Andhra Pradesh

Visakhapatnam-II

CC/18/2012

Tekkali Eswari - Complainant(s)

Versus

The General Manager - Opp.Party(s)

Adari Appa Rao

15 Jun 2015

ORDER

                                              Date of Registration of the Complaint:13-01-2012 

                                                                                                Date of Order:15-06-2015

BEFORE THE DISTRICT CONSUMERS FORUM-II AT

                                VISAKHAPATNAM

 

P  r  e  s  e  n  t:

1.  Sri H. Ananda Rao, M.A., L.L.B.,

     President           

2. Smt K. Saroja, M.A. B.L.,

     Lady Member 

                                3. Sri C.V. Rao, M.A., B.L.,

                                     Male Member

 

                              Monday, the 15^th day of June, 2015.

                                CONSUMER CASE No.18/2012

Between:-

Sri Tekkali Eswari, W/o (late) Ramu, Hindu, aged

35 years, House No.9-76, Madhyaveedhi,

Munagapaka, Visakhapatnam District,

Pin: 531 033, presently come down to Visakhapatnam.

                                                                                           ….. Complainant

And:-

1.The General Manager, Tata AIG Life Insurance

   Company Limited, Corporate/Regd. Office,

   5^th & 6^th Floors, Peninsula Towers, Peninsula

   Corporate Park, Ganpatrao Kadam Marg.

   Lower Parel (W), Mumbai-400 013.

2.The Branch Manager, Tata AIG Life Insurance

   Company Limited., 2^nd Floor Upstairs of Andhra Bank,

   Opp: Vemana Mandiram, Aseelumetta Junction,

   Visakhapatnam -530 003.

                                                                                          …  Opposite Parties

                     

This case coming on 07.05.2015 for final hearing before us in the presence of Sri Adari Appa Rao, Advocate for the Complainant and Sri T.V.S.K. Kanaka Raju & M.A.S. Prabha, Advocates for the Opposite Parties and having stood over till this date for consideration, this Forum made the following:

 

                                                ORDER

        (As per Smt. K. Saroja Honourable Lady Member on behalf of the Bench)

 

1.       The case of the Complainant in brief is that the Complainant’s husband obtained an Insurance Policy from the Opposite Parties bearing No.C059419969 for an amount of Rs.2,00,000/- (Rupees Two lakhs only).   The Complainant has showed as the nominee in the said policy.   The date of commencement of risk covers from 09.03.2010.   On 02.08.2010 the insured accidentally slipped and fell down in their house while cleaning floor, and faced head injury, then he was shifted to Area Hospital at Anakapalle for treatment, as an Out-Patient.    After taken the treatment, he was shifted to their house, but unfortunately on 04.08.2010 he died due to above accident.   The Complainant informed the same to the 1^st Opposite Party dated 03.01.2011 and asked them to issue the Claim Form and requested them to settle the claim.   On 17.05.2011 the Complainant had received a repudiation letter from the 2^nd Opposite Party.  Then the Complainant issued another letter dated 25.06.2011 to the Opposite Parties, the Opposite Parties received the same but they did not settle the matter as the Complainant’s husband was suffering from Tuberculosis (TB).   Hence, this Complaint.

2.       a) For an amount of Rs.2,00,000/- (Rupees Two lakhs only) together with interest at the rate of 24% per annum on it from the date of claiming the amount till its payment;

          b) Compensation of Rs.50,000/- (Rupees fifty thousand only) towards  mental agony, pain and suffering;

          c) For the costs of the Complainant and;  

          d) For such other relief or reliefs as this Forum deems fit and proper under the circumstances of the case.

 

3.       The 2^nd Opposite Party strongly resisted the claim of the Complainant by contending, as can be seen from their counter.   The Opposite Parties stated that the Complainant’s husband concealed the fact that he had been suffering from Tuberculosis much prior to the application for insurance.   So, the Opposite Parties have rightly repudiated the claim of the Complainant so they have no liability to pay any reliefs asked by the Complainant.  

 

4.       At the time of enquiry, both parties filed their affidavits as well as written arguments to support their contentions.   Exs.A1 to A8 and Ex.B1 to B4 are marked for either side.

 

5.       Ex.A1 is the Policy Data (Schedule of Benefits and Premium) issued by the Opposite Parties in favour of the Complainant dated 09.03.2010.  Ex.A2 is the original copy of Treatment Details dated 02.08.2010.  Ex.A3 is the original Death Certificate issued by the Gram Sachivalayam, Munagapaka Panchayath dated 28.08.2010. Ex.A4 is the photo copy of Death Intimation letter addressed to the Manager of the 1^st Opposite Party dated 03.01.2011.   Ex.A5 is the original repudiation letter sent by the 2^nd Opposite Party dated 31.03.2011.   Ex.A6 is the original cover of letter sent by the 2^nd Opposite Party to the Complainant dated 17.05.2011.  Ex.A7 is photo copy of letter addressed by the Complainant to the 1^st Opposite Party dated 13.06.2011.   Ex.A8 is the original Re-joinder letter sent by the 1^st Opposite Party to the Complainant 30.07.2011. 

