Andhra Pradesh

Visakhapatnam-II

CC/250/2008

Y.V.Narasimha Murthy - Complainant(s)

Versus

United India Insurance Company Ltd., - Opp.Party(s)

DNS Gupta

27 Jun 2015

ORDER

                                              Date of Registration of the Complaint:24-01.2012

                                                                                                Date of Order:27-06-2015

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

 

                                Saturday, the 27^th day of June 2015.

                                 CONSUMER CASE No.250/2008

Between:-

Y.V. Narasimha Murthy, S/o late Y. Venkatachalam,

aged 58 years, residing at Flat No. II/7, Swati Apartments,

Lawsonsbay Colony, Visakhapatnam.

….. Complainant

And:-

1.United India Insurance Company Limited,

   represented by its Divisional Manager,

   Divisional Office: 4, 1^st floor, Possenette Bhavan,

   Tilak Road, Hyderabad.

2.Family Health Plan Ltd., rep. by its Manager,

   Aditya JR Towers, 8-2-120/86/9/A & B, 3^rd floor,

   Road No.2, Banjara Hills, Hyderabad-500 034.

3.United India Insurance Company Limited,

   represented by its Manager, Regd. Office, 24,

   White Road, Chennai-600 014.

4.Andhra Bank, rep. by its Branch Manager,

   M.V.P. Colony, Visakhapatnam.

                                                                                       …  Opposite Parties     

                     

          This case coming on 16.06.2015 for final hearing before us in the presence of Sri C.R. Vasantha Kumar, Advocate for the Complainant and  Sri B. Purushothama Reddy,  Advocate for the 1^st  Opposite Party and Sri S. Jagannadham, Advocate for the 4^th Opposite Party  and the 2^nd Opposite Party  is called absent and the 3^rd Opposite Party being exparte and having stood over till this date for consideration, this Forum made the following:

 

                                                ORDER

          (As per Sri. H. Ananda Rao, Honourable President, on behalf of the Bench)

 

1.       This consumer complaint is filed by the Complainant against the  Opposite Parties directing them to pay the claim amount of Rs.1,87,324/- (Rupees One lakh, eighty seven thousand, three hundred and twenty four only), Rs.1,00,000/- (Rupees One lakh only) towards damages,  Rs.10,000/- (Rupees Ten thousand only) towards compensation and Rs.1,000/- (Rupees One thousand only) towards costs.

 

2.       The case of the Complainant in brief is that he is a Senior Citizen and he is a member of the family consisting of himself, his wife and two children, he was hale and healthy, that as a measure of social security, he had joined the Group Insurance Policy for the benefit of his family in the event of ill-health, and that was traduced through the Banker-4^th Opposite Party as he was having term deposit account with them.  The policy was non-medical to his knowledge and he was not asked to furnish the details of health either or him or any one of his family members.   The Opposite Parties had accepted the proposal of the Complainant and treated him as a member of the policy bearing No. 050400/48/05/00551.

 

3.       That on 19.05.2006 he had Chest Pain and as such was admitted into Appolo Hospital, whereas he was treated by Dr. P.V. Naresh Kumar and he had incurred expenditure of an amount of Rs.1,87,324/- towards hospitalization and medical expenses for his treatment.   Earlier the Complainant never had such illness and he had requested the Opposite Parties to pay the said amount which was refused by the Opposite Parties on the ground that he had the same ailment earlier to the risk coverage and as such, the Opposite Parties repudiated the claim.   On that the Opposite Parties received the notice and acknowledged the same and no payment was effected nor was any action initiated.   Hence, this Complaint.

 

4.      The case of the Opposite Parties 1,3 and 4 by resisted the claim of the Complainant by contending, as can be seen from their counter, the Complainant suppressed the fact that he was suffering from cardiac illness etc.,  even prior to taking up the policy, as such they repudiated the claim made by the Complainant.   There was no deficiency in service by them and there is no cause of action, for filing the complaint and pray for dismissal.

 

5.       To prove the case on behalf of the Complainant, he filed his affidavit   and got marked as Exs.A1 to A7.   On the other hand, on behalf of the Opposite Parties, the 1^st Opposite Party filed their proof affidavits, but no documents are marked for the Opposite Parties.

 

6.       Ex.A1 is the photo copy of Brochure of Group Insurance Policy-AB Arogydaam issued by the Andhra Bank.   Ex.A2 is the photo copy of AB-Arogydaam Medical Insurance Proposal Form dated 12.04.2006.  Ex.A3 is the photo copy of Certificate of Insurance issued by the 1^st Opposite Party to the Complainant dated 04.05.2006.   Ex.A4 is the office copy of Registered Lawyer’s Notice by the Complainant’s counsel to the Opposite Parties dated 26.12.2006.  Ex.A5 is the 4 Acknowledgement cards received by the Complainant’s counsel from the Opposite Parties dated 28.12.2006.  Ex.A6 is the office copy of registered letter given by the Complainant’s counsel to the 1^st Opposite Party dated 26.03.2007.   Ex.A7 is the Acknowledgement received from the 1^st Opposite Party by the Complainant’s counsel dated 29.03.2007.

 

7.       Both sides filed their respective written arguments.

8.       Heard oral arguments from both sides.

9.       Now the point that arises for determination is:-

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

 

10.     Before going to merits of the case, it is relevant for us the said originally the complaint filed by the Complainant was dismissed and the Complainant preferred an appeal F.A.  No.17/2011 on the file of Hon’ble A.P. State Consumer Disputes Redressal Commission.   Where in it was observed that “the appellant has filed seven documents purported to be the bills/receipts, cash memo, certificate from the surgeon, hospitalization, claim form etc.   As the documents are filed at the appellate stage, the consideration and receiving them in evidence would deprive the Opposite Parties an opportunity to verify and question their proof and relevance and thereby to remit back the case.

