Andhra Pradesh

Visakhapatnam-II

CC/96/2012

Konatala Devi - Complainant(s)

Versus

The Regional Manager - Opp.Party(s)

Adari Appa Rao

10 Apr 2015

ORDER

                                             Registration of the Complaint:09-04-2012                                                                            Date of Order :10-04-2015

BEFORE THE DISTRICT CONSUMERS FORUM-II:AT VISAKHAPATNAM

                             Present:

1.Sri H.ANANDHA RAO, M.A., L.L.B.,

       President

2.Sri C.V.N. RAO, M.A., B.L.,

                                             Male Member

3.Smt.K.SAROJA, M.A., B.L.,

       Lady Member

 

FRIDAY, 10^TH DAY OF APRIL, 2015

        CONSUMER CASE NO.96/2012

 

BETWEEN:

 

SMT.KONATALA DEVI W/O KURMA, HINDU,

AGED 27 YEARS, D.NO.15-16-57,

PEELA VENKATAREDDY STREET, GAVARAPALEM,

ANAKAPALLE, VISAKHAPATNAM DISTRICT-531 002.

                                                                                      …COMPLAINANT

A N D:

 

1.THE REGIONAL MANAGER, RELIANCE LIFE INSURANCE

COMPANY LIMITED, SRI BALAJI MANGALAGIRI COMPLEX,

SIRIURAM, VISAKHAPATNAM-530 003.

2.THE BRANCH MANAGER, RELIANCE LIFE INSURANCE

COMPANY LIMITED, BESIDE RAMACHANDRA THEATRE,

CHODAVARAM ROAD, ANAKAPALLE, VISAKHAPATNAM-531 001.

          …OPPOSITE PARTIES

 

This case coming on 01-04-2015 for final hearing before this Forum in the presence of SRI ADARI APPA RAO, Advocate for the Complainant and of SRI T.S.D.SRINIVAS & T.SAMSUKUMAR, Advocate for the Opposite Parties, and having stood over till this day for consideration, the Forum made the following:

 

O  R  D  E  R

(As per the Honourable President on behalf of the Bench)

1.       The Complainant filed the present complaint against the OPs, directing them to pay an amount of Rs.8,00,000/- together with interest @ 24% p.a., from the date of claiming the amount till its payment, Rs.2,00,000/- towards compensation and costs.

2.       The case of the complainant in brief is that the complainant husband viz., Konatala Kurma during his life time had taken a term plan policy with the OPs for an amount of Rs.8,00,000/- vide policy no.12823648 on 24^th October, 2008  in which the complainant is  the nominee of the said policy and on 11-02-2008, the complainant’s husband had accidentally faced jaundice and fever and he was treated at Anakapalle Government Hospital, the Doctor treated him and prescribed some medicines, while consuming medicines he died on 15-02-2009 due to the above said reason and the complainant had informed the 2^nd OP about the death of the insured by way of a letter through courier dated 03-06-2009 and asked them to settle the claim amount as she is the nominee of her deceased husband but the OPs failed to settle the claim nor sent any reply . Meanwhile, the complainant had filed a complaint before the Honourable Chariman Permanent LOK Adalat Bench, at Visakhapatnam with a view to settle the matter amicably and the OPs filed counter by contending that the complainant had not submitted the original documents to them and then the complainant received back those original documents  from the Lok Adalath and submitted the same to the OPs on 20-03-2010  but the OPs have not settled the matter  and the complainant has vexed with the attitude of the OPs and in the meanwhile, the Chairman of the Lok Adalath was also retired, as there is no officer, hence, the complainant filed a memo for dismissal of the case as not pressed  and received all the documents from the Lok Adalath and filed the present complaint before this Honourable Forum. The OPs are intentionally avoiding to pay the insurance amount to the complainant, which amounts to deficiency of service. Hence, this complaint.

3.       The case of Opposite Parties denying the material averments of the complaint is that the complaint is not maintainable because the complaint is not a valid complaint as defined under section 2(1) (d) of the Consumer Protection Act, 1986. The OPs also contended that the life insured has concealed his ill-health to the OPs and that he was hospitalized in the month of June, 2008 as Life Assured was suffering Fever, Penumania, Septieemia and Convulsions and hence the complainant has not approached the Forum with clean hands and has suppressed the material fact, just to misguide  the Honourable Forum and there is no deficiency of service on the part of the OPs. For these reasons, the compliant is liable to be dismissed.

