Andhra Pradesh

Chittoor-II at triputi

CC/26/2015

Smt. Reddyvari Hamsaveni, alias R.Hamsa, W/o. Late R.Raja Reddy - Complainant(s)

Versus

The Manager (Claims Section), SBI, General Insurance Company Ltd., - Opp.Party(s)

Syed Ghouse Ali

28 Oct 2016

ORDER

 

 

                                                                                                Filing Date:-17-06-2015                                                                                                               Order Date:  28-10-2016

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II, CHITTOOR AT TIRUPATI.

Present: - Sri. Ramakrishnaiah, President

                                                       Smt. T. Anitha, Member

FRIDAY, THE TWENTY EIGHTH DAY OF OCTOBER, TWO THOUSAND

AND SIXTEEN

 

C.C.No.26/2015

Between

1.Smt. R.Hamsaveni @ R.Hamsa,

W/o. Late R. Raja Reddy, Hindu,

Aged about 54 years, House wife,

 

2. R.Anand Kumar, S/o. Late R.Raja Reddy,

Hindu, aged about 32 years,

 

Both are residing at:

D.No.5-5-344/A,

Sarojinidevi Layout,

Tirupati Town,

Chittoor District.                                                                   … Complainants

 

And

1.The Manager (Claims Section),

SBI, General Insurance Company Ltd.,

Regd.Office at ‘NATRAJ’, 101,201&301,

Junction of Western Express Highway,

Andheri-Kurla Road, ANDHERI (East),

MUMBAI-400069,

State of Maharastra.

 

2. The Branch Manager,

SBI, General Insurance Company Ltd.,

D.No. 20-3-124, 3^rd Floor,

Penumadi Towers, Yerramitta,

Akkarampalli Road, Tirupati – 517507,

Chittoor District,

Stae of Andhra Pradesh.                                                    … Opposite parties

             This complaint coming on before us for final hearing on 14.10.2016 and upon perusing the complaint, chief affidavit, written arguments of the complainant and the  opposite parties and other relevant material papers on record and on hearing of             Sri. Syed Ghouse Ali, counsel for the complainant and Sri.K.Krishna Murthy, counsel for the opposite parties having stood over till this day for consideration, the Forum made the following:                                               

ORDER

DELIVERED BY SMT. T. ANITHA, MEMBER

ON BEHALF OF THE BENCH

           This complaint is filed by the complainant under Section 12 of the Consumer Protection Act 1986, complaining the deficiency of service on part of the opposite parties and prayed this Forum to direct the opposite parties to pay the assured amount of Rs.4,00,000/- to the complainant with interest @ 36% p.a. from the date of the claim i.e.16.05.2014 till realization and to pay Rs.20,000/- towards damages for causing mental agony and financial loss with interest if any and to pay costs of the complaint.

          2. The brief facts of the case are:  The husband of the 1^st complainant and the     father of the 2^nd complainant took insurance policy of the opposite parties in his life time Vide Masters Policy No. 137300-0000-00 with SBI Account No.SB31291267722 for a sum of Rs.4,00,000/- which commencing from 04.05.2013 for one year by paying prescribed premium amount and the opposite parties issued a  policy Certificate No.023258882 Dt.06.05.2013 to cover personal Accident Insurance Claim. The complainant further submitted that her husband accidentally fell from tree on 23.02.2014 and they rushed him to the SVRRGG Hospital and admitted with I.P.No.516 in Neurosurgery Department and while he was taking treatment on 27.02.2014 he died due to CERVICAL SPINE INJURY QUADRIPLEGIA RESPIRATORY DISTRESS and same was declared by the doctors and issued certificate to that effect. The complainants further submitted that they made a claim on 16.05.2014 by approaching the agent of the opposite party and submitted all the material documents such as original insurance certificate, no objection certificate from the 2^nd complainant, Revenue Records etc on 21.07.2014 and same was numbered as Claim No. 006225. The complainant submitted that after receiving the documents which are necessary to consider the claim of the complainant the opposite parties failed to consider their claim. Hence after repeated reminder letters by the 1^st complainant and finally she issued legal notice on 15.04.2015 to consider their claim, after receipt of the same the opposite parties failed to consider the claim which is nothing but deficiency of service on part of the opposite parties. Hence the complainant filed the present complaint.

           3. The opposite parties came in to appearance and opposite party no.1 filed the written version and same was adopted by the opposite party no.2. The opposite parties admitted the policy of Sri Reddyvari Raja Reddy the husband of the complainant no.1 and father of the complainant no.2 and admitted the claim and further contended that they issued letters to the complainants on 16.06.2014 and 02.07.2014 to submit required documents for the process of their claim, even after receipt of the said letters the complainants failed to submit the same.