 

11.     After receiving the file notices severe of both sides and they appellant filed in IA 177/09 for receiving the documents and they are allowed marking them as Ex.A7.

 

12.     The Complainant had obtained the insurance policy by the 4^th Opposite Party and his suffered Chest Pain on 19.05.2006 and he was admitted in Appolo Hospital and incurred an expenditure of Rs.1,87,324/- towards hospitalization and medical expenses for his treatment .   According to the Complainant suffering from cardiac illness, he had obtained insurance policy willfully and intentionally with a malafide intention.   In order to substantiate the case of the Complainant i.e., claiming for medical expenses for his treatment and hospitalization in Appolo Hospital by Dr. P.V. Naresh Kumar, he filed Ex.A7 Medical Bills, Treatment, Discharge Summary etc.  On a careful perusal of the Ex.A7 it is evident that the Complainant incurred an amount of Rs.1,87,324/-=65 paise towards hospitalization expenses, Bill towards treatment, on a perusal of the bills, discharge summary etc.,  I see no reasons, to disbelieve them further the evidence affidavit of the Complainant is supported the bills.   It is held in CRP-I 2009 (307) repudiation of insurance claim on the ground of suppression of the pre-existing of disease at the time of taking policy when the medical record reveals that the Complainant had Chest pain and no the history suggestive of MIV of passed contention that the Complainant deliberately suppressed the deceased not substantially, repudiation of the claim amount to deficiency in service.

 

13.     In the instance of the case, there is no evidence whatsoever, to prove the insured suffered from any disease or received the treatment before purchased of policy.  On the other hand, the evidence on record goes to show after obtaining policy and due to the deceased suffered by the Complainant referred supra, he was admitted in the Appolo Hospital and incurred expenditure and it is supported by Ex.A7 and there upon filed the claim and the same was repudiated by the insurance company which is a claiming indication of the deficiency of service on the part of the Opposite Parties.  The facts narrated above are rightly applicable to the facts of the present case.   The acts of the Opposite Parties in repudiation of claim of the Complainant amounts to deficiency in service, for all these reasons, the Complainant is entitled for amount as sought for relief?  

 

 

14.     Now the question that comes up for consideration, at this stages of our discussion what is the rate of interest for which the Complainant is entitled.   The rate of interest claimed by the Complainant is 9% p.a.  This rate of interest claimed by the Complainant appears to be excessive, of course, it is a fact that the transaction covered by Ex.A1 is in commercial in nature, but that does not and cannot mean to say that the Complainant is a licenced to claim interest @ 9% p.a. on Ex.A1.    But at the same time, it is an 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. on Ex.A1 would better serve the ends of justice.    Consequently, we proposed to fix at rate in question @ 9% p.a. on Ex.A1 in question.   Accordingly interest is ordered.

 

15.     Whether the Complainant is entitled for compensation of Rs.,10,000/- is to be considered.   It appears as seen from the evidence of PW-1 that the Complainant was compelled to approach the Opposite Party and therefore experienced a lot of physical strain besides mental agony and financial loss. It is un-dispute fact that the Opposite Party did not refund the amount subscribed by the Complainant.   Naturally that made 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 25,000/- would serve the ends of justice.   We therefore, proposed to award compensation of Rs.25,000 /-,  in the circumstances of the case on hand. Accordingly this point is answered. 

 

16.     Before parting our discussion, it is incumbent and imperative on our part to consider the costs of litigation.    The Complainant ought not have to approach this Forum had his claim for refund of the sum of Rs.,1,87,324/- 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 claims for cost deserves to be allowed.   In our considered and unanimous opinion awarding a sum of Rs. 1,000/- as costs would appropriate and reasonable.   Accordingly costs are awarded.

 

17.     In the result, the Complaint is allowed in part directing the Opposite Parties to pay an amount of Rs.1,87,324/- (Rupees One lakh, eighty seven thousand, three hundred and twenty four only) with interest @ 9% p.a. from April, 2007 till the date of realization, Rs.25,000/- (Rupees twenty five thousand only) towards compensation and Rs.1,000/- (Rupees One thousand only) towards costs.   Time for compliance, one month.

     Dictated to the Steno, transcribed by him, corrected and pronounced by us in the Open Forum, this the 27^th day of June, 2015.

   Sd/-                                                Sd/-                                               Sd/-         

Male Member                      Lady Member                                 President

 

                                       APPENDIX OF EVIDENCE

For the Complainant:-

NO.	DATE	DESCRIPTIONOFTHEDOCUMENTS	REMARKS
Ex.A01		Brochure of Group Insurance Policy-AB Arogydaam issued by the Andhra Bank	Photo copy
Ex.A02	12.04.2006	AB-Arogydaam Medical Insurance Proposal Form	Photo copy
Ex.A03	04.05.2006	Certificate of Insurance issued by the 1st OP to the Complainant	Photo copy
Ex.A04	26.12.2006	Registered Lawyer’s Notice issued by the Complainant’s counsel to the Ops	Office copy
Ex.A05	28.12.2006	4 Acknowledgement Cards received by the Complainant’s counsel from the Ops	Original
Ex.A06	26.03.2007	Registered letter given by the Complainant’s counsel to the 1st OP	Office copy
Ex.A07	29.03.2007	Acknowledgement received from the 1st OP by the Complainant’s counsel	Original

For the Opposite Parties:-                                                                             

                                      -Nil-

 

    Sd/-                                          Sd/-                                            Sd/-

Male Member                       Lady Member                                   President