4.       To prove the case on behalf of the complainant, she filed his evidence affidavit and got marked Exhibits A1 to A13.  On the other hand, on behalf of the OPs, the Territory Manager of the OPs filed his evidence affidavit and got marked Exhibits B1 to B9 & Exhibit C1 is marked on behalf of the OPs.

                                                              .   

 

5. Exhibit A1 is the Policy Bond dated 24-10-2008, Exhibit A2 is the Death Claim intimation letter dated 03-06-2009, Exhibit A3 is the Counter receipt dated 03-06-2009, Exhibit A4 is the Courier Acknowledgement, dated 03-06-2009, Exhibit A5 is the Death Certificate, dated 24-03-2009, Exhibit A6 is the Treatment Details, dated 11-02-2009, Exhibit A7 is the Acknowledgement letter issued by the 2^nd OP, dated 20-03-2010, Exhibit A8 is the Order copy issued by the Chariman Permanent Lok Adalat, dated 15-09-2011, Exhibit A9 is the Right to information act letter submitted to the Public Information Officer, Area, Hospital, Anakapalle, dated 17-06-2013, Exhibit A10 is the Postal Receipt dated 17-06-2013, Exhibit A11 is the Postal Acknowledgement, dated 28-06-2013, Exhibit A12 is the Letter issued by the Medical Superintendent, Area Hospital, Anakapalle along with the outpatient ticket, Exhibit A13 is the Postal Cover, dated 17-07-2013

6.       Exhibit B1 is the Certified copies of CSR Hospital Records dated 12-06-2008, Exhibit B2 is the Proposal form dated 01-01-2008, Exhibit B3 is the C.S.R. Hospital, dated 12-06-2008, Exhibit B4 is the Andhra Vidya Parishad filed by complainant, Exhibit B5 is the Medical Opinion, dated 07-06-2010, Exhibit B6 is the Repudiation letter dated 31-05-2010 and Exhibit B9 is the Investigator report of M/s Zubair and company dated 11-12-2009.

7.       Exhibit C1 is the Case Record.

8.       Both parties filed their respective written arguments.

9.       Heard oral arguments from both sides.

10.     Now the point for determination to be determined in this case is;

Whether there is any deficiency of service on the part of the OPs and the Complainant is entitled to any reliefs asked for?

11.     As seen from pleadings on record, it is not in dispute that the husband of the Complainant Konathala Kurma during his life time, had taken Reliance Term Plan Policy for an amount of Rs.8,00,000/- from OP vide policy No.12823648 on 24-10-2008 and the Complainant herein is his nominee who died on 15-02-2009 and thereupon the same was intimated to OP requesting them to settle the claim. But due to failure, the complainant filed a Pre-Litigation Case in PLAC 1087/09 and thereupon by filing a memo, the complainant herein not pressed it and filed the present complaint.

12.     The case of the complainant herein is that on 10-02-2009 her husband accidentally faced jaundice and fever, and during treatment, he died on 15-03-2008. As the death of her husband is accidental, therefore she is entitled for the claim insured. On the other hand, according to OP, the deceased was having pre existing disease which resulted his death but suppressing the said facts, he obtained the insurance from them, as such, the complainant herein is not entitled to the insured sum.  To prove the case under which she was appointed as a nominee of the deceased and Exhibit A6, A9-13, the hospital records showing that the insured was treated in Area Hospital at Anakapalle. Exhibits marked on behalf of the complainant clearly goes to show that the deceased was admitted in Area Hospital, Anakapalli and he was treated and during the course of treatment, he died. On the other hand, in order to show that the deceased was having pre- existing disease.  OP mainly relied upon Exhibit B2, B3, B4 and B6 but Unfortunately, it does not disclose the name of the disease. On the other hand, those documents show the medical treatment relating to one Kurma who is not all the insured deceased plaintiff herein. Thus, it can be safely held that basing on the aforesaid documents, that the OPs failed to substantiate that the deceased was having pre existing disease prior to his death. The record as well as documents filed by the complainant clearly and categorically goes to show that the acts of the OP indicates, there is a clear deficiency of service on the part of the OP. Therefore, the complainant is entitled for the sum insured in favour of her deceased husband.