          The opposite parties further contended that the complainants failed to prove that the deceased died due to injuries sustained by him through accident and failed to submit FIR, Postmortem Certificate and case sheet regarding the admission and treatment given to the deceased Reddyvari Raja Reddy at SVRRGG Hospital, Tirupati. Hence as the complainants failed to prove that the deceased died due to accident and failed to submit the required documents to settle the claim and also failed to file family members certificate to prove that they are the legal heirs of the deceased Raja Reddy. Hence there is no deficiency of service on part of them and the complaint is liable to be dismissed.

           4. The complainant no.1 filed her evidence on affidavit and on Exs.A1to A14 were marked on behalf of the complainant. On behalf of the opposite parties one Munish L.Kerkar S/o. Lakahan Kerkar, Assistant Manager filed his evidence on affidavit and on behalf of the opposite parties Ex.B1 to B4 were marked on behalf of them. Both parties filed their written arguments and oral arguments were heard.

          5.  Now the points for consideration are:

              (i) Whether there is any deficiency of service on part of the opposite parties    

                    towards the complainants?            

             (ii)  Whether the complainant is entitled for the reliefs as prayed for? If so?            

             (iii)  To what Result?

           6. Point No:-(i).  There is no dispute regarding the accidental insurance policy taken by the deceased at his life time from the opposite parties, because same was admitted by them. The main contention of the complainant, that her husband one Raja Reddy accidentally fell from tree on 23.02.2014 and he was admitted in SVRRGG Hospital, Tirupati and died on 27.02.2014 while he was taking treatment. The complainant who is the legally wedded wife of the deceased made a claim on 16.05.2014, but till today the opposite parties failed to consider her claim even after submission of required documents to process the claim.  

          The opposite parties filed the written version by admitting the policy of the complainant and further contended that the complainants failed to submit the required documents to process their claim even after several reminders issued by them to consider their claim. The opposite parties contended that the deceased was died due to injuries sustained by him through accident but, the complainants failed to file any supportive documents  i.e FIR, Postmortem Report, Case sheet of the deceased and also the family members certificate issued by the competent authority to show that the complainants are the legal heirs of the deceased Raja Reddy. Hence in the absence of any documentary proof that the deceased was died due to accident, the opposite parties are not able to consider the claim of the complainant and because of the latches on part of the complainant only the claim is still pending and there is no deficiency of service on part of the opposite parties and prayed this forum to dismiss the complaint.

          On behalf of the complainant Exs.A1 to A14 were marked. The Ex.A2 the medical certificate cum receipt issued by the Superintendent, SVRRGH Hospital, Tirupati          dt: 4.12.2014 regarding the admission of the patient on 23.02.2014 and he died on 27.02.2014 and also the complainant filed Ex.A5 & A7 the Aadhar cards of the complainants which shows that the deceased was the husband of the first complainant and father of the second complainant and the Ex.A7 the ration card issued by the competent authority which clearly shows that  the complainants are the legal heirs of the deceased. Hence it clearly shows that the complainants are the legal heirs of the deceased Raja Reddy.

         When the present complaint is pending the complainant filed the petition to sent for the document that is case sheet of the deceased from SVRRGG  Hospital, Tirupati the said petition was allowed and one Sri.K.Chandra, record Assistant of the SVRRGG Hospital was deputed by superintendent of SVRRGH Hospital attended before the Honourable District Forum, Tirupati on 18.08. 2016 and he submitted the case sheet of the deceased Raja Reddy and same was marked as Ex.X1, in the said case sheet in the O.P.Card dt: 23.02.2014 at about 02.18pm one patient was named Raja Reddy was brought to the hospital for the treatment, that he sustained injuries because he fell from tree at about 02.00pm and he was admitted in Neuro Surgery Department and he died on 27.02.2014 while he was taking treatment.  Hence it clearly shows that the deceased died due to the injuries sustained by him through accident as per Ex.X1. The complainant filed Ex:A2 medical certificate cum receipt issued by the superintendent SVRRGH Hospital, Tiruapti Dt: 04.12.2014 confirming the death of Rajareddy along with the complaint, itself clearly manifests the reason for the death of deceased, but the opposite parties even after submitting the said document by the complainant they have not settled the claim and have taken the same plea that because of the absence of proof of  accident they have not consider the claim is not at all acceptable. Hence it clearly shows that there is a deficiency of service on part of the opposite parties towards the complainant. Hence this point is answered in favour of the complainant.        

          7.Point(ii):-   In view of our finding in point no.1, the complainant is entitled to the policy amount of Rs.4,00,000/-.The complainant claimed Rs.20,000/- towards the damages for causing mental agony. According to the complainant they made a claim on 16.04.2014 and along with required documents and made several reminders to settle their claim, but the opposite parties after receipt of the same kept the claim pending. Hence the opposite parties are not justified in taking more than two years to settle the claim. Hence in our view the complainant is entitled for Rs.5,000/- towards mental agony and deficiency of service and also the complainant is also entitled  for Rs.2,000/- towards costs of the complaint. Hence this point is accordingly answered.

