LL.M.,

 Lady Member & FAC President

 

Sri V.V.L.Narasimha Rao, B.A., LL.M., PGDHR,

Member

 

Friday, the 28^th day of November, 2014

 

Consumer Complaint No:347/2012

Between:    

 

Chadaram Kumari W/o late Govinda Rao, Hindu, aged 40 years, residing at D.No.3-41, Majjiveedhi, Timmarajupeta, Anakapalli, Visakhapatnam District.                                                                            …   Complainant

And:

 

1. Star Health and allied Insurance Company ltd., regd. Office 1, New Tank Street, Valluvar Kottam High Road, Nungambakka, Chennai.

 

2. Star Health and allied Insurance Company ltd., rep. by its Branch Manager, Flat No.101, Govinda Mansion, VIP Road, Visakhapatnam.

                                                                             …       Opposite Parties

 

This case is coming for final hearing on 26.11.2014 in the presence of Sri M.Sivarama Krishna Advocate for the Complainant and of Sri Kandala Srinivasa Rao Advocate for Opposite Parties and having stood over till this date, the Forum delivered the following:

                           

: O R D E R :

(As per Smt. K.V.R.Maheswari, Honourable President(FAC) on

behalf of the Bench)

 

1.     The brief averments of the complaint are that the complainant’s husband Chadaram Govinda Rao S/o Apparao had taken an insurance policy from the opposite parties during his life time vide policy No.131314/02/2008/000013 on 26.04.2007 for an amount of Rs.4,00,000/- and the complainant’s name is mentioned as nominee in the policy.  While so, on 02.06.2007 the complainant’s husband was bitten by a street dog, on the same day he was taken to Government Hospital there he took treatment  and returned back to his house and later suffered with the disease of Rabbis and died on 02.08.2007 due to the said fatal disease.  The Complainant stated that while she was cleaning almarah in the month of June, 2011 she found an Insurance policy Bond, then she came to know that her husband had taken an insurance policy, immediately she addressed a letter dated 13.06.2011 to the 1^st opposite party and intimated the death of her husband to the concerned authorities of the said opposite party and also sent a Xerox copy of death certificate of her deceased husband and as well as the insurance policy.  After receiving the letter issued by the opposite parties, they gave a reply on 19.10.2011 demanding to send original policy bond and original Death Certificate of the deceased life assured.  Then, the Complainant sent the original policy and death certificate and medical certificates to the opposite parties and after sending the claim form to the opposite parties, the complainant requested them to settle the death claim but the opposite parties are postponing the same on one pretext or the other and they neither rejected the claim amount nor paid the amount to the complainant, which clearly shows the deficiency in service on the part of the opposite parties. 

2.     The Complainant stated that as per the rules and regulations of the opposite parties, the deceased life assured complied all formalities at the time of taking policy from the opposite parties and after his death the complainant submitted all the relevant documents to the opposite parties and because of her husband’s sudden death being a nominee she is entitled to receive the claim amount together with interest.  Hence, this complaint to direct the opposite parties;

a)     to pay an amount of Rs.4,00,000/- towards claim amount along with 24% p.a. interest from 13.06.2011 till the date of payment.

b)     to pay Rs.50,000/- towards compensation and Rs.25,000/- towards damages besides costs.