13.     Now the question that comes up for consideration, at this stage of our discussion is, what is the rate of interest for which the Complainant is entitled.   The rate of interest claimed by the Complainant is 24% p.a.  This rate of interest claimed by the Complainant appear to be excessive, of course, it is a fact that the transaction covered by Ex.A1 is commercial in nature, but that does not and cannot mean to say that the Complainant is a licensed to claim interest @ 24% p.a. on Ex.A 1.  But at the same time, it is imperative on our part to award a reasonable interest.   Having regard to all these facts and circumstances, we sincerely feel having considered the case on hand awarding of interest @ 9% p.a. would better serve the ends of justice.    Consequently, we proposed to fix at rate in question @ 9% p.a. on Ex.A 7 i.e., Letter addressed by the Complainant which was duly acknowledged by the 1^st OP. Accordingly interest is ordered.

14.     Whether the Complainant is entitled for compensation of Rs.2,00,000/- is to be considered.   It appears as seen from the evidence of Complainant that the Complainant was compelled to approach the Opposite Parties and therefore experienced a lot of physical strain besides mental agony and financial loss. It is an un-disputed fact that the Opposite Parties did not refund the advance amount paid by the Complainant.   Naturally, that might have put the Complainant to suffer some mental agony besides physical stress and strain.   In this view of the matter, we sincerely feel that it is a fit case to award compensation.   But that does not and cannot mean to say that the Complainant claim for compensation is acceptable.    Having regard to all these facts and circumstances, we are of the considered opinion, award of compensation of 40,000/- would serve the ends of justice.   We therefore, proposed to award compensation of Rs.40,000 /-,  in the circumstances of the case on hand. Accordingly this point is answered.

15.     Before parting our discussion, it is incumbent and imperative on our part to consider the costs of litigation.    The Complainants ought not have to approach this Forum had his claim for refund of the advance amount of Rs.8,00,000/- or reliefs sought for have been honored by the Opposite Parties within a reasonable time and in view of the matter, the Complainant’s claim for costs deserves to be allowed.   In our considered and unanimous opinion awarding a sum of Rs.2,500/- as costs would appropriate and reasonable.   Accordingly costs are awarded.

16.     In the light of our discussion, referred supra, the complainant is entitled to receive the sum of Rs.8,00,000/- together with subsequent interest @ 9% p.a., from 20-03-2010 till the date of realization, a compensation of Rs.40,000/- and also costs of Rs.2,500/-.

17.     In the result, the complaint is allowed in part, directing the OPs to pay an amount of Rs.8,00,000/- (Rupees eight Lakhs only) with subsequent interest @ 9% p.a., from 20-03-2010 till the date of realization and compensation of Rs.40,000/- (Rupees Forty Thousand only) and 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 Stenographer, transcribed by him, corrected and pronounced by us in the open Forum, on this the 10^th day of April, 2015.                                    (TGR)

 

Sd/-                                             Sd/-                                        Sd/-     

LADY MEMBER                            MALE MEMBER                        PRESIDENT       

 

APPENDIX OF EVIDENCE

  For the Complainant:-

Exhibits	Date	Description	Remarks
A 1	24-10-2008	Policy Bond	Photocopy
A2	03-06-2009	Death claim intimation letter	Photocopy
A3	03-06-2009	Courier Receipt	Original
A4	03-06-2009	Courier Acknowledgement	Original
A5	24-03-2009	Death Certificate	Original
A6	11-02-2009	Treatment details	Photocopy
A7	20-03-2010	Acknowledgement letter issued by the 2nd OP	Original
A8	15-09-2011	Order copy issued by the chairman Permanent Lok-Adalath	Original
A9	17-06-2013	Right to Information Act letter submitted to the Public Information Officer, Area Hospital, Anakapalle	Photocopy
A10	17-06-2013	Postal Receipt	Original
A11	28-06-2013	Postal Acknowledgement	Original
A12	17-07-2013	Letter issued by the Medical superintendent Area Hospital, Anakapalle along with the Out-Patient  Ticket	Original
A13	17-07-2013	Postal Cover	Original

For the Opposite Parties:-  

Exhibits	Date	Description	Remarks
B1	01-10-2008	Proposal form	Original
B2	12-06-2008	C.S.R.Hospital Records	Certified copies
B3		OP Chit issued by Andhra Vaidya Parishad	Photocopy
B4	07-06-2010	Medical Opinion	Photocopy
B5	31-05-2010	Repudiation letter	Photocopy
B6	11-12-2009	Investigation Report	Photocopy

 

Exhibit C-1 is the Case record, dated 12-06-2008

 

Sd/-                                             Sd/-                                        Sd/-     

LADY MEMBER                            MALE MEMBER                        PRESIDENT