Karnataka

Chitradurga

CC/57/2015

Smt.Girijamma W/o. Late Yadagodu Rajashekraiah - Complainant(s)

Versus

The Manager, HDFC Life Insurance Co.Ltd., - Opp.Party(s)

Shri.K.B.Chandrappa

14 Mar 2016

ORDER

   COMPLAINT FILED ON :04/09/2014

               DISPOSED ON:14/03/2016

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHITRADURGA

 

CC. NO. 57/2015 DATED: 14th MARCH 2016

 

PRESENT :-     SRI. T.N. SREENIVASAIAH      PRESIDENT                                      B.A., LL.B.,

                        SRI.H.RAMASWAMY,               MEMBER

                                         B.Com., LL.B.,(Spl.)

        SMT.G.E.SOWBHAGYALAKSHMI,       

                                         B.A., LL.B.,                   MEMBER

COMPLAINANTS	Smt.Girijamma, W/o Late Yadagodu Rajashekaraiah, Household work, Hale Sirigere Village, Harihara Taluk, Davanagere Dist.   (Rep by Smt/Sri. K.B. Chandrappa,  Advocate)
OPPOSITE PARTIES	1. The Manager, HDFC Standard Life Insurance Co. Ltd., I Floor, Old Savitha Bhavan Building, Beside Head Post Office, Holalkere Road, Chitradurga.   2. The Manager (Claims), HDFC Standard Life Insurance Co. Ltd., 11th Floor, Lodha Excelus, Apollo Mills Compound, N.M. Joshi Road, Mahalaxmi, Mumbai-400 011.   (Rep by Smt/Sri. K.E. Mallikarjuna,  Advocate for OP No.1 and OP No.2 ex-parte)

SMT.G.E. SOWBHAGYALAKSHMI, MEMBER.

ORDER

 

The complainant has been filed this complaint U/s 12 of C.P. Act 1986 against the opposite parties (here in called OPs) to direct the OP to pay compensation for a sum of Rs.10,00,000/- along with current interest and future at the rate of 24% p.a and mental agony and court cost and to grant such other reliefs.

 

 2.    Brief facts of the complaint is that, the complainant is the permanent resident of Hale Sirigere Village in Harihara Taluk.  Her husband namely Yadagodu Rajashekaraiah had obtained the policy from OP No.1 office situated at Chitradurga and the same is working under the control of its head office OP No.2.  The policy issued by the OP No.1 under the name and style "Click to Protect"(Term Plan) policy bearing No.16554496, the same is valid from 15.01.2014 to 15.01.2034.  The said policy term is 20 years and the husband of the complainant has to pay Rs.5,373/- per year to the OP No.1 and policy bond has been issued in favor of the complainant's husband.  The said policy covers the risk of the life of the policy holder in case of natural death or accidental death.  The said policy assured for a sum of Rs.10,00,000/-.  The said policy issued by the OP No.1 in favour of complainant's husband for the terms and condition that, every year the policy holder has to pay the premium, during the life time of policy holder, the said insurance company has not returned the policy amount and its benefits, it only covers the risk of the policy holder died naturally or in case the death is occurred due to accidental injuries, in the said circumstances only, the said policy covers the risk, and insurance company has to pay the sum assured to the nominee. 

 

3.     Complainant further stated that, the deceased Yadagodu Rajashekaraiah was working as an agriculturist and business man and he obtained the said policy and made his wife namely Girijamma, the present complainant, as his surviving nominee.  The said complainant and her children are entirely depending upon the earnings of her husband Yadagodu Rajashekaraiah.

 

4.     That on 03.09.2014 said Yadagodu Rajashekaraiah died due to chest pain (heart attack) at his residence, leaving behind his wife and children as his surviving nominee. 

 

5.     The complainant has given the claim form on 23.09.2014, along with original policy bond, death certificate of her husband, and cancelled cheque, bank account statement, voter ID, Pan Card and other relevant documents to the OPs, to settle the claim, after that, the OPs 1 and 2 are appointed the investigator by name Santhosh, the said investigator, completed his investigation, and recorded the statement of my client, and collected all the necessary document from the complainant and submitted the same, but the OPs inspite of knowing the fact, have not settle the claim even to this date, the complainant demanded and requested the OPs orally on several times, to settle the claim immediately, but the OPs have drag on to settle the claim, by one pretext  or the other, thereby complainant suffered lot, put into great mental shock, agony and now the complainant suffering from great financial problem. 

 

6.     Complainant further stated that, the OPs assured that, if the policy holder died, the policy amount will be paid to his nominee, she had approach the OPs with the original insurance policy of her husband and receipt, to pay the entire policy amount as assured by the OPs but the OPs are not settled the full and final settlement of insurance policy amount to the complainant.  The complainant requested and demanded the OP to pay the entire policy amount of her husband deceased Yadagodu Rajashekaraiah, in spite of it OPs have not taken any action in this regard. 

 

7.     It is stated that, the OPs No.1 and 2 neither paid the full insurance policy amount to the nominee i.e., to the complainant, thereby the complainant suffered lot, and she will put to great mental shock and agony, this clearly goes to show that the OPs have committed deficiency of their service and unfair trade practice towards the complainant.

 

8.     The complainant got issued the legal notice to the OPs No. 1 and 2 through her Advocate dated 18.11.2014 by RPAD and the said notice are served upon the OPs No.1 and 2, for that the OPs are got issued the evasive reply notice, the several averments made in the reply notice, are all false, created and concocted and they are repudiate the claim of the complainant and then the OPs told that, shortly settled the claim of the complainant, but even to this date, the OPs have not settled the legal claim of the complainant.  Hence, this complaint.

 

9.     The cause of action for the complaint has arisen on 15.01.2014 when the policy was issued in the name of the husband of the complainant, and policy holder was died on 03.09.2014 at his residence Hole Sirigere and submitted the claim form to the OPs on 23.09.2014 and the OPs issued the request letter on 18.11.2014 to the complainant, and the OP got issued the evasive reply notice dated 25.03.2015 on all the subsequent dates of correspondence, the OPs repudiate the claim of the complainant, and the office of the OP No.1 is situated at Chitradurga Town and OP No.1 issued the policy in favour of the complainant husband is within the jurisdiction of this Forum.  Hence, the complaint is within time and prayed for allow the complaint with cost.   

     

 

10.   On service of notice, the OPs appeared through his Advocate Sri. K.E. Mallikarjuna and not filed any version and affidavit evidence and not filed any documents on his side.

 

11. Complainant herself examined as PW-1 by filing affidavit evidence and filed  documents, the same were got marked as Ex A-1 to A-7.   

 

12. Heard the arguments.

 

13.   Now the Points that arise for our consideration for the decision of the complaint are that:-

 

Point No.1:-Whether the complainants prove that, her husband had taken insurance policy from the OPs and he died on 03.09.2014 and the claim under the policy made by the complainant has been repudiated by the OPs, thereby OPs have committed deficiency of service and unfair trade practice and she is entitled for the reliefs as prayed in the complaint?

 

Point No.2:- What order?

 

      

14. Our findings on the above points are as follows.

 

        Point No.1:- Partly Affirmative.

        Point No.2:- As per the final order.

::REASONS::

 

15. Point No. 1:-  It is the case of the complainant that, her husband namely Yadagodu Rajashekaraiah obtained the policy from OP No.1 under the name and style "Click to Protect"(Term Plan) policy bearing No.16554496 which was valid for the period from 15.01.2014 to 15.01.2034 for a term  of 20 years.   The husband of the complainant has to pay the premium of Rs.5,373/- per year to the OP No.1 and policy bond has been issued in his favor and the said policy covers the risk of the life assured in case of natural death or accidental death for a sum of Rs.10,00,000/- for the terms and condition that, every year the policy holder has to pay the premium, during the life time of policy holder, the said insurance company has not returned the policy amount and its benefits, it only covers the risk of the policy holder died naturally or in case the death is occurred due to accidental injuries, in the said circumstances only, the said policy covers the risk, and insurance company has to pay the sum assured to the nominee. 

 

16.   It is further taken contention that, the deceased Yadagodu Rajashekaraiah was an agriculturist and business man and he obtained the said policy and made his wife namely complainant, as his surviving nominee.  The said complainant and her children are entirely depending upon the earnings of her husband Yadagodu Rajashekaraiah.  On 03.09.2014 said Yadagodu Rajashekaraiah died due to chest pain (heart attack) at his residence, leaving behind his wife and children as his surviving nominee.  The complainant has given the claim form on 23.09.2014, along with original policy bond, death certificate of her husband, and cancelled cheque, bank account statement, voter ID, Pan Card and other relevant documents to the OPs, to settle the claim. After that, the OPs 1 and 2 are appointed the investigator by name Santhosh and he completed his investigation and recorded the statement of the complainant and collected all the necessary documents from the complainant and submitted the same to the OPs.  But the OPs did not settle the claim even till today.  The complainant demanded and requested the OPs orally on several times to settle the claim but, the OPs drag on to settle the claim one or the other pretext.  Therefore,   complainant suffered a lot and put into great mental agony financial problem. 

 

17.   It is further stated that, the OPs assured that, if the policy holder died, the policy amount will be paid to his nominee, therefore, complainant approached the OPs with the original insurance policy and receipt to pay the entire policy amount as assured by the OPs but, the OPs failed to settle the insurance policy amount to the complainant.  The several requests and demands made by the complainant to settle the entire policy amount, the OPs No.1 and 2 neither paid the full insurance policy amount to the nominee i.e., to the complainant, this clearly goes to show the deficiency in service and unfair trade practice on the part of OPs.  Thereafter,  complainant got issued the legal notice to the OPs No. 1 and 2 through her Advocate dated 18.11.2014 by RPAD, for that the OPs got issued the evasive reply and they have repudiate the claim of the complainant and told that, shortly they will settle the claim of the complainant, but, till today, OPs have not settled the claim of the complainant, which amounts to deficiency of service and unfair trade practice.  Therefore, complainant prayed for allow the complaint with cost.

 

18.   To prove the case of complainant, complainant herself examined as PW-1 by filing affidavit evidence and filed documents, the same were marked as Ex.A-1 to Ex.A-7.  On perusal of the documents, Ex.A-1 certified copy of the death certificate of policy holder i.e., husband of the complainant Yadagodu Rajashekaraiah, died on 03.09.2014 at his native place.  Ex.A-2 repudiation letter dated 25.03.2015 issued by the OPs.  It shows that the OPs have repudiated the claim of the complainant, it shows husband of the complainant obtained the policy No.16554496 from OPs and paid premium to OPs.  After receiving the premium, OPs issued the policy on 19.01.2014 by name HDFC Life Click 2 protect Policy No.16554496 for a sum assured of Rs.10,00,000/- towards the death benefits.  It further shows that, the OPs have repudiated the claim of the complainant stating that, "we regret our inability to accept your claim under policy No.16554496" and further stated "in case your claim to the company, you can do so within 30 days of receipt of this letter on the following address i.e., OP No.2".  Ex.A-3, 4 and 5 death claim applications given by the complainant to the OP No.2 along with documents requested to settle the claim with respect to the above said policy dated 23.09.2014, 03.11.2014 and 12.11.2014 respectively.  Ex.A-6 legal notice dated 18.11.2014 issued by the complainant through his Advocate calling upon the OP to settle the claim of the complainant.  Ex.A-7 Speed Post Acknowledgements and receipt, shows the said notice duly served on the OPs 1 and 2.  Ex.A-3 to 5 shows that, complainant has produced all the relevant documents to the OPs and requested to settle the claim of the complainant.  Ex.A-2 shows that, OPs have repudiated the claim of the complainant.  The reason stated in the Ex.A-2 for repudiation of the claim is not genuine but, OP without any proper reason repudiated the claim.  It clearly shows that, the OPs have committed deficiency in their service.  On perusal of the entire case records and documents, husband of the complainant had obtained the policy from OPs by name HDFC Life 2 Protect bearing Policy No.16554496 for sum assured of Rs.10,00,000/- towards the death benefits on 09.07.2014 for the period from 15.01.2014 to 15.01.2034 for 20 years.  As per Ex.A-1 the policy holder i.e., husband of the complainant died on 03.09.2014 at his native place due to heart attack.   At the time of the death of the policy holder the policy was in force.  It is the duty of the OPs to settle the claim of the complainant.  On perusal of the Ex.A-3 to A-5 shows the complainant produced all the relevant documents along with claim forms to the OPs and requested to settle the claim under the above said policy.  As per Ex.A-2 OPs have repudiated the claim of the complainant on 25.03.2015 and stated that, in case you wish to represent your claim to the company, you can do so within 30 days of receipt of this letter on the following address i.e., OP No.2. 

