BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM ::
KADAPA Y.S.R DISTRICT
PRESENT SRI V.C. GUNNAIAH, B.Com., M.L., PRESIDENT
SMT. K. SIREESHA, B.L., LADY MEMBER
SRI M.V.R. SHARMA, B.A. MEMBER
Tuesday, 16th December 2014
CONSUMER COMPLAINT Nos. 07, 08 & 09 / 2012
I. C.C. No. 07/2012
1. Kandula Venkata Subba Reddy, S/o Nadipi Subba Reddy.
Aged about 48 years, Hindu, residing at 3-44,
Payasampalli Village, Veerapunayuni Palli Mandal,
YSR District, Andhra Pradesh State.
2. Kandula Parvathamma, W/o Late K. Venkata Suibba Reddy
Aged about 34 years, House wife,
3. Kandula Nageswara Reddy, S/o Late K. Venkata Subba Reddy,
aged about 13 years, Minor, Rep. by his mother and natural
guardian Kandula Parvathamma, W/o Late K. Venkata Subba Reddy,
aged about 34 years, Hindu, House wife,
4. Kandula Swapna, D/o Late K. Venkata Subba Reddy,
aged about 18 years, Hindu,
No. 2 to 3 also are residing at 3-44, Payasampalli Village,
Veerapunayuni Palli Mandal, YSR District,
Andhra Pradesh State.
(Complainants 2 to 4 added as per
I.A.No. 136/2012, dt. 8-6-2012) ….. Complainants.
Vs.
1) Birla Sunlife Insurance Co. Ld., Rep. by its
Chief Executive Officer, One India Bulls Centre,
Tower – 1, 15 & 16 Floor, Jupiter Mill Compound,
841 Senapati Bapat Marg, Elipinstone road,
Mumbai – 400 013.
2) Birla Sunlife Insurance Co. Ltd., Rep. by its
Manager, H.No. 24-390 above, Lakshmi Devamma Clinic,
Gandhi road, Proddatur, YSR District, Andhra Pradesh. ….. Respondents.
II. C.C. No. 08/2012
1. Kandula Venkata Subba Reddy, S/o Nadipi Subba Reddy.
Aged about 48 years, Hindu, residing at 3-44,
Payasampalli Village, Veerapunayuni Palli Mandal,
YSR District, Andhra Pradesh State.
2. Kandula Parvathamma, W/o Late K. Venkata Suibba Reddy
Aged about 34 years, House wife,
3. Kandula Nageswara Reddy, S/o Late K. Venkata Subba Reddy,
aged about 13 years, Minor, Rep. by his mother and natural
guardian Kandula Parvathamma, W/o Late K. Venkata Subba Reddy,
aged about 34 years, Hindu, House wife,
4. Kandula Swapna, D/o Late K. Venkata Subba Reddy,
aged about 18 years, Hindu,
No. 2 to 3 also are residing at 3-44, Payasampalli Village,
Veerapunayuni Palli Mandal, YSR District,
Andhra Pradesh State.
(Complainants 2 to 4 added as per
I.A.No. 137/2012, dt. 8-6-2012) ….. Complainants.
Vs.
1) Birla Sunlife Insurance Co. Ld., Rep. by its
Chief Executive Officer, One India Bulls Centre,
Tower – 1, 15 & 16 Floor, Jupiter Mill Compound,
841 Senapati Bapat Marg, Elipinstone road,
Mumbai – 400 013.
2) Birla Sunlife Insurance Co. Ltd., Rep. by its
Manager, H.No. 24-390 above, Lakshmi Devamma Clinic,
Gandhi road, Proddatur, YSR District, Andhra Pradesh. ….. Respondents.
III. C.C. No. 09/2012
1. Kandula Venkata Subba Reddy, S/o Nadipi Subba Reddy.
Aged about 48 years, Hindu, residing at 3-44,
Payasampalli Village, Veerapunayuni Palli Mandal,
YSR District, Andhra Pradesh State.
