BEFORE THE DISTRICT FORUM: KURNOOL

Present: Sri. T.Sundara Ramaiah, B.Com B.L., President

And

Sri. M.Krishna Reddy, M.Sc., M.Phil., Male Member

And

         Smt. S.Nazeerunnisa, B.A., B.L., Lady Member

Friday the 9^th day of March, 2012

C.C.No.155/2011

Between:

K.Bali Reddy, S/o K.Lakshmi Reddy, Contractor,

R/o H.No.28/458, Ward No.28, Nandyal - 518 502, Kurnool District.           

                                …Complainant

-Vs-

1. The Managing Director,M/s HDFC Standard Life Insurance Company Limited,

   5^th Floor, Eureka Towers,Mindspace Complex,Link Road, Malad (West),Mumbai - 400 064.

2. M/s HDFC ERGO General Insurance Company Limited,Represented  by its Claim Manager, Venkatesham Goud,

   2^nd Floor, 6-3-46/1,Road No.1,Bankara Hills, Hyderabad - 500 034.

3.The Branch Manager,        M/s HDFC Standard Life Insurance Company Limited, Opposite Meenakshi Lodge,

   Near R.T.C. Bus Stand,Nandyal- 518 502, Kurnool District.             

                             ....Opposite ParTies

This complaint is coming on this day for orders in the presence of Sri A.Ramasubba Reddy, Advocate for complainant and opposite parties 1 and 3 called absent and Sri L.Hari Hara Natha Reddy, Advocate for opposite party No.2 and upon perusing the material papers on record, the Forum made the following.     

                                        ORDER

                  (As per Sri. T.Sundara Ramaiah, President)

   C.C. No.155/2011

1.     This complaint is filed under section 12 of C. P. Act, 1986 praying:-

1. To direct the opposite parties to pay an amount of Rs.1,76,948/-;

1. To grant interest @ 24% per annum from the date of i.e., 27-05-2009;

1. To grant compensation of Rs.20,000/-;

1. To grant costs of Rs.5,000/-.

2.    The case of the complainant in brief is as under:-  The complainant insured his life with the opposite parties  for covering the risks of critical illness under the policy bearing No.12352229 dated 14-11-2008.  At the time of acceptance of the policy the doctor of the opposite parties conducted all the relevant tests and satisfied with the health condition of the complainant.  The opposite parties after satisfying fully about the health condition of the complainant issued the policy dated 14-11-2008.  On 18-10-2010 the complainant was admitted in KIMS Hospital, Hyderabad and underwent Heart Surgery.  The complainant spent an amount of Rs.1,76,948/-.  The complainant submitted the claim along with medical bills and case sheet.  The opposite party repudiated the claim on the ground that the complainant did not disclose vital information at the time of submitting the proposal form.  The complainant did not suppress any vital information in the proposal form.  The repudiation of the claim by the opposite parties is unfair.  There is deficiency of service on the part of opposite parties.  Hence the complaint.

3.     The claim against opposite party No.2 is dismissed as not pressed.  Opposite parties 1 and 3 set exparte.

4.     On behalf of the complainant Ex.A1 to A12 are marked sworn affidavit of complainant is filed. 

5.     Complainant filed written arguments.

6.     Now the points that arise for consideration are:

1. Whether there is deficiency of service on the part of opposite parties 1 and 3?

1. Whether the complainant is entitled for the reliefs as prayed for?

1. To what relief?

7.      POINTS i and ii:- Admittedly the complainant insured his life covering the risks of critical illness with the opposite parties 1 and 3 under the policy bearing No.12352229.  The sum assured under the policy is Rs.2,00,000/-.  The risk on the policy had commenced on 22-12-2008.  It is the case of the complainant that when the policy was in force he underwent Heart Surgery in KIMS Hospital and incurred an amount of Rs.1,76,948/-.  The complainant filed Ex.A2 Discharge Summery showing that he was inpatient in KIMS Hospital, Hyderabad from 18-10-2010 to 27-10-2010.  It is also mentioned in Ex.A2 that the complainant underwent Heart Surgery on 20-10-2010. The complainant filed Ex.A4 final bill issued by KIMS Hospital, where in it is mentioned that an amount of Rs.1,65,536/- was received by it from the complainant.  The complainant also filed Ex.A3 bill issued by KIMS Hospital for Rs.11,412/-.

