This case coming on 21.01.2015 for final hearing before this Forum in the presence of Sri V.S.R.S. Naidu, Advocate for the complainants and the opposite parties 1 & 2 having been set ex parte, and having stood over till this date for consideration, this Forum has pronounced the following:
O R D E R
(Per Sri A. Madhusudana Rao, Member)
This is a complaint filed by the complainants U/Sec.12 of Consumer Protection Act 1986 to direct the opposite parties to pay a sum of Rs.2,39,228-79ps with interest at 24% p.a. from the date of default of claim amount and also to pay Rs.50,000/- towards damages for mental agony.
2. The case of the complainant is that the 1st opposite party is the branch office, who issued the insurance policy No.U161779979, sum assured Rs.2,50,000/- in favour of Mattaparthi Suryanarayana, which is commencing from 3.10.2011 to 3.10.2028 and the 2nd opposite party is the registered office. The 1st complainant is the wife and the 2nd complainant is the son of the late Mattaparthi Suryanarayana, S/o.Venkanna. The said policy was issued by the 1st opposite party through its authorized agent Sri T. Satyanarayana Murthy. The said Suryanarayana paid a sum of Rs.12,500/- towards half yearly premium for the above said policy. At the time of issuing the above said policy, their authorized agent and officials from the 1st opposite party noted the correct age of the said Suryanarayana as 59 years as per household card of his family which was issued by M.R.O. office, P. Gannavaram and also appearance of his physic and health condition of the said Suryanarayana. The said Suryanarayana died intestate on 22.2.2012 leaving behind him the complainants as his class-I legal heirs at Yenugupalli. After the death of Suryanarayana, intimated the same through his claim intimation along with relevant documents which was received by the 1st opposite party, but the claims department did not verify the claim intimation of complainants properly and issued the cheque bearing No.701619 dt.30.7.2012 for a sum of Rs.10,771-21ps and sent the same to the complainants towards full and final settlement with covering letter dt.4.6.2012 instead of full payment of Rs.2,50,000/- on the false plea alleging that the correct age of the said Suryanarayana not disclosed in the policy. The complainants approached the customer services Tata AIG and represented for settlement of claim. But the claim is not yet settled.
The complainants got issued a regd. legal notice to the opposite parties on 29.8.2012 for seeking settlement of claim. The same was received by the opposite parties and kept quiet. Hence, the complaint.
3. The opposite parties remained exparte despite receipt of notices from this Forum.
4. Heard the complainant. The complainant filed proof affidavit, Exs.A1 to A5 have been marked for the complainant.
5. Points raised for consideration are:
1. Whether there is any deficiency in service on the part of the opposite parties?
2. Whether the complainants are entitled for the reliefs asked for?
3. To what relief?
6. POINT Nos.1 & 2:- On perusal of the record, it is found that the present complainants are the class-I legal heirs of one Mattaparthi Suryanarayana, who obtained Tata AIG Life Invest Assure Flexi Supreme Policy bearing No.U161779979 from the opposite parties for an assured amount of Rs.2,50,000/- which is valid from 3.10.2011 to 3.10.2028 on half yearly premium payment basis of Rs.12,500/- through their agent one T. Satyanarayana Murthy (Code No.004384788). The opposite parties noted the correct age of the deceased as 59 years at the time of issuance of the above said policy as per household card issued by M.R.O., P. Gannavaram. The deceased policyholder died intestate on 22.2.2012 i.e. within 4 months of issuance of the policy. On that, the death was intimated to the opposite parties for claim amount with all relevant documents and the claim was registered on 22.3.2012 vide claim No.VI 12001785, but the claims department of the opposite parties did not verify the claim properly and issued a cheque for Rs.10,771-21ps vide cheque bearing No.701619 dt.30.7.2012 as per Ex.A1 letter dt.4.6.2012 towards settlement of claim instead of assured amount of Rs.2,50,000/- with a false allegation that the correct age of the deceased was not disclosed in the policy.
Under those circumstances, the legal heirs made a representation dt.25.6.2012 to the 2nd opposite party and the Insurance Ombudsman, Hyderabad vide Ex.A2. The 1st opposite party did not give any reply whereas the office of the Ombudsman advised the complainants through letter dt.13.7.2012 vide Ex.A3 to approach the customer services of TATA AIG Insurance Company. Then, the complainants represented to the Customer Services of opposite parties for the settlement of claim, but the claim was not yet settled. The complainants got issued legal notice dt.29.8.2012 vide Ex.A4 demanding for settlement of claim, but the opposite parties kept quiet despite receipt of the said legal notice vide Ex.A5 postal receipts.
We observed that an advocate filed vakalat on behalf of the 2nd opposite party, but not filed written version to the reasons best known to the 2nd opposite party insurance company, hence called absent and set exparte. Further, we observed that as the opposite parties not settled the claim of the complainants, the complainants got issued legal notices vide Ex.A4 to both the opposite parties demanding for settlement of insurance claim to the extent of Rs.2,39,228-79ps after deduction of Rs.10,771-21ps already paid to the complainants after the death of the deceased. The opposite parties received the notices as per Ex.A5 receipts, but kept quiet. It is further observed from Ex.A1 letter addressed to the 2nd complainant, the 2nd opposite party alleged that the deceased insured’s correct age at the time of proposal i.e. 29.09.2011 was beyond insurable age for the said policy and repudiated the total claim amount of Rs.2,50,000/-, but paid only Rs.10,771-21ps as per cheque No.701619 dt.30.5.2012 as full and final settlement of the claim. If the insured crossed the insurable age for the said policy, how could the opposite parties got issued the said policy to the deceased? Further, the opposite parties failed to produce any cogent evidence to that effect. The 2nd opposite party further stated that upon encashment of the above mentioned cheque, the company will stand discharged of all it liability under the policy, which is a unilateral decision by the opposite party insurance company. We further observed that the complainants approached the Tata AIG Customer Care Cell as per the advice of Insurance Ombudsman dt.13.7.2012, the customer care cell never evince any interest towards settlement of the complainants insurance claim.
The complainants relied on a decision rendered by the High Court of Judicature, Telangana & Andhra Pradesh at Hyderabad in Birla Sunlife Insurance Company Ltd., Mumbai Vs. Insurance Ombudsman & another: 2014 (6) ALD 176 in which it was held that evidence relied upon by the insurer is too flimsy to suffice for repudiation of claim of the complainant. Plea of fraud sought pressed into the service also not sustainable in absence of any cogent and convincing material in support of the same and so, this decision is apt to the facts and circumstances of the present complaint.
With the discussion held supra and under the facts and circumstances of the case, we have no other option, but to allow the complaint and we are in the considered opinion that the complainants are entitled for the claim amount of Rs.2,39,228-79ps from the opposite parties with interest, however, not entitled for any compensation.
7. POINT No.3: In the result, the complaint is allowed, directing the opposite parties to pay an amount of Rs.2,39,228-79ps with interest @ 9% p.a. from the date of refund of account value at the bid price i.e. 4.6.2012 till realization. We further direct the opposite parties to pay Rs.2,000/- towards costs of the complaint to the complainants. Time for compliance is two months from the date of receipt of copy of this order.
Dictated to the Stenographer, typed to my dictation, corrected and pronounced by us in open Forum, on this the 6th day of February, 2015.
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT.
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
FOR COMPLAINANTS: None. FOR OPPOSITE PARTIES: None.
DOCUMENTS MARKED
FOR COMPLAINANTS:
Ex.A1 Letter from the 2nd opposite party to the 2nd complainant on 4.6.2012.
Ex.A2 Reply to the 2nd opposite party and Insurance Ombudsman by the 2nd complainant
dt.25.6.2012.
Ex.A3 Reply from Insurance Ombudsman to the 2nd complainant dt.13.7.2012.
Ex.A4 O/c of Regd. legal notice dt.29.8.2012 to the opposite parties.
Ex.A5 Postal Receipts dt.30.8.2012.
FOR OPPOSTIE PARTIES: - Nil -
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