 

6.       Ex.B1 is the photo copy of Application Form of the insured/deceased dated 09.03.2011.   Ex.B2 is the photo copy of DMC Munagapaka RNTCP, Sub-centre wise TB case details S/C Munagapaka years of 2003 to 2008.  Ex.B3 is the photo copy of repudiation letter addressed by the 2^nd Opposite Party to the Complainant dated 31.03.2011.   Ex.B4 photo copy of Policy Data (Schedule of Benefits and Premium) issued by the Opposite Parties in favour of the Complainant dated 09.03.2010. 

 

7.       The fact shown from Ex.A7 is that the Complainant wrote a letter dated 13.06.2011 to the Opposite Party stating that her husband did not suffered from any disease in his life like Tuberculosis, his health is in good condition, in his total life he did not suffer from any disease.    Ex.A8 reveals that the insured stated in the application form in step No.9 question 4 health details of life insured the insured replied no.

 

8.       The point that would arise for determination in the case is:-

Whether there is any deficiency in service on the part of the Opposite Parties.   Whether the Complainant is entitled to any reliefs asked for?

 

9.         After careful perusal of the case record, this Forum finds that there is  dispute regarding health condition of insured.   The insured obtained insurance policy from the Opposite Parties, and paid premium of Rs.3,949/-.   The Opposite Parties repudiated the claim of the Complainant that the insured suppressed the heath condition i.e., he is suffering from Tuberculosis and obtained the policy, but they did not file any affidavit of investigator and original documents i.e., Ex.B2.   The Opposite Parties filed Ex.B2 is not issued by the Authenticated Officer, so this document is not valid.   They simply stated that the Complainant’s husband suffered from Tuberculosis but they did not file any treatment particulars before this Forum.  It amounts to deficiency in service on the part of the Opposite Parties.  The Complainant suffered a lot of mental agony by the acts of the Opposite Parties and forced to file this complaint is entitled to compensation.   Hence, the Complainant is entitled to insurance amount with interest, some compensation and costs too.

 

10.     In the result, this Complainant is allowed directing the Opposite Parties 1 and 2: a) to pay an amount of Rs.2,00,000/- (Rupees Two lakhs only) with interest @ 9% p.a. from 30.07.2011 till the date of actual realization, b) a compensation of Rs.20,000/- (Rupees Twenty thousand only) and c) Costs of Rs.2,500/- (Rupees Two thousand and five hundred only) to the Complainant.   Time for compliance, one month from the date of this order.

Dictated to the Steno, transcribed by him, corrected and pronounced by us in the Open Forum, this 15^th day of June, 2015.       

             

Sd/-                                      Sd/-                                       Sd/-

President                              Male Member                      Lady Member

                                     

 

APPENDIX OF EVIDENCE

For the Complainant:-

NO.	DATE	DESCRIPTIONOFTHEDOCUMENTS	REMARKS
Ex.A01	09.03.2010	Policy Data (Schedule of benefits and Premium) issued by the Ops in favour of the Complainant	Original
Ex.A02	02.08.2010	Treatment Details	Original
Ex.A03	28.08.2010	Death Certificate issued by the Gram Sachivalayam, Munagapaka Panchayath in favour of insured/deceased	Original
Ex.A04	03.01.2011	Death Intimation letter addressed by the Manager of the 1st OP	Photo copy
Ex.A05	31.03.2011	Repudiation letter sent by the 2nd OP	Original
Ex.A06	17.05.2011	Cover of letter sent by the 2nd OP to the Complainant	Original
Ex.A07	13.06.2011	Letter addressed by the Complainant to the 1st OP	Photo copy
Ex.A08	30.07.2011	Re-joinder letter sent by the 1st OP to the Complainant	Original

For the Opposite Parties:-            

                                                          

NO.	DATE	DESCRIPTIONOFTHEDOCUMENTS	REMARKS
Ex.B01	09.03.2011	Application Form of the insured/deceased	Photo copy
Ex.B02	2003 to 2008	DMC Munagapaka RNTCP, Sub-Centre wise TB case details S/C  Munagapakla	Photo copy
Ex.B03	31.03.2011	Repudiation letter addressed by the 2nd OP to the Complainant	Photo copy
Ex.B04	09.03.2010	Policy Data (Schedule of benefits and Premium) issued by the Ops in favour of the Complainant	Photo copy

 

                                                                                   

Sd/-                                  Sd/-                                               Sd/-

President                          Male Member                                Lady Member