2. Kandula Parvathamma, W/o Late K. Venkata Suibba Reddy
Aged about 34 years, House wife,
3. Kandula Nageswara Reddy, S/o Late K. Venkata Subba Reddy,
aged about 13 years, Minor, Rep. by his mother and natural
guardian Kandula Parvathamma, W/o Late K. Venkata Subba Reddy,
aged about 34 years, Hindu, House wife,
4. Kandula Swapna, D/o Late K. Venkata Subba Reddy,
aged about 18 years, Hindu,
No. 2 to 3 also are residing at 3-44, Payasampalli Village,
Veerapunayuni Palli Mandal, YSR District,
Andhra Pradesh State.
(Complainants 2 to 4 added as per
I.A.No. 138/2012, dt. 8-6-2012) ….. Complainants.
Vs.
1) Birla Sunlife Insurance Co. Ld., Rep. by its
Chief Executive Officer, One India Bulls Centre,
Tower – 1, 15 & 16 Floor, Jupiter Mill Compound,
841 Senapati Bapat Marg, Elipinstone road,
Mumbai – 400 013.
2) Birla Sunlife Insurance Co. Ltd., Rep. by its
Manager, H.No. 24-390 above, Lakshmi Devamma Clinic,
Gandhi road, Proddatur, YSR District, Andhra Pradesh. ….. Respondents.
These complaints coming on this day for final hearing on 02-12-6-2014 in the presence of Sri V. Eswara Reddy, Advocate for complainants and Sri C.K. Bramhaiah, Advocate for Respondents and upon perusing the material papers on record, the Forum made the following:-
C O M M O N O R D E R
(Per Sri V.C. Gunnaiah, President)
Since the complainants and the respondents in all the above cases i.e. C.C. Nos. 07/2012, 08/2012 & 09/2012 are same and question involved is also the same and the pleadings are also identical, they are disposed of by this common order.
2. The complainants in the above three complaint cases are filed under Section 12 & 14 R/w Section 2 (1) of the Consumer Protection Act, 1986 (for short herein after called as C.P. Act).
3. C.C.No. 7/2012:- The complainants in C.C.No. 7/2012 filed complaint praying this forum to direct the respondents to pay policy assured sum of Rs. 1,83,600/- + additional death accidental benefit of Rs. 1,83,600/- totaling Rs. 3,67,200/- with interest @ 12% p.a. and to pay Rs. 20,000/- towards mental agony and Rs. 10,000/- towards costs for deficiency of services on the part of the respondents in paying insurance amount.
4. C.C.No. 8/2012:- The complainants in C.C.No. 8/2012 filed complaint praying this forum to direct the respondents to pay policy assured sum of Rs. 13,50,000/- with accidental death benefit along with interest @ 12% p.a. and to pay Rs. 20,000/- towards mental agony and Rs. 10,000/- towards costs for deficiency of services on the part of the respondents in paying insurance amount.
5. C.C.No. 9/2012:- The complainants in C.C.No. 9/2012 filed complaint praying this forum to direct the respondents to pay policy assured sum of Rs. 13,50,000/- with accidental death benefit along with interest @ 12% p.a. and to pay Rs. 20,000/- towards mental agony and Rs. 10,000/- towards costs for deficiency of services on the part of the respondents in paying insurance amount.