           8.Point(iii):-   In view of our discussion on points no.1 and 2, we are of the opinion that there is deficiency of service on part of the opposite parties and the complainants are entitled to the reliefs sought for, as such the complaint is to be allowed.

             In the result, the complaint is allowed in part directing the opposite parties 1 and 2 jointly and severally to pay an insurance amount of Rs.4,00,000/- (rupees four lakhs only) and the opposite parties further directed to pay Rs.5,000/- (rupees five thousand only) towards compensation for mental agony and deficiency of service suffered by the complainant and to pay Rs.2,000/- (rupees two thousand only) towards costs of the complaint. The opposite parties further directed to comply with the order within six (6) weeks from the date of receipt of copy of this order. Failing which, the above mentioned insurance amount of Rs.4,00,000/- (rupees four lakhs only) and  compensation amount of Rs.5,000/- (rupees five thousand only) shall carry interest @ 9% p.a. from the date of the complaint till realization.      

          Dictated to the stenographer, transcribed and typed by her, corrected and pronounced by me in the Open Forum this the 28^th day of October, 2016.

         Sd/-                                                                                                                Sd/-                                                                                                      

  Lady Member                                                                                                             President

 

APPENDIX OF EVIDENCE

 

Witnesses Examined on behalf of Complainant/s.

 

PW-1:  Smt R. Hamsaveni @ R.Hamsa (Chief Affidavit filed).

 

Witnesses Examined on behalf of Opposite Party/s.

 

RW-1: Mr. Manish L Kerkar (Chief Affidavit filed).

 

EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT/S.

Exhibits (Ex.A)	Description of Documents
	Photo copy (with Attestation) of Certificate cum letter of acceptance of Insurance issued by the 1st respondent to the Insurer/declared/R. Raja Reddy. Dt: 06.05.2013.
	Photo copy of Medical Certificate cum Receipt issued by the Superintendent, SVRRGG Hospital, Tirupati, Confirming the death of R. Raja Reddy.                Dt: 04.12.2014.
	Photo copy (with attestation) of Death Certificate of R. Raja Reddy issued by the Tirupati Municipal Corporation. Dt: 18.03.2014.
	Photo copy (with attestation) of Aadhaar Card of Late R.Raja Reddy. Aadhaar No.8721 1031 9222.
	Photo copy (with attestation) of Aadhaar Card of 1st Complainant R. Hamsa. Aadhaar No.4451 9740 6539
	Photo copy of Aadhaar Card of 2nd Complainant R. Anand Kumar. Aadhaar No.2604 2320 1131.
	Photo copy (with attestation) Ration Card of Late R.Raja Reddy.
	Office copy of letter to the Respondents given by the 1st Complainant.           Dt: 16.09.2014.
	Office copy of letter to the Respondents given by the 1st Complainant.           Dt: 05.11.2014.
	Office copy of letter to the Respondents given by the 1st Complainant.           Dt: 09.01.2015.
	Served letter (Attested Copy) of 1st Respondent to the Complainant.              Dt: 05.03.2015.
	Served letter (Attested Copy) of 1st Respondent to the Complainant.              Dt: 10.04.2015.
	Office copy of Demand Notice issued by the 1st Complainant to the Respondents.  Dt: 15.04.2015.
	Photo copy of Postal acknowledgement tracking record of 1st Respondent.

EXHIBITS MARKED ON BEHALF OF THE OPPOSITE PARTY/S.

Exhibits (Ex.B)	Description of Documents
	Photo copy of Insurance policy filed on behalf of Opposite Parties 1 and 2.  Dt: 06.05.2013.
	Photo copy of First Remainder Letter to R.V. Ananda Kumar by Opposite Party No.1. Dt: 02.07.2014.
	Photo copy of Letter Communicates to R.V. Ananda Kumar by Opposite Party No.1. Dt: 10.06.2015.
	Policy with terms and conditions filed on behalf of Opposite Parties 1 and 2. Dt: 05.01.2016

 

EXHIBITS MARKED ON BEHALF OF THE THIRD PARTY.

Exhibits	Description of Documents
(Ex-X1)	Original Case Sheet of R. Raja Reddy with Registration No.5196/2014.

 

                                                                                                                                     Sd/-

        President

                                                           // TRUE COPY //

                                                             // BY ORDER //

 

 

                                         Head Clerk/Sheristadar

                                              Dist. Consumer Forum-II, Tirupati.

 

 

Copies to:  1) The Complainant.

                   2)The Opposite parties 1 and 2.