The Executive Claims, Reliance Life Insurance ltd., Khammam. - Opp.Party(s)
Siddamsetti Venkateswarlu, Advocate, Khammam.
12 Nov 2010
ORDER
BEFORE THE DISTRICT CONSUMER FORUM AT KHAMMAM Varadaiah Nagar, Opp CSI Church consumer case(CC) No. CC/09/49
Kum. Gade Sailaja, D/o. Late Srinivas, R/o. Saradhi Nagar, Khammam.
...........Appellant(s)
Vs.
The Executive Claims, Reliance Life Insurance ltd., Khammam.
...........Respondent(s)
BEFORE:
Complainant(s)/Appellant(s):
OppositeParty/Respondent(s):
OppositeParty/Respondent(s):
OppositeParty/Respondent(s):
ORDER
BEFORE THE DISTRICT CONSUMERS FORUM AT KHAMMAM Dated this, the 09th day of November, 2010 CORAM: 1. Sri Vijay Kumar, B.Com., LL.B., President 2. Smt. V. Vijaya Rekha, B.Sc. B.L., Member 3. Sri.R.Kiran Kumar, B.Sc., LL.B., Member C.C.No.49 of 2009 Between: Kum. Gade Sailaja, D/o late Srinivas, Age:12years, being minor, rep. by her natural guardian, mother Smt. G.Rajani, R/o H.No. 1-5-70, Saradhinagar, Khammam Complainant And The Executive Claims, Reliance Life Insurance, Ltd., H.No.: 2-3-137/138, Gandhi Chowk, Khammam Town & District. Opposite party This C.C. is coming on before this Forum for final hearing in the presence of Sri S. Venkateswarlu, Advocate for complainant and of Sri G. Sita Rama Rao, Advocate for opposite party; upon perusing the material papers on record; upon hearing the arguments, and having stood over for consideration, till this day, this Forum passed the following:- ORDER (Per Sri.Vijay Kumar, President) This complaint is filed u/s.12-A of Consumer Protection Act, 1986. The averments made in the complaint are that the father of the complainant by name Gade Srinivas had obtained Insurance Child Policy bearing No.11731707 under Reliance Secure Child Regular from the opposite party for a sum of Rs.1, 00,000/-. The said policy was issued on 24-03-2008. Later Gade Srinivas, life assured died on 30-06-2008, at Mamatha General Hospital, Khammam. The above said policy was in force on the date of death of father of the complainant. He paid premium from time to time. Late Gade Srinivas nominated the complainant as a nominee, by virtue of said nomination the complainant became entitled for the amount covered under the policy. After the death of her father, the complainant through her mother submitted the claim form enclosing the original policy, death certificate and other documents. Late Gade Srinivas has not undergone treatment for any decease, all the relevant documents were submitted on 11-08-2008 in the Khammam branch of opposite party company, but the claim had not been settled. There is no communication from the end of opposite party. On 30-01-2009, the complainant got issued a legal notice to the opposite party demanding to settle the claim and the same was served, on that the opposite party got issued a reply notice on 05-02-2009 with false averments. Hence this complaint. 2. On receipt of notice, the opposite party appeared through its counsel and filed the counter. In the counter, all the averments made in the complaint are admitted in toto. It is admitted in the counter that late Gade Srinivas had taken Reliance Secure Child Regular plan policy for a sum of Rs.1,00,000/- by paying annual premium of Rs.20,000/- for a term of 10 years. The policy commenced from 24-03-2008 onwards. It is also admitted in the counter that the life assured Gade Srinivas expired on 30-06-2008 and in the course of scrutiny of documents, it was found that the deceased/policy holder was suffering from Cirrohosis of Liver with Portal Hypertension and diabetes Mellitus Type-II, Renal Failure, which is self evident from the Claim Form B. In order to fulfill the death claim of the complainant, the opposite party required previous medical reports of the deceased. The same was informed to the complainant vide letters dated 18-07-2008, 02-08-2008, 18-08-2008, 27-08-2008, 15-09-2008,06-10-2008 and 21-10-2008. The copies of said letters have been filed. The complainant failed to comply with requests for processing of death claim. The opposite party kept the claim on hold for want of documents. It is further submitted in the counter that the claim has not been repudiated, but it is kept on hold for want of documents. There is no deficiency of service on the part of opposite party and prayed to dismiss the complaint. On behalf of the complainant, chief affidavit is filed and the following documents have been filed. Ex.A1:- Office copy of legal notice, dated 30-1-2009. Ex.A2:- Courier receipt, 30-01-2009 Ex.A3:- Reply notice, dated 05.02.2009. Ex.A4:- Broacher of Reliance Secure Child Plan. Ex.A5:- Statement of account of deceased Gade Srinivas. Ex.A6:- Broacher of Reliance Secure Child (Regular) Plan Policy. The complainant as well as the opposite party filed written arguments. On behalf of the opposite party the following documents were filed and marked as Exhibits. Ex.B1:- Insurance Policy. Ex.B2:- Claim Form B. And other documents are the letters got issued by opposite party requesting the complainant to furnish the required documents. Heard both sides, perused the oral and documentary evidence. Upon which the points that arose for consideration are, 1) Whether the complainant is entitled to the amount covered under the policy? 2) To what relief? Point No.1:- It is an undisputed fact that the father of the complainant by name Gade Srinivas has taken a policy bearing No. 11731707 on 18-03-2008 for a sum of Rs.1,00,000/- by paying annual premium amount of Rs. 20,000/- for a term of 10 years commencing from 24-03-2008. The said life assured died on 30-06-2008. On the death of life assured the wife of the life assured submitted claim documents to the opposite party, whereby it was found that the policy holder was suffering from Cirrohosis of Liver with Portal Hypertension and diabetes Mellitus Type-II, Renal Failure, which is evident from claim form B, i.e. Ex.B2. In order to fulfill the death claim of the complainant, the opposite party company requires previous medical record and thereby addressed a number of letters to the complainant to furnish the previous health record of the life assured. For want of these documents the claim has not been repudiated. However, it is kept on hold. On perusal of Ex.B2, which is claim form B, medical attendance certificate become evident that the life assured died on 30-06-2008 with a complaint of Cirrohosis of Liver with Portal Hypertension and diabetes Mellitus Type-II, Renal Failure, this document is submitted by the complainant. Even after submitting claim form B, the opposite party wants to drag on the matter under one pretext or the other. Ex.B2 is very clear regarding the cause of death of life assured. It appears that the opposite party is unnecessarily dragging on the matter on some flimcy grounds. In fact, the beneficiary is a minor child, all the required documents have been submitted by the complainant to settle the claim of the life assured. In spite of submitting the required documents, the opposite party wants to drag on the matter unnecessarily. Apart from this the learned counsel for the complainant invites attention of this Forum regarding the terms and conditions of the broacher published by the opposite party company, which is marked as Ex.A.6, wherein it is clearly mentioned that in the event of the death of parent, the policy is in full force all future premiums are waived thereafter for the remaining policy term. The policy continues and the Company will continue to pay the original premiums as chosen by the policyholder on due date. According to this condition, the complainant is entitled not only to the sum assured, but also Rs.20,000/- paid towards premium amount by the life assured. In the light of these discussions the complaint is fit to be allowed. In the result, the complaint is allowed, directing the opposite party to pay an amount of Rs.1,00,000/- (Rupees one lakh only) covered under the policy bearing No.11731707 to the complainant together with interest at 9% p.a. from the date of filing of the complaint till the date of deposit and also directed to pay an amount of Rs.20,000/- paid towards premium. The complainant is a minor. In order to safe guard the interest of the minor, the amounts so deposited by the opposite party shall be kept in FDR until she attains the age of majority. There is no order as to costs and compensation. Dictated to the steno, transcribed by her, corrected and pronounced by us in the open forum on this 9th day of November, 2010. PRESIDENT MEMBER MEMBER DISTRICT CONSUMERS FORUM KHAMMAM Appendix of Evidence Witnesses examined for complainant: - None- Witnesses examined for opposite parties: - None- Exhibits marked for complainant: Ex.A1:- Office copy of legal notice, dated 30-1-2009. Ex.A2:- Courier receipt, 30-01-2009 Ex.A3:- Reply notice, dated 05.02.2009. Ex.A4:- Broacher of Reliance Secure Child Plan. Ex.A5:- Statement of account of deceased Gade Srinivas. Ex.A6:- Broacher of Reliance Secure Child (Regular) Plan Policy. Exhibits marked for opposite parties : Ex.B1:- Insurance Policy. Ex.B2:- Claim Form B. PRESIDENT MEMBER MEMBER DISTRICT CONSUMERS FORUM KHAMMAM
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