6. C.C.No. 7/2012:- The averments of complaint in C.C07/2012 in brevity are that K. Venkata Subba Reddy is the policy holder of policy No. 044522297 issued by the respondents company on 25-10-2011. The policy covers assured amount of Rs. 1,83,600/- + accidental death benefit of Rs. 1,83,600/- totaling Rs. 3,67,200/- to the policy holder. The policy risk commenced from 25-11-2010 onwards. 1st complainant is the cousin of policy holder K. Venkata Subba Reddy, 2nd complainant is the wife of K. Venkata Subba Reddy policy holder and 3rd & 4th complainants are minor son and daughter of policy holder K. Venkata Subba Reddy. Complainants 2 to 4 are legal heirs of deceased K. Venkata Subba Reddy of policy holder. On the request of the respondents company agent the deceased policy holder took policies after going medical tests and after paying premium of Rs. 6,059/- and the respondents company issued policy bearing No. 044522297 in favour of K. Venkata Subba Reddy. While so on 17-3-2011 at about 10.00 a.m the policy holder K. Venkata Subba Reddy went to his agriculture fields at about 12.30 p.m a snake bite him, he was shifted to Govt. Hospital, Vempalli while undergoing treatment he died in hospital at about 5.00 p.m due to snake bite. 2nd complainant gave complaint to Gangireddy palli Police station on 18-3-2011 stating that her husband died due to snake bite and police registered a case under Cr. No. 30/2011 under section 174 of Cr.PC and conducted inquest and post mortem over the dead body of the deceased K. Venkata Subba Reddy. Inquest and post mortem revealed K. Venkata Subba Reddy died due to snake bite. Thus the death of K. Venkata Subba Reddy the policy holder was accidental death and the policy covers accidental death benefits. 1st complainant was shown as nominee by the deceased. The complainants are living jointly, after the death of policy holder complainant No. 1 approached respondent No. 2 by producing all relevant documents for settlement of the policy claim. He also approached the R2 claim the benefits under the policy issued to deceased K. Venkata Subba Reddy. But they did not give proper reply and not settl3ed the policy amount. Hence, he issued legal notice on 4-11-2011 to the respondents calling upon them to pay Rs. 3,67,200/- with interest @ 12% p.a. respondent No. 1 gave reply on 22-11-2011 with false allegations that the life assured was under treatment for pulmonary tuberculosis prior to the date of application and repudiated the claim and the same is not correct. Hence, the complaint for policy assured amount + accidental death benefit under the policy from the respondents.
7. The respondents 1 & 2 / opposite parties 1 & 2 filed common counter denying the allegations in the complaint and called upon the complainants to prove all of them. It is further averred that the deceased policy holder after completely understanding the terms and conditions of the product of Bachat Endowment Plan of the opposite parties applied for Insurance Policy vide proposal form No. A42348615, dt. 22-11-2010 and 1st complainant was the proposed nominee. In proposal form the policy holder gave all relevant details and information in the prescribed form for an assured sum of Rs. 1,83,600/- and the premium is Rs. 6,059/- annually for term of 20 years. On the information and declaration given by the policy holder the opposite parties issued policy. In the proposal form the policy holder gave answers pertaining to insurance declaration and medical history of the life assured, he filled up and signed. The policy holder duly understood the terms and conditions of the policy. If the questioner are incorrect and untrue the contract shall be null and void and no liability to the opposite parties to pay assured amount. During the course of investigation it was revealed that the deceased policy holder was under treatment for pulmonary tuberculosis prior to the date of application for issuance of policy and he was suffering with HIV infection and approached Primary Health Center, Veerapunarayana palli and underwent treatment for the said disease from March 2010. Thus policy holder suppressed the material facts of ill health prior to the issuing of policy. Hence, the opposite parties does not held any liability under the said policy of life insurance contract are contracts “uberrimae fides”. Whether observes good faith on the parties to the contract i.e. discloses all material facts in respect of risk covered by the insurance. But the deceased policy holder suppressed the material facts and mislead the insurer. Therefore, the insurer gave a reply to the complainant to the notice issued on 4-11-2011. Thus there is no deficiency of service on the part of the opposite parties and they rightly repudiated the claim of the complainants. Hence, the complaint is liable to be dismissed.
