BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri. T.Sundara Ramaiah, B.Com B.L., President
And
Sri. M.Krishna Reddy, M.Sc., M.Phil., Male Member
And
Smt. S.Nazeerunnisa, B.A., B.L., Lady Member
Monday the 31st day of October, 2011
C.C.No.35/2011
Between:
T.Venkateswarlu, S/o Late T.Govindarajulu,
H.No.76/97/386/8,N.T.R. Nagar, Kallur Village and Mandal, Kurnool District.
…Complainant
-Vs-
The Branch Manager,M/S Reliance Life Insurance Company Limited,
R.M.K.Plaza, Shop No.32,Opp- Z.P. Park Road,Kurnool - 518 001.
...Opposite ParTy
This complaint is coming on this day for orders in the presence of Sri S.Ranga Ravi Kumar, Advocate for complainant and Sri G.Nagendra Nath Yadav, Advocate for opposite party and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Sri. M.Krishna Reddy, Male Member)
C.C. No.35/2011
1. This case is filed by the complaint under section 12 of C. P. Act, 1986 praying a direction on opposite party for the payment of :-
- Policy assured amount of Rs.1,00,000/- with 24% per annum interest from the date of death.
- Rs.25,000/- as relief for mental agony.
- Rs.25,000/- as compensation for negligent act and other reliefs.
2. In short the case of the complainant is that his father Govindarajulu submitting medical certificate, insured his life with opposite party under the policy No.16292176 paying premium of Rs.20,000/- for a period of 20 years, covering the risk from 08-02-2010. The insured suddenly died due to sun stroke on 08-03-2010. The complainant being the nominee, applied to opposite party for the sanction of assured policy amount, submitting necessary documents. But opposite party rejected the claim on 11-05-2010 stating that the deceased did not disclose his preexisting decease at the time of taking the policy. Injured by the injustice done by the opposite party, the complainant filed this complaint before this Forum seeking an order for appropriate reliefs.
3. In reply to the notice of the Forum, opposite party filed counter denying his liability to the complainant’s claim. The case of opposite party in brief is that the insured submitted an application for Rs.1,00,000/- insurance, proposing for issuance of Reliance super invest assure basic plan by paying premium of Rs.20,000/-. Accordingly a policy bearing No.16292176 was issued to the insured covering the risk from 09-02-2010. The contract of insurance is based on trust. The person who takes insurance is required to inform the complete details pertaining his health and habbits at the time of filling the Proposal Form. The health condition of the insured is vital fact to determine the eligibility for insurance. The insured died due to sun stroke on 07-03-2010 i.e., with in one month from the date of issuance of the policy. On thorough investigation by the investigator, it was known that the life assured was hospitalized for the treatment of heart disease, diabetes, hypertension etc., from 04-02-2008 to 14-02-2008 in Government General Hospital, Kurnool. The life assured concealed this fact willfully and furnished wrong information to get policy benefit. On the basis of investigation report, the claim of the complainant is repudiated on 11-05-2010 and refunded the fund balance of Rs.10,512-50/-. From what is stated above the opposite party pleaded that the claim of the complainant is rightly rejected and the case against opposite party is prayed for dismissal.
4. Both Parties filed their sworn affidavits and marked documents. Complainant documents are Ex.A1 to Ex.A5 and opposite party documents are Ex.B1 to Ex.B5.
5. Written Arguments were filed by both complainant and opposite party.
6. Hence the points for consideration are:
- Whether there is any deficiency on the part of opposite party?
- Whether the complainant is entitled for any reliefs?
- To what relief?
7. POINTS 1 and 2:- Admittedly the father of the complainant insured his life with opposite party for a period of 20 years commencing from 08-02-2010 for Rs.1,00,000/- by paying Rs.20,000/- premium, appointing his son T.Venkateswarulu as his nominee. The insured died on 07-03-2010 due to sun stroke. On the date of death of insured the policy was in force. The complainant being the nominee of insured submitted claim form with all enclosures. Ex.A3 the Xerox copy of policy, Ex.A2 Xerox copy of premium receipt, Ex.A4 the Xerox copy of death certificate, Ex.A5 the claim representation. Opposite party settled the claim and paid fund balance of Rs.10,512-50 to the complainant on 11-05-2010 instead of paying the sum assured amount of Rs.1,00,000/- for the reason that the insured did not disclose his preexisting diseases in the proposal form. The basis for the detection of non-disclosed preexisting diseases is the investigation report submitted by investigator Zubair & Company Secunderabad. Ex.B4 the Xerox copy of investigation report annexed with three papers of hospital records. Out of three pages of hospital records one page contains date of admission and date of discharge but no I.P number and name of the patient, second page which contains outpatient number and name of the patient, was tampered at many places, the third page is scan report containing outpatient/IP number mismatching with that in second page. Added to it nowhere in all the three hospital records, the name of the doctor who treated the patient is not noted. Further the opposite party did not choose to examine the concerned doctor and take his deposition to support his action. So Ex.B4 which forms the only basis for the rejection of complainant’s claim is found to be an erroneous document. In view of what is stated above the contention of opposite party is rejected and the claim of the complainant is admitted.
8. Point No.3:- The claim of Rs.1,00,000/- sum assured is allowed with 9% per annum interest instead of 24% per annum. The period of interest from the date of settlement (11-05-2010) is accepted but not from the date of death. RS.1,000/- is sanctioned as compensation for mental agony.
9. In the result, the complaint is allowed directing the opposite party to pay the insured amount of Rs.1,00,000/- with interest 9% per annum from 11-05-2010, Rs.1,000/- as compensation for mental agony and Rs.500/- as cost of the case. Time for compliance is one month 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 31st day of October, 2011.
Sd/- Sd/- Sd/-
MALE MEMBER PRESIDENT LADY MEMBER
APPENDIX OF EVIDENCE Witnesses Examined
For the complainant : Nill For the opposite party : Nill
List of exhibits marked for the complainant :-
Ex.A1 Photo copy of Form –C Certificate of identity
dated 15-03-2010.
Ex.A2. Photo copy of Premium Collection Receipt for Rs.20,000/-dated 08-02-2010.
Ex.A3 Photo copy of Settlement letter dated 01-11-2009.
Ex.A4 Photo copy of Death Certificate issued by Registrar of Births and Deaths, Kurnool Municipal Corporation, Kurnool District dated 12-03-2010.
Ex.A5 Photo copy of request letter of complainant to Reliance Life Insurance, Hyderabad, dated 28-04-2010.
List of exhibits marked for the opposite party:-
Ex.B1 Letter of Authority dated 19-05-2011.
Ex.B2 Photo copy of First Appeal No.242/2006 order of Honourable National Commission, New Delhi,
dated 27-07-2010.
Ex.B3 Photo copy of Common Proposal Form for Life Insurance
Linked Plan dated 08-02-2010.
Ex.B4 Photo copy of Investigation Report Strictly Confidential
dated 29-04-2010.
Ex.B5 Photo copy of Letter by opposite party to complainant
dated 11-05-2010.
Sd/- Sd/- Sd/-
MALE MEMBER PRESIDENT LADY 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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