Smt. Sirasani Adinarayanamma, W/o Sirasani Jogi Reddy,

aged about 52 years, R/a Chimalacheruvupalli Village,

Galiveedu Mandal, Kadapa District. ….. Complainant.

Vs.



1) Shriram Life Insurance Co. Ltd., Rep. by its

Executive Director, 3-6-478, 3rd follor, Anand Estate,

Liberty Road, Himayatnagar, Hyderabad.

2) Shriram Life Insurance Co. Ltd, Rep. by its

Asst. General Manager, Tirupati, Chittoor district.

3) Shriram Life Insurance Co. Ltd, Rep. by its

Divisional Manager, Proddatur, Kadapa District.

4) Shriram Life Insurance Co. Ltd, Rep. by its

Branch Manager, branch Office, Proddatur,

Kadapa District. ….. Respondents.








O R D E R








1. Complaint filed under section 12 of the Consumer Protection Act 1986.



2. The brief facts of the complaint is as follows:- The husband of the complainant by name late Sirasani Jogi Reddy had taken one life insurance policy SHRI RAKSHA with double benefit on his life for Rs. 2,00,000/- from R4 vide policy No. NP 080600046866. This policy was commenced from 16-5-2006 late S. Jogi Reddy nominated his wife i.e. the complainant as his nominee to the above policy.


The insured has remitted Rs. 24,450/- towards annual premium of the policy along with accident rider and FIB rider. As per the terms of the policy, in case of death of the insured at any time during the premium term, the nominee would be entitled to receive double assured sum including vested bonus. The insured paid 2nd year premium of Rs. 24,634/- on 18-6-2007 to R4 by way of D.D. and obtained receipt. The husband of the complainant was admitted in ESI hospital, Hyderabad due to ill health on 16-7-2007 with the complaint of cellulites and fracture of right leg. He died on 24-7-2007 due to cardio respiratory arrest. The complainant made a claim to the respondents by furnishing all documents as required by them. But the complainant received repudiation letter dt. 17-3-2008 from R2.


In the said repudiation letter R2 stated that the claim of the complainant was repudiated on the ground of in correct information about pre-existing health problems of the insured. Immediately, the complainant approached R4 and requested him to settle her genuine claim. But there was no response from him. Having vexed with the negligence attitude of the respondents. The complainant got issued a legal notice dt. 10-6-2008 calling upon the respondents to pay double amount of sum assured. For which R1 issued a reply notice dt. 3-7-2008 alleging that insured was known patient of hyper tension with cellulites left leg and he suppressed the same at the time of taking policy.


The insured had suffered from hyper tension and cellulites just before one month of his death and he came to know; that he had that disease only after investigations made by ESI hospital, Hyderabad. The husband of the complainant had no intention to deceive respondents by this it is crystal clear that the insured had no knowledge about disease prior to taking of above insurance policy. Hence, the question of non-disclosure of pre-existing disease does not arise. Without any basis the respondents alleged that the insured had a history of hyper tension with cellulites. Before accepting the proposal of the insured i.e. late S. Jogi Reddy the respondents called for special medical reports of the insured.


After thorough medical examinations and obtaining its repots, the respondents company had issued insurance policy for an amount of Rs. 2,00,000/- on the life of insured i.e. late S. Jogi Reddy husband of the complainant. The husband of the complainant never suppressed any material facts, which is basis for issuance of policy. He suffered with alleged diseases only one month before his death. The insured never took medical treatment for any kind of disease prior to taking of the policy and he never suffered with such aliments prior to taking of policy as alleged by the respondents.


Without application of mind, the respondents repudiated the genuine claim of the complainant. On flimsy grounds, the respondents cannot escape from their liability from settling the claim of the complainant. The services of the respondents are deficient in nature. Hence, the complainant filed this complaint requesting this forum to allow the complaint and to pass orders in favour of the complainant directing the respondents a) to pay Rs. 4,00,000/- (Rs. 2,00,000/- + Rs. 2,00,000/-) towards double benefit assured amount together with vested bonus under policy No. NP 080600046866 along with 24% interest from the date of death of the insured i.e. from 24-7-2007 till the date of realization, b) to pay compensation of Rs. 50,000/- for causing physical stain and mental agony and c) to pay Rs. 2,000/- towards the cost of the complaint.