8. C.C No. 8/2012: - The averments of complaint in C.C08/2012 in brevity are that K. Venkata Subba Reddy is the policy holder of policy No. 04490147 issued by the respondents company on 31-10-2010. The policy covers assured amount of Rs. 13,50,000/- with accidental death benefit to the policy holder. The policy risk commenced from 31-10-2010 onwards. 1st complainant is the cousin of policy holder K. Venkata Subba Reddy, 2nd complainant is the wife of K. Venkata Subba Reddy policy holder and 3rd & 4th complainants are minor son and daughter of policy holder K. Venkata Subba Reddy. Complainants 2 to 4 are legal heirs of deceased K. Venkata Subba Reddy of policy holder. On the request of the respondents company agent the deceased policy holder took policies after going medical tests and after paying premium of Rs. 8,870/- towards policy under various heads in 2nd respondent office and thereafter on 30-10-2010 the respondent company issued above policy. The policy. The policy coverage is as follows.
Coverage | Face amount (Rupees) | Model Premium |
BSLI Dream Endow 2010 BSA-Term 20 pay 20 | 1,50,000/- | 7,500/- |
BSLI Dream Endow 2010 ESA – Term 20 pay 20 | 10,00,000/- | 1,205/- |
BSLI ADD Rider 2010 – Term 20 pay 20 | 2,00,000/- | 165/- |
The policy covers accidental death benefit also. While so on 17-3-2011 at about 10.00 a.m the policy holder K. Venkata Subba Reddy went to his agriculture fields at about 12.30 p.m a snake bite him, he was shifted to Govt. Hospital, Vempalli while undergoing treatment he died in hospital at about 5.00 p.m due to snake bite. 2nd complainant gave complaint to Gangireddy palli Police station on 18-3-2011 stating that her husband died due to snake bite and police registered a case under Cr. No. 30/2011 under section 174 of Cr.PC and conducted inquest and post mortem over the dead body of the deceased K. Venkata Subba Reddy. Inquest and post mortem revealed K. Venkata Subba Reddy died due to snake bite. Thus the death of K. Venkata Subba Reddy the policy holder was accidental death and the policy covers accidental death benefits. 1st complainant was shown as nominee by the deceased. The complainants are living jointly, after the death of policy holder complainant No. 1 approached respondent No. 2 by producing all relevant documents for settlement of the policy claim. He also approached the R2 claim the benefits under the policy issued to deceased K. Venkata Subba Reddy. But they did not give proper reply and not settl3ed the policy amount. Hence, he issued legal notice on 4-11-2011 to the respondents calling upon them to pay Rs. 13,50,000/- with interest @ 12% p.a. respondent No. 1 gave reply on 22-11-2011 with false allegations that the life assured was under treatment for pulmonary tuberculosis prior to the date of application and repudiated the claim and the same is not correct. Hence, the complaint for policy assured amount + accidental death benefit under the policy from the respondents.
9. The respondents 1 & 2 / opposite parties 1 & 2 filed common counter denying the allegations in the complaint and called upon the complainants to prove all of them. It is further averred that the deceased policy holder after completely understanding the terms and conditions of the product of Bachat Endowment Plan of the opposite parties applied for Insurance Policy and issued policy and 1st complainant was the proposed as his nominee. In proposal form the policy holder gave all relevant details and information in the prescribed form for an assured sum of Rs. 13,50,000/- and the premium of Rs. 8.870/-. On the information and declaration given by the policy holder the opposite parties issued policy. In the proposal form the policy holder gave answers pertaining to insurance declaration and medical history of the life assured, he filled up and signed the policy holder duly understood the terms and conditions of the policy. If the questioner are incorrect and untrue the contract shall be null and void and no liability to the opposite parties to pay assured amount. During the course of investigation it was revealed that the deceased policy holder was under treatment for pulmonary tuberculosis prior to the date of application for issuance of policy and he was suffering with HIV infection and approached Primary Health Center, Veerapunarayana palli and underwent treatment for the said disease from March 2010. Thus policy holder suppressed the material facts of ill health prior to the issuing of policy. Hence, the opposite parties does not held any liability under the said policy of life insurance contract are contracts “uberrimae fides”. Whether observes good faith on the parties to the contract i.e. discloses all material facts in respect of risk covered by the insurance. But the deceased policy holder suppressed the material facts and mislead the insurer. Therefore, the insurer gave a reply to the complainant to the notice issued on 4-11-2011. Thus there is no deficiency of service on the part of the opposite parties and they rightly repudiated the claim of the complainants. Hence, the complaint is liable to be dismissed.