8.     Admittedly after the discharge from the Hospital the complainant submitted the claim to the opposite parties.  The opposite parties repudiated the claim stating that the complainant did not disclose in the proposal form that he was Diabetes Millets prior to date of the proposal.  In the discharge summery Ex.A2 it is mentioned that the complainant was suffering from Diabetes since four months prior to 18-10-2010.  The date of proposal was 14-11-2008.  The opposite parties did not come forward to contest the matter.  The opposite parties did not place medical evidence on record to show that the complainant was suffering from Diabetes on the date of the proposal i.e., 14-11-2008.  The complainant filed Ex.A11 notice where in he admitted that in the original discharge summery it was erroneously mentioned that he was suffering from Diabetes for last four years instead of four months.  Basing on the original Discharge Summery the opposite parties have repudiated the claim of the complainant.  As already stated there is mention in Ex.A2 discharge summery that the complainant was suffering from Diabetes since four months prior to 18-10-2010.  The repudiation of the claim of the complainant by the opposite parties stating that the complainant was suffering from Diabetes by the date of the proposal i.e., 14-11-2008 is not just and proper.  There is deficiency of service on the part of the opposite parties 1 and 3.  The complainant is entitled to receive Rs.1,76,948/- from the opposite parties 1 and 3.

9.     In the result, the complaint is partly allowed directing the opposite parties 1 and 3 jointly and severally to pay an amount of Rs.1,76,948/- to the complainant along with costs of Rs.500/- within two month from the date of the order.  The complaint against opposite party No.2 is dismissed.

        Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 9^th day of March, 2012.

Sd/-                                       Sd/-                                          Sd/-

MALE MEMBER                     PRESIDENT                   LADY MEMBER

                                 APPENDIX OF EVIDENCE

                                    Witnesses Examined

For the complainant : Nil                For the opposite parties : Nill

List of exhibits marked for the complainant:-

Ex.A1                Photo copy of Proposal Form dated 14-11-2008.

Ex.A2.       Discharge Summary of Krishna Institute of Medical Sciences, Secunderabad dated 27-10-2010.

Ex.A3                Medical Bills issued by KIMS, Secunderabad

dated 19-10-2010.

Ex.A4                A Bunch of Medical Bills issued by KIMS, Secunderabad.

Ex.A5                Repudiation Letter dated 16-12-2010.

Ex.A6                Office copy of Letter by complainant to opposite party No.1

dated 22-01-2011.

Ex.A7                Reply Letter by opposite party No.1 to complainant

                dated 31-01-2011.

Ex.A8                Office copy of Letter by complainant to opposite party No.1

                dated 13-07-2011.

Ex.A9                Reply Letter by opposite party No.1 to complainant

                dated 19-07-2011.

Ex.A10       Reply Letter by opposite party No.1 to complainant

                dated 20-07-2011.

Ex.A11       Office copy of Letter by complainant to opposite party No.1

                dated 18-08-2011.

Ex.A12       Reply Letter by opposite party No.1 to complainant

                dated 26-08-2011.

List of exhibits marked for the opposite parties:- NILL

Sd/-                                       Sd/-                                          Sd/-

MALE MEMBER                    PRESIDENT                  LADY MEMBER

    // Certified free copy communicated under Rule 4 (10) of the

A.P.S.C.D.R.C. Rules, 1987//                                                                                                 

Copy to:-

Complainant and Opposite parties  :

Copy was made ready on             :

Copy was dispatched on               :