 

19.   We have carefully verifying the case records, affidavit evidence and documents filed by the complainant.  OPs are liable to settle the claim of the complainant i.e., the sum assured for of Rs.10,00,000/- as mentioned in the above said policy.  At the time of the death of the policy holder, the policy was in force and the OPs have no reason to escape from their liability in settling the claim.  OPs have failed to produce any evidence or documents before this Forum for non settling the claim of the complainant.  Till today OPs have not tried to settle the claim of the complainant.  When there is an acceptance of policy and the same was issued in favour of deceased Yadagodu Rajashekraiah, who is the husband of complainant and the same was in force at the time of death of the policy holder, the complainant is entitled to get the sum assured under the policy.  The attitude of the OPs clearly shows that, the OPs have committed deficiency of service and unfair trade practice towards the complainant.  Hence, we have no agitation to come to the conclusion that, the OPs have committed deficiency in service and unfair trade practice.  Accordingly, we answer Point No.1 held as affirmative. 

 

 20.  Point No.2:- As discussed on the above point and for the reasons stated therein, we pass the following:

 

 

ORDER

 

The complaint filed by the complainant u/Sec.12 of C.P Act ,1986 is partly allowed.

It is ordered that, the OPs are hereby directed to pay a sum of Rs.10,00,000/- along with  interest at the rate of 6% p.a from the date of complaint till realization to the complainant. 

It is further ordered that, the OPs are hereby directed to pay a sum of Rs.10,000/- for mental agony and Rs.5,000/- towards cost of the proceedings to the complainant.   

It is further ordered that, the OPs are hereby directed to comply the above said order within two months from the date of this order.

Accordingly, complaint is partly allowed. 

 

(This order is made with the consent of President and Member after the correction of the draft on 14/03/2016 and it is pronounced in the open Court after our signatures.)

 

 

 

 

 

MEMBER                                                         MEMBER   

 

 

PRESIDENT

 

-:ANNEXURES:-

Complainant by filing affidavit evidence taken as PW-1

Witness examined on behalf of Complainant:

                                                -Nil-

Witnesses examined on behalf of OPs:

-Nil-

Documents marked on behalf of Complainant:

01	Ex-A-1:-	Certified copy of the death certificate of husband of the complainant Yadagodu Rajashekaraiah.
02	Ex-A-2:-	Copy of repudiation letter dated 25.03.2015 issued by the OPs.
03	Ex-A-3 to 5:-	Death claim applications given by the complainant to the OP No.2 along with documents
04	Ex-A-6:-	Copy of legal notice dated 18.11.2014
05	Ex-A-7:-	Speed Post Acknowledgements and receipt.

 

Documents marked on behalf of OPs:

 

-Nil-

 

 

MEMBER                                                         MEMBER      

               

 

 

PRESIDENT

Rhr.