10. C.C. No. 09/2012:- The averments of complaint in C.C09/2012 in brevity are that K. Venkata Subba Reddy is the policy holder of policy No. 004515454 issued by the respondents company on 20-11-2010. The policy covers assured amount of Rs. 13,50,000/- with accidental death benefit to the policy holder. The policy risk commenced from 20-11-2010 onwards. 1st complainant is the cousin of policy holder K. Venkata Subba Reddy, 2nd complainant is the wife of K. Venkata Subba Reddy policy holder and 3rd & 4th complainants are minor son and daughter of policy holder K. Venkata Subba Reddy. Complainants 2 to 4 are legal heirs of deceased K. Venkata Subba Reddy of policy holder. On the request of the respondents company agent the deceased policy holder took policies after going medical tests and after paying premium of Rs. 8,870/- towards policy under various heads in 2nd respondent office and thereafter on 20-11-2010 the respondent company issued above policy. The policy. The policy coverage is as follows.
Coverage | Face amount (Rupees) | Model Premium |
BSLI Dream Endow 2010 BSA-Term 20 pay 20 | 1,50,000/- | 7,500/- |
BSLI Dream Endow 2010 ESA – Term 20 pay 20 | 10,00,000/- | 1,205/- |
BSLI ADD Rider 2010 – Term 20 pay 20 | 2,00,000/- | 165/- |
The policy covers accidental death benefit also. While so on 17-3-2011 at about 10.00 a.m the policy holder K. Venkata Subba Reddy went to his agriculture fields at about 12.30 p.m a snake bite him, he was shifted to Govt. Hospital, Vempalli while undergoing treatment he died in hospital at about 5.00 p.m due to snake bite. 2nd complainant gave complaint to Gangireddy palli Police station on 18-3-2011 stating that her husband died due to snake bite and police registered a case under Cr. No. 30/2011 under section 174 of Cr.PC and conducted inquest and post mortem over the dead body of the deceased K. Venkata Subba Reddy. Inquest and post mortem revealed K. Venkata Subba Reddy died due to snake bite. Thus the death of K. Venkata Subba Reddy the policy holder was accidental death and the policy covers accidental death benefits. 1st complainant was shown as nominee by the deceased. The complainants are living jointly, after the death of policy holder complainant No. 1 approached respondent No. 2 by producing all relevant documents for settlement of the policy claim. He also approached the R2 claim the benefits under the policy issued to deceased K. Venkata Subba Reddy. But they did not give proper reply and not settl3ed the policy amount. Hence, he issued legal notice on 4-11-2011 to the respondents calling upon them to pay Rs. 13,50,000/- with interest @ 12% p.a. respondent No. 1 gave reply on 22-11-2011 with false allegations that the life assured was under treatment for pulmonary tuberculosis prior to the date of application and repudiated the claim and the same is not correct. Hence, the complaint for policy assured amount + accidental death benefit under the policy from the respondents.
11. The respondents 1 & 2 / opposite parties 1 & 2 filed common counter denying the allegations in the complaint and called upon the complainants to prove all of them. It is further averred that the deceased policy holder after completely understanding the terms and conditions of the product of Bachat Endowment Plan of the opposite parties applied for Insurance Policy and issued policy and 1st complainant was the proposed as his nominee. In proposal form the policy holder gave all relevant details and information in the prescribed form for an assured sum of Rs. 13,50,000/- and the premium of Rs. 8.870/-. On the information and declaration given by the policy holder the opposite parties issued policy. In the proposal form the policy holder gave answers pertaining to insurance declaration and medical history of the life assured, he filled up and signed the policy holder duly understood the terms and conditions of the policy. If the questioner are incorrect and untrue the contract shall be null and void and no liability to the opposite parties to pay assured amount. During the course of investigation it was revealed that the deceased policy holder was under treatment for pulmonary tuberculosis prior to the date of application for issuance of policy and he was suffering with HIV infection and approached Primary Health Center, Veerapunarayana palli and underwent treatment for the said disease from March 2010. Thus policy holder suppressed the material facts of ill health prior to the issuing of policy. Hence, the opposite parties does not held any liability under the said policy of life insurance contract are contracts “uberrimae fides”. Whether observes good faith on the parties to the contract i.e. discloses all material facts in respect of risk covered by the insurance. But the deceased policy holder suppressed the material facts and mislead the insurer. Therefore, the insurer gave a reply to the complainant to the notice issued on 4-11-2011. Thus there is no deficiency of service on the part of the opposite parties and they rightly repudiated the claim of the complainants. Hence, the complaint is liable to be dismissed.
12. The three matters have been disposed by this forum on 22-6-2012 by common order and dismissed all complaints. The complainants preferred appeals before Hon’ble A.P. Consumer Disputes Redressal Commission, Hyderabad in F.A. Nos. 569/2012, 570/2012 and 571/2012 and the Hon’ble Hon’ble A.P. Consumer Disputes Redressal Commission by common order allowed the F.A’s on 25-3-2013 by setting aside the orders of this forum and remitted back the matters for fresh disposal according to law keeping in view of the observations made in the order after giving an opportunity to both parties to produce further evidence by examining the doctor concerned, who issued post mortem certificate etc., about the death of deceased.
13. After receiving case records an opportunity was given to both parties to adduce evidence on behalf of the complainant Dr. Narendradu is examined as PW1 and got marked Exhibits A1 to A9 and on behalf of respondents Dr. S. Anil Ravi Kumar is examined as RW1 and got marked exhibits B1 to B6.
14. On the basis of the above pleadings the following points are settled for determination.
- Whether there is any negligence and deficiency of service on the part of the respondents?
- Whether the complainants are entitled for the relief’s as prayed for?
- To what relief?
15. Heard both sides.
16. Point No.1:- It is not a dispute between the parties that K. Venkata Subba Reddy is a policy holder bearing policy No. 044522297, dt. 25-11-2010 in C.C. No. 02/2012, policy No. 004490147, dt. 31-10-2010 for an amount of Rs. 13,50,000/- in C.c. No. 8/2012 and policy No. 004515454, dt. 20-11-2010 for an amount of Rs. 13,50,000/- in C.C. No. 09/2012. It is also not in dispute that the deceased life assured K. Venkata Subba Reddy paid premiums to the above policies before issuing them to him by the respondents. Thus it is proved by the complainants that the life assured K. Venkata Subba Reddy obtained the above policies issued by the respondents on the respective dates i.e. on 25-11-2010, 31-10-2010 and 20-11-2010 by paying premium of Rs. 6,059/-, Rs. 8,070/- and Rs. 8,870/- for the above policies. The policies came into force from 21-10-2010, 31-10-2010 and 20-11-2010 respectively.
17. According to complainants the policy holder K. Venkata Subba Reddy died on 17-3-2011 due to snake bite. The respondents / opposite parties denied the death of deceased due to snake bite contending that the deceased policy holder was suffering with pulmonary disease and HIV and took treatment. Thus, he suppressed his medical health condition prior to issuing policy and died due to that diseases.
18. Now it has to be seen whether the deceased policy holder K. Venkata Subba Reddy died due to snake bite or pulmonary or HIV disease and the deceased suppressed the material facts in the proposal form and the respondents / opposite parties can repudiated the contract on that ground.
19. PW1 is the doctor, who worked as Medical Officer in Government Hospital, Vempalli from 1992 to 2011. He is examined to speak about the post mortem conducted on the deceased policy holder K. Venkata Subba Reddy and the cause of his death. According to PW1, the doctor on 18-3-2011 at about 3.00 p.m he received requisition from S.H.O., Gangi Reddypalli police station and conducted post mortem examination over the dead body of K. Venkata Subba Reddy and found the following injuries viz., 1) two fang marks with severe discoloured oedematous area all over the left dorsal foot, 2) A moderately built and nurshined male body of 5.7 ft. present on the dorsal with approximately 34 years of age. Left foot is discoloured with massive edema. He also conducted internal examination. He is of the opinion that the deceased would appeared to be died of sudden shock and cardiorespiratory failure, due to snake bite on left dorsal foot 20 to 24 hours prior to the examination. In cross examination of PW1 by respondents it is not established death is not due to snake bite. As against this evidence the respondents examined RW1, who is Medical officer at Veerapunainapalli from March 2011 onwards. According to him the deceased K. Venkata Subba Reddy was treated for tuberculosis from March 2010 to September 2010 and Ex. A4 record contains that he is HIV positive. His evidence also disclosed that he is having more chances of opportunistic infections and if he takes antiretroviral therapy he has prolong span of life. In the cross examination he further says that the deceased has first category of pulmonary disease, which is not dangerous stage and no X-ray was taken on him and there was no imminent danger to him leading to death. Ex. B4 does not contain the stage of HIV. His evidence also discloses in earlier stage of pulmonary disease lungs would normally function and no possibility of death at that stage.
20. So by the evidence of PW1, the post mortem doctor and Ex. A4 post mortem certificate it is proved by the complainants that the deceased died due to snake bite on 17-3-2010 and not due to any pulmonary disease or HIV disease. Ex. A3 inquest report also revealed that the deceased died due to snake bite only. The FIR Ex. A2 given by 2nd complainant revealed that the deceased died due to snake bite and gave report by his wife to police. Though a contention was raised that the deceased had pulmonary disease and HIV positive and he suppressed the same. But the cause of death in this case is not due to pulmonary disease or HIV. The evidence of doctor RW1 clearly goes to show that the deceased was treated for pulmonary disease and found HIV positive but the pulmonary disease was at first stage and is not danger leading to death of him at this stage. So the death of deceased was not due to pulmonary disease or HIV positive by him. On that ground the respondents / opposite parties cannot repudiate the claim when the policies covered risk of accidental death of the deceased policy holder. In this case the complainants clearly and categorically established that the deceased K. Venkata Subba Reddy, who is policy holder in three policies referred above died due to snake bite on 17-3-2011, which is accidental death. Therefore, the respondents / opposite parties who issued above policies to the deceased are liable to pay the sum assured with accidental death benefits to the legal heirs of deceased i.e. complainants 2 to 4, who are wife and children of him and the complainant 2 to 4 are entitled to receive the sum assured and death benefits under the policies. But the respondents / opposite parties did not settled the claim of complainants, though legal notice was issued. Therefore, there is deficiency of service and negligence in settling the claim of complainants by the respondents. Accordingly, point No. 1 is answered in favour of complainants.
21. Point No. 2. The 1st complainant is shown as nominee by the deceased policy holder under three policies above. But as seen from the record the 1st complainant is no way concerned to receive the claim under the policies when the complainants 2 to 4, who are wife and children and legal heirs of deceased policy holder are very much alive. In this case the complainants 2 to 4, wife and minor son and daughter of deceased policy holder K. Venkata Subba Reddy are entitled to the sum assured and death benefits under the policies in this case. Therefore, we hold the policy amounts and benefits covered there under shall go to the complainants 2 to 4 only and they are entitled to receive the sum from the respondents. 1st complainant K. Venkata Subba Reddy was shown as nominee is not entitled for the claim under the policies. Thus the complaint against 1st complainant is liable to be dismissed. Accordingly, point No. 2 is answered.
