BEFORE THE DISTRICT FORUM:KURNOOL

Present: Sri.P.V.Nageswara Rao,M.A.,LL.M., President(FAC)

And

Smt. C.Preethi,  M.A.LL.B., Lady Member

And

Sri. M.Krishna Reddy, M.Sc.,M.Phil., Male Member

Thursday  the 01^st  day of October , 2009

C.C. 62/09

Between:

Smt. D.Sree Devi, W/o. D.Bhaskar,

R/o. MIG 210, A.P.Housing Board Colony, Adoni-518 302, Kurnool District.                       …Complainant

-Vs-

1. The Branch Manager, Shriram Life Insurance company Limited,

D.No.20/453/3, Nakapi Building, Opp T.T.Town P.S, Adoni-518 301.

2. The Assistant General Manager, Shriram Life Insurance company Limited,

3-6-478 , III Floor , Andna Estate, Liberty Road, Himayat Nagar,

Hyderabad-500029.                             …Opposite Parties

                        This complaint is coming on this day for orders in the presence of Sri. A.Rama Subba Reddy, Advocate, for the complainant, and Sri. S.V.Krishna Reddy Advocate for opposite parties and upon perusing the material papers on record, the Forum made the following.

ORDER

(As per Sri. P.V.Nageswara Rao,President (FAC)

C.C. 62/09

1.     Complaint filed under section 11 of the Consumer Protection Act 1986.

2.     The brief facts of the complaint is as follows:-  The complainant was a daughter  of Late  Y. Basi Reddy  who insured  his  life with opposite party No. 1  and obtained a policy bearing No. 08070071898 commenced from 22-04-2008 for five years period with single  premium  of Rs.50,000/- paid by  him. The assured  amount was 5 times of the premium  value in addition to value of the units in which the opposite party invested. In all Rs.2,50,000/-  and value of the  units  was payable  in case of death of the  assured. The complainant was  a nominee to the insured . On 06-05-2008   Basi Reddy died  and it was informed to opposite party No. 1 who sent  claim form to the complainant.  It was submitted  to the opposite parties with all  formalities  for her claim. The opposite parties  insisted  for sending  form B  and medical report of the deceased. Since the insured  died in natural suddenly there was no treatment  and the claimant  expressed  her inability  to send  the form B.  Basi Reddy was not hospitalized. The complainant addressed   many letters to settle the claim  . The opposite party No. 2  on 12-08-2008 wrote a letter requesting  to send the form B and medical reports . It was informed  on 14-08-2008  that the deceased  was not hospitalized . On 04-09-2008  the complainant wrote a letter  to the opposite parties  to settle the claim . Again on 06-09-2008 the opposite party No. 2 wrote a letter for medical reports . The complainant sent the same information  as she sent earlier   . But the claim was not settled.  Thus,  the opposite parties  played unfair trade practice  towards the complainant.  The complainant filed   the complaint of Rs.2,50,000/-  towards policy and Rs.10,000/- towards compensation and 24% p.a towards  interest  and cost of the complaint.

3.     The opposite party No. 2 filed written version  adopted  by opposite party No. 1 with a memo . The opposite party No. 2 denied  the complaint  and its averments.  The forum had no jurisdiction to entertain the complaint and  the complainant was not a consumer  under the provisions of C.P. Act  and it was not a consumer dispute.  Y. Basi Reddy took a policy of “ Shri Plus (SP)”  bearing No. LNO80800071898 from opposite party No.2 for assured sum of Rs.62,500/- commenced on 22-04-2008 with his daughter i.e,  complainant as nominee. At the time of taking the policy to deceased policy holder for supplied with proposal  form regarding  his health conditions and habits under questioner No. 25. Basing on the  information  provided  in the proposal  form the opposite party No. 2 accepted the  risk on the life of the deceased  and issued  the policy. The complainant  as a daughter  of the deceased policy holder and nominee wrote a letter  on 20-05-2008 informing  the death of the policy holder on 06-05-2008 . On 26-05-2008 the opposite party No. 2 wrote a letter  to the complainant  to submit  claim forms  ABC along  with medical    reports.    Inspite of   reminders  on   13-06-2008 ,  08-07-2008 , the complainant  did not submit the  claim forms  and hence the  claim was closed on 24-04-2008  and  a  letter    was addressed to the complainant.  Later the complainant  submitted the  claim forms  ABC  to opposite party No.2 . But the claim  form B-1 kept blank. Since the claim  was early  claim arising within one month  from the date of  commencement of the policy and investigation  was conducted  which revealed that the deceased was suffering  from diabetes and hypertension since long time and was regularly treatment. The investigator   was G.Ram Murthy  , Hyderabad . The deceased  did not disclosed  health problem  in the proposal  form at the time of taking the policy  . Otherwise the policy would not have  been issued  . Thus the  opposite party No. 2 sent claim form  B to the complainant and requested  to submit  with declaration  of the doctor. The burden was on complainant  to prove the cause  of death of  the deceased. Accept a  medical professional no one  could declare the  death as sudden and  natural. Thus the claim  was closed and inform to the complainant  by way of letter 12-08-2008 . Therefore  there were no bonafides  and hence the complaint may be dismissed with costs.