3. R1 filed a counter stating and denied all the allegations put forth in the complaint, except which are specifically admitted here and the averments which are not specifically admitted herein are deemed to be denied and the complaint is not maintainable either on facts or at law and the same is liable to be dismissed in limine.


The daughters of the deceased, by name Saraswathi, is an employee of Shriram Chits (P) Ltd., at Proddatur and she arranged the subject policy in favour of her father which commenced from 16-5-2006. at the time of taking of the policy, the company has suggested the deceased to fill the proposal form with correct details regarding his health condition, pre-diseases, if any, habits etc., as required under the questionnaire of the proposal form. Basing on the information provided in the proposal form only, the company has issued the subject policy in favour of the deceased in utmost good faith.


The deceased has nominated his wife, Adminarayanamma as his nominee under the policy. Through a letter dt. 12-11-2007, the complainant has intimated the company that her husband / policy holder died on 24-7-2007 at ESI Hospital, Hyderabad. On that, the company has supplied concerned claim forms to her for processing the claim. However, it is an early death claim; and the company has conducted its regular investigation into the matter through their investigator, G. Rama Murthy, Hyderabad. The investigation has revealed that the deceased was a known patient of Hyper tension with Cellulites (left leg) and further he was a patient of HIV positive which were not disclosed by the deceased policy holder at the time of taking of the policy.


It is submitted that had the company been informed about the said pre-health problems before taking the policy, the same would not have been issued by the company. The primary duty of the proposer while taking the life insurance policy is to disclose about his / her health conditions, pre-disease, if any, habits of the life proposed for insurance. As the deceased, Sirasani Jogi Reddy has deliberately suppressed the material facts which were suppressed to be disclosed at the time of taking the policy, the contractor has now become void, unenforceable and not legally binding on the company. Therefore, the company is not liable to pay any amount towards policy claim and other benefits.


The company vide its letter dt. 4-6-2009 has applied to the ESI Hospital under RTI Act to provide the entire medical records pertaining to the treatment taken by the deceased policy holder. The Hospital authorities vide their letter dt. 4-7-2009 had intimated to the company that the deceased life assured was first time admitted into their hospital on 25-6-2007 and discharged on 14-7-2007 again he was admitted on 16-7-2007 and expired on 24-7-2007. But they have not provided any medical records as requested and upon personal interaction by one of the official of the company, the Hospital authorities have informed that they cannot provide medical records to the third parties, since it is a case of HIV related. Hence, the burden lies on the complainant to produce the entire medical record of the deceased policy holder.


The medical records submitted by the complainant itself disclose that the deceased was suffering from Hypertension with Cellulites left leg and also a patient of HIV positive. But the complainant intentionally did not speak out regarding the ailments of the deceased in her complaint and thereby tried to deviate the attention of the Hon’ble Forum. In this case some curious points are there for observation of the Hon’ble Forum at the first instance, the deceased was got admitted into ESI Hospital, Hyderabad on 25-6-2007 with complaints of cough, pedal oedema and boils over left leg and he was discharged on 14-7-2007 at the request of the patient.


The diagnosis was that he was suffering from Hypertenion, Cellulites (left leg) and HIV positive. Again, the deceased was taken to the same hospital on 16-7-2008 with the same complaints. The enquiries at the hospital have revealed that the deceased has fallen down in bath room on 18-7-2007 and received fractures to neck bone (humurus bone) and the neck of femur bone (right). But the daughter of the deceased has stated that the deceased went out of the hospital to have a tea and he was hit by an auto and received fracture injuries.


Thus it was found by the investigator that the family members of the deceased are trying to suppress some facts. It is a clear finding of the investigator that the patient/deceased has absconded from the hospital without intimating the doctors / staff on 23-7-2007 and returned by him on 24-7-2007. On routine rounds, he was found dead at 3.15 p.m on the same day. This is very unusual while the patient was treated as an in patient in a responsible hospital like ESI Hospital. One Dr. Ravi kiran has revealed before the Investigator that the deceased was a case of HIV positive. Thus there are so many facts and circumstances which were suppressed by the deceased and his family members including the treatment.