3.     On the other hand, 2^nd opposite party filed its counter and the

same was adopted by the 1^st opposite party.  The opposite parties denied the allegations mentioned in the complaint and pleaded that the complainant is put to strict proof of the allegation that she is the wife of one late Chadaram Govinda Rao that he has taken a policy bearing No.l131314/02/2008/000013 mentioning her name as nominee.  The Opposite parties further pleaded that the deceased life assured died due to dog bite and proper treatment was given to him in the government hospital that it is a competent and recognized hospital to handle such cases and it is a matter of common knowledge that if any death occurs, it is the duty of the hospital authorities and also family members to report the matter to police duly registering it as MLC case.  But no such report was given to them in this case. The opposite parties stated that the plaintiff has no knowledge until June, 2011 i.e., while she was cleaning almarah, she found the insurance policy.  No document of the DLA regarding admission in the Government hospital or getting treatment or discharge summary or occurrence of death is filed by the complainant.  The Complainant came to know about her husband’s policy after four years of his death while cleaning almarah is totally unbelievable and baseless.  Thus the averments in complaint are no way near the aspect of sufficiency of cause as envisaged by the provisions of the Act.  The Opposite parties stated that with respect to the letter addressed to the opposite parties by the complainant, the opposite parties gave a reply on 19.10.2011 and it is pertinent to note that as per the terms and conditions of the Insurance Policy more precisely at Page-4, General conditions (applicable to all sections under this policy) Claim Documents: “Insured person has to produce should produce necessary documents to process the claim”, but the complainant failed to produce the said documents which are very essential like FIR, Post Mortem Report, forensic Report etc., to prove the actual cause of death.  The Opposite parties again issued a reminder requesting the complainant to produce necessary documents, wherein, it was clearly mentioned that the required papers are to be sent within 15 days of notice failing which the claim will be treated as closed.  The Complainant did not produce any papers even after a reply and reminders by these opposite parties and therefore, no claim could be processed.  Hence, there is no deficiency of service on the part of the opposite parties.  The complaint is totally devoid of merits and barred by limitation and there is no valid cause of action for the complainant, hence she cannot entitled the reliefs, as such the complaint is dismissed with exemplary costs. 

4.     At the time of enquiry, the complainant filed evidence affidavits along with documents which are marked as Ex.A1 to A5.  The complainant also filed written arguments.  On the other hand, the opposite parties filed their counter, evidence affidavit and written arguments.  No documents are marked on behalf of opposite party.  Heard both the counsels who reiterated their versions.

5.     In view of the respective contentions, the point that would arise for determination is:-

Whether there is any deficiency in service on the part of the opposite parties, if so can the complainant entitle for the reliefs prayed for?

6.     Ex.A1 dated 26.04.2007 is evidenced that the complainant’s husband Ch.Govinda Rao is the life assured wherein Ch.Kumari is mentioned as nominee and assignee relationship is mentioned as spouse for the sum assured Rs.4,00,000/-.  The opposite parties plea is that there is no strict proof of that the complainant is the wife of deceased life assured. But in our view at the time of settling the claim amount it is the bounden duty of the insurance company to verify with the address proof and photo ID proof regarding the genuineness of nominee.  Hence, in our view if the opposite parties have doubt about the nominee then they have to clarify it by verification. 

7.     Ex.A2 is the O.P chit issued by the Government Hospital dated 02.06.2007 wherein it mentioned that “c/o dog bite lower extremely of right leg: STRAY dog and the doctor prescribed injunction o.5CC im and tablets Diclotenac 50mg and cap Ampelilin 500mg.  Ex.A3 is the death certificate of deceased life assured dated 24.12.2010. Ex.A4 is the death intimation letter to the opposite parties by the complainant on 13.06.2011 wherein, the complainant mentioned encloses as policy copy and death certificate.  The 2^nd page of Ex.A4 i.e., courier receipt shows that the opposite parties received the letter issued by the complainant on 13.06.2011.  Ex.A5 is the final reminder issued by the opposite party to the complainant on 19.10.2011 by requesting the complainant to submit death certificate, Inquest report, FIR, MLC, Post Mortem report, original policy coroner’s report etc.

8.     The contention of the complainant is that after the death of her husband i.e., on 02.08.2007, the complainant came to know about the policy in the month of June, 2011 and immediately she issued a letter on 13.06.2011 then, the opposite parties issued a reply on 19.10.2011 and demanding the complainant to send original documents and as per their request the complainant send all the original documents to the opposite  parties but the opposite parties failed to settle the issue.

9.     The main plea of the opposite parties is that the complainant is put to strict proof of that she is the wife of DLA where her name was mentioned as nominee, but at the time of settling the claim the opposite parties will verify the photo ID address proof of the complainant regarding the nominee. The other plea of the opposite parties is that the DLA died due to dog bite, but neither the complainant nor the hospital authorities registered the death as it is MLC case and no FIR and inquest report was filed by the complainant.  It is normal in practice that if any person’s death occurs in the house, no one goes for MLC or Post mortem and also not registered FIR.

10.    In the oral arguments of the opposite parties’ counsel stressed that “if really DLA died due to dog bite and if really took treatment for rabbis, there should be document by the complainant. But except the O.P chit no document filed, which is not sufficient”.  But it is of our view, as per Apex Court’s decision, it is the duty of the opposite parties, that the burden of proof lies on the opposite parties with regard to the suppression of material facts by the complainant if any.  More over, the opposite parties neither repudiate the claim nor settle the claim amount.  But simply says in its counter that there is no claim and the claim is closed.  As per the versions of the complainant, the complainant submitted all the originals after the letter issued by the opposite parties regarding the submission of original letter dated 19.10.2011, as per the complainant’s version in page-4 para-4 line-18 of the complaint, but the Forum perused the documents filed by the complainant and came to know that the original death certificate and policy bond filed by the complainant before the Forum, hence, we are of the view that the complainant not submitted the originals with the opposite parties.  Hence, there is no deficiency of service on the part of the opposite parties as such the complainant cannot entitle for compensation.  But it is the bounden duty of the opposite parties to settle the claim amount after submission of originals by the complainant.

11.    It is to be noted that Ex.A2 is the crucial document to know that, the LA approached Government Hospital due to dog bite.  In that document there is clear mention regarding dog bite and prescribed medicines.  After two months of dog bite, the life assured died.  Being an illiterate woman, the complainant may not approach the opposite parties within time and failed to submit the originals.  But we are of the concerned view that, under principles of natural justice, after submission of original documents, the opposite parties have to settle the claim amount. 

12.    The other plea of the opposite parties that there is abnormal delay as after four years of the death of her husband i.e., DLA the complainant approached the opposite parties to settle the claim amount.  But we are of the view that when the delay of 2 years were condoned by this Forum, we cannot go into that plea again as already delay was condoned and the CC is registered.  Here is the question that whether the complainant submitted all the originals or not.  When the matter was reopened for clarification, the complainant’s counsel represented that the complainant received two original policy bonds against this policy, one original bond is submitted to opposite parties and another original policy bond is filed before the Forum.  But Forum is of the view that no insurance company issue two original bonds for one policy.  The Complainant not submitted original documents to opposite parties.  As she failed to submit the originals to the opposite parties, she has to submit the originals within one month on receipt of this order and the opposite parties have to settle the claim amount within three months.

        Accordingly, this point is answered.

13.    In the result, the complaint is partly allowed directing the opposite parties 1 & 2 to settle the claim amount on receipt of necessary documents along with policy bond from the complainant within three months.  The complainant is also directed to submit all necessary documents along with policy bond to the opposite parties within 15 days from the date of receipt of this order.  No order as to the compensation and costs.    

Dictated to the Shorthand Writer, transcribed by her, corrected and pronounced by us in the open Forum on this the 28^th day of November, 2014.

 

 

    Sd/-                                                                       Sd/-

Member                                                                 President (FAC)

                                                                   District Consumer Forum-I 

                                                                             Visakhapatnam

 

APPENDIX OF EVIDENCE

 

Exhibits Marked for the Complainant:

Ex.A1	26.04.2007	Insurance policy bond	Original
Ex.A2	02.06.2007	O.P. chit issued by the Government Hospital.	Photostat copy
Ex.A3	24.04.2010	Death Certificate of Chadaram Govinda Rao S/o Apparao issued by Grama Panchayat.	Original
Ex.A4	13.06.2011	Death Intimation letter to the 1st opposite party.	Photostat copy
Ex.A5	19.10.2011	Reply letter from 1st opposite party.	Original

Exhibits Marked for the Opposite Parties:

NIL

 

    Sd/-                                                                       Sd/-

Member                                                                  President (FAC)

                                                                   District Consumer Forum-I

                                                                             Visakhapatnam

 

 

 

 

//VSSKL//