4.     On the basis of the above pleadings the points for consideration are

(i)     Whether there is any negligence or deficiency of service and unfair trade practice towards the complainant.

(ii)    Whether the complainant is entitled to the relief as prayed for?

(iii)  To what relief ?.

5      On behalf of the complainant Ex.A1 to A7 were marked . No documents  were marked on behalf of the  opposite parties.

6.     Point No. 1 & 2:   In the written version itself  the opposite parties  admitted that Late Y. Basi Reddy  during his life time took one policy  called “ Shri Plus (SP)”  bearing No. LN080800071898  from opposite party No. 2 for sum assured for Rs.62,500/-  under single premium of Rs.50,000/- commenced on 22-04-2008 keeping to complainant  as his nominee who was a daughter  of the deceased.  The Ex.A1 was the copy  of the policy . Ex.A2 was the  Xerox copy  of he premium receipt. The complainant filed  Ex.A3 a Xerox copy of the death certificate that the insured  on 06-05-2008. Subsequent  to the death of the insured the complainant addressed letters  informing the death of the policy holder  . But the opposite party No. 2 contended that   the  claim  forms  ABC  for  sent to   the    complainant.  On   26-05-2008 but there were  not submitted  and hence the claim  was closed and to that effect a letter was addressed on  24-07-2008 . The complainant  on 14-08-2008  wrote a letter  to the opposite party No. 2 that the insured  died in natural cause of death  and hence there were no medical reports  . The opposite party No. 2 in the written version had stated that an investigator  by Sri Ram Murthy , Hyderabad ,conducted the investigation and found that the deceased  policy holder  was suffering from hypertension  and diabetes  . But the investigators  report and with concerned  proof of the deceased  have may be filed in its  absence . It was clear that the deceased died  in the natural cause of death. Suddenly  in view of  it  there was no scope to give  treatment in a hospital  and obtain the case sheets  on medical reports. The office copy of the  letters addressed by the complainant  to opposite party No. 2 was Ex.A5.  The opposite party No. 2 wrote a letter on 12-08-2008 requesting the complainant submitted the medical reports  with claim  form B . A letter was  Ex.A4. The complainant wrote  another letter on 04-09-2008 to opposite party No. 2  it was Ex.A6  . On 06-09-2008 the opposite party No. 2 wrote a letter   to the complainant  that to grace out  to the medical reports   and submit , it was Ex.A7 . The only ground  raised by the opposite party  was the complainant  filed to submits  the medical reports  regarding the  health conditions  of the deceased. When the complainant  expressed  that the deceased  died due to natural death without hospitalization  there was no scope to obtain  the medical reports. Thus, the opposite parties had done unfair trade practice  towards the complainant which would amounts to deficiency of service.

7.     In the result , the complaint is allowed directing the opposite parties  1 and 2 jointly and severally liable to pay Rs.2,50,000/- to the complainant  and Rs.2,000/- towards compensation and Rs.1,000/- towards costs  within 45 days from the date of receipt of this order.

Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 1^st day of October ,  2009.

       Sd/-                                   Sd/-                  Sd/-

LADY MEMBER              PRESIDENT FAC)     MALE MEMBER

APPENDIX OF EVIDENCE

Witnesses Examined

For the complainant :  Nil           For the opposite parties : Nil

List of exhibits marked for the complainant:-

List  of exhibits marked for the opposite parties:   Nil

         Sd/-                            Sd/-                                  Sd/-

LADY MEMBER               PRESIDENT (FAC)               MALE MEMBER  

// Certified free copy communicated under Rule 4 (10) of the

A.P.S.C.D.R.C. Rules, 1987//

Copy to:-

Complainant and Opposite parties      

Copy was made ready on                :

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