The complainant did not furnish the duly filled up claim forms which are requested by the company to be furnished by her through their letter dt. 22-11-2007. since she did not turn up, the company has sent another letter dt. 31-12-2007 and 14-1-2008 requesting her to send the same. Later, the complainant has sent the claim forms and on thorough scrutiny, the company has repudiated her claim vide their letter dt. 17-3-2008 aggrieved by the same, the complainant has got issued a legal notice dt. 10-6-2008 for which the company has issued a reply dt. 3-7-2008.


Thus in view of the above facts and circumstances, reasons, it is clear that the deceased has obtained the subject policy by suppressing the previous history of the diseases particularly HIV positive, might be under social stigma and due to fear that his status will be lowered in the eyes of his family members if the fact was disclosed. But the insurance is a contract and governed by the principal of “uberrima Fide” and the proposer applying for insurance policy is expected and bound to correctly furnish all material information regarding the health habits, family history, personal medical history etc., of the life proposed. In case of any default or hostile information, the contract will become void. Therefore, prayed the Hon’ble Forum may be pleased to dismiss the complaint against this respondent with exemplary costs in the interest of justice.



4. R3 filed a memo adopting the counter of R1.

5. R2 and R4 were called absent and set exparte on 18-8-2009.

6. On the basis of the above pleadings the following points are settled for determination.

i. Whether there is any negligence and deficiency of service on the part of the respondents?

ii. Whether the complainant is entitled to the relief as prayed for?

iii. To what relief?



7. On behalf of the complainant Ex. A1 to A9 were marked and on behalf of the respondent Ex. B1 to B11 were marked. Oral arguments were heard from both sides.



8. Point No. 1 & 2 Ex. A1 is the Xerox copy of policy bearing No. NP 080600046866 issued by the respondents in favour of S. Jogi Reddy. Ex. A2 is the Xerox copy of death certificate of the insured. Ex. A3 is the Xerox copy of repudiation letter dt. 17-3-2008 issued by R2. Ex. A4 is the Xerox copy of legal notice dt. 10-6-2008 issued by the complainant to the respondents. Ex. A5 are four postal receipts bearing Nos. 5077, 5078, 5079 and 5080. Ex. A6 are three postal acknowledgement cards. Ex. A7 is the original reply notice dt. 3-7-2008 issued by R1 to the complainant. Ex. A8 is the Xerox coy of medical certificate of cause of death issued by ESI Hospital, Hyderabad. Ex. A9 is the Xerox coy of hospital record issued by ESI Hospital, Hyderabad. Ex. B1 is the Xerox copy of proposal for insurance submitted by the deceased S. Jogi Reddy. Ex. B2 is the Xerox copy of death intimation letter dt. 12-11-2007 sent by the complainant.


Ex. B3 is the Xerox coy of letter dt. 22-11-2007 sent by the respondents company. Ex. B4 is the Xerox copy of letter dt. 31-12-2007 sent by the respondents company. Ex. B5 is the Xerox copy of letter dt. 14-1-2008 sent by the respondents company. Ex. B6 is the Xerox copy of claim forms, A, B and C. Ex. B7 is the Xerox copy of medical reports (Ex. A9) issued by ESI Hospital, Hyderabad. Ex. B8 is the Xerox copy of medical record of Osmania General Hospital, Hyderabad. Ex. B9 is the Xerox copy of investigation report dt. 11-2-2008 of G. Ramamurthy. Ex. B10 is the Xerox coy of letter dt. 4-6-2009 sent by the respondents company to the ESI Hospital, Hyderabad. Ex. B11 is the Xerox copy of reply letter dt. 4-7-2009 of the ESI hospital, Hyderabad addressed to the respondents.