22. Point No. 3:- C.C. No. 7/2012 In the result the complaint is allowed, directing the respondents to pay an amount of Rs. 3,67,200/- (Rupees three lakhs sixty seven thousand two hundred only) with interest @ 6% p.a. from the date of filing of the complaint i.e. on 8-6-2012 till realization, to pay Rs. 2,000/- (Rupees Two thousand only) towards mental agony and Rs. 1,000/- (Rupees one thousand only) towards costs to the complainants 2 to 4 i.e. wife, son and daughter of the deceased / insured K. Venkata Subba Reddy. The 1st complainant Kandula Venkata Subba Reddy is not entitled for any compensation and complaint against him is dismissed without costs. The respondents shall pay above amounts within 45 days from the date of receipt of this order.
23. C.C. No. 8/2012 :- In the result the complaint is allowed, directing the respondents to pay an amount of Rs. 13,50,000/- (Rupees Thirteen lakhs Fifty thousand only) with interest @ 6% p.a. from the date of filing of the complaint i.e. on 8-6-2012 till realization, to pay Rs. 2,000/- (Rupees Two thousand only) towards mental agony and Rs. 1,000/- (Rupees one thousand only) towards costs to the complainants 2 to 4 i.e. wife, son and daughter of the deceased / insured K. Venkata Subba Reddy. The 1st complainant Kandula Venkata Subba Reddy is not entitled for any compensation and complaint against him is dismissed without costs. The respondents shall pay above amounts within 45 days from the date of receipt of this order
24. C.C. No. 9/2012 :- In the result the complaint is allowed, directing the respondents to pay an amount of Rs. 13,50,000/- (Rupees Thirteen lakhs Fifty thousand only) with interest @ 6% p.a. from the date of filing of the complaint i.e. on 8-6-2012 till realization, to pay Rs. 2,000/- (Rupees Two thousand only) towards mental agony and Rs. 1,000/- (Rupees one thousand only) towards costs to the complainants 2 to 4 i.e. wife, son and daughter of the deceased / insured K. Venkata Subba Reddy. The 1st complainant Kandula Venkata Subba Reddy is not entitled for any compensation and complaint against him is dismissed without costs. The respondents shall pay above amounts within 45 days from the date of receipt of this order
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open forum, this the 16th December 2014.
MEMBER MEMBER PRESIDENT
C.C. No. 7/2012, 8/2012 & 9/2012
APPENDIX OF EVIDENCE
Witnesses examined.
For Complainant
PW1 Dr. K. Narendradu, dt. 05-6-2014.
For Respondents :
RW1 Dr. S. Anil Ravi Kumar, dt. 10-10-2014.
DOCUMENTS MARKED
Exhibits marked for complainants: -
Ex. A1 P/c of premium paid certificate issued in favour of K. Venkata Subba
Reddy.
Ex. A2 P/c of FIR No. 30/2011, dt. 15-3-2011.
Ex. A3 P/c of inquest report.
Ex. A4 P/c of post mortem certificate.
Ex. A5 O/c of legal notice from complainants advocate to Respondents,
dt. 4 -11-2011.
Ex. A6 O/c of reply notice from Respondents to complainants advocate,
dt. 22-11-2011
Ex. A7 Two postal receipts.
Ex. A8 Two postal acknowledgement cards.
Ex. A9 P/c of death certificate issued by the Village secretary, Payasam palli,
V.N. pall Mandal.
Exhibits marked for Respondents: -
Ex. B1 P/c of application for proposal.
Ex. B2 P/c of claimants statement.
Ex. B3 P/c of letter dt. 4-7-2011.
Ex. B4 P/c of out patient card issued by PHC, V.N.palli,
Ex. B5 P/c of investigation report, dt. 27-9-2011.
Ex. B6 P/c of repudiation letter dt. 27-9-2011.
MEMBER MEMBER PRESIDENT
Copy to :-
- Sri V. Eswara Reddy, Advocate for complainants.
2) Sri C.K. Bramhaiah, Advocate for Respondents
B.V.P