9. As could be seen from the documentary evidence the husband of the complainant by name S. Jogi Reddy had taken the policy in question on his life from R4 for a sum assured Rs. 2,00,000/- with double sum assured bonus plus vested bonus if the death occurred at any time during the premium term. This policy was commenced from 16-5-2006 and the complainant is the nominee of this policy. The husband of the complainant was admitted in ESI hospital, Hyderabad on 16-7-2007 and found dead on 24-7-2007 as per Ex. A3, repudiation letter of R2 the claim of the complainant was repudiated on the ground of incorrect information furnished by the husband of the complainant about pre-existing heath problem of the insured.


Now the question is whether the husband of the complainant suppressed the pre-existing diseases willfully which are known to him as contended by the respondents. At the time of issuance of the policy in question the age of the insured was 57 years, as such the respondent company insisted for special medical reports and after through medical examinations the special reports on his medical history was obtained by the respondents company and issued insurance policy for amount of Rs. 2,00,000/- on the life of Jogi Reddy husband of the complainant. It was in 2006 and the commencement of the policy was on 16-5-2006.


The insured as per the contention of the complainant and documentary evidence on record was admitted in the hospital on 16-7-2007 and died on 24-7-2007. As per Ex. A8 immediate cause of death of death was cardio respiratory arrest due to pulmonary enbolisam antecedent cause was hyper tension and fracture of right femur. The learned counsel for the respondents contended that the deceased Jogi Reddy husband of the complainant was known patient of hyper tension with cellulites of lift leg were not disclosed by him at the time of taking policy.


On this ground the claim was repudiated. As could be seen from the medical records i.e. Ex. B8, medical certificate of cause of death issued by ESI hospital, Hyderabad the immediate cause of death was cardio respiratory arrest and 2nd one i.e. antecedent cause of hyper tension and the last item of cause of death was fracture of right femur. So as per Ex. A8 the hyper tension is 2nd cause and cellulites left leg was the 3rd cause. The main cause of death was cardio respiratory arrest and according to the complainant this was not known to the complainant at the time of submitting proposal forms in 2006.


The contention of the complainant is supported by the version of the respondents company that the husband of the complainant under went special medical tests before acceptance of the proposals and after specifying the respondents company that the insured husband of the complainant was not having any pre-existing disease as alleged by the respondents company. The respondents company accepted the proposal and issued the insurance policy in favour of the insured husband of the complainant. The contention of the respondent that the decease like cellulites (light leg) is a typical disease that will be there in the body and it will not be known at the initial stage and to surface the symptoms of this type of diseases it consumes minimum five years of time.


Even according to the contention of the respondents the disease cellulites of right leg slowly come out and it consumes five years of time, strengthen the case of the complainant because he underwent special medical tests at the time of proposals in the year 2006 and the medical reports are silent about cellulites right leg or any other pre-existing disease. By all probabilities the complainant may not be knowing about his pre-existing diseases at the time of proposals and in view of the documentary evidence, especially medical reports particularly Ex. A8 the complainant deserves consideration in her favour. The points are answered accordingly.



10. Point No. 3 In the result, the complaint is allowed, directing the respondents 1 to 4 jointly and severally liable to pay a sum of Rs. 2,00,000/- + Rs. 2,00,000/- (Rs. 4,00,000/- Rupees four lakhs only) towards double benefit assured amount along with vested bonus to the complainant, to pay Rs. 5,000/- (Rupees five thousand only) towards compensation for mental agony and to pay Rs. 2,000/- (Rupees two thousand only) towards costs, payable within 60 days from the date of receipt of this order. If the respondents 1 to 4 failed to pay the amount the complainant is entitled to receive interest @ 9% p.a. from the date of issue of the order.

Smt. Sirasani Adinarayanamma, W/o Sirasani Jogi Reddy,

aged about 52 years, R/a Chimalacheruvupalli Village,

Galiveedu Mandal, Kadapa District. ….. Complainant.

Vs.



1) Shriram Life Insurance Co. Ltd., Rep. by its

Executive Director, 3-6-478, 3rd follor, Anand Estate,

Liberty Road, Himayatnagar, Hyderabad.

2) Shriram Life Insurance Co. Ltd, Rep. by its

Asst. General Manager, Tirupati, Chittoor district.

3) Shriram Life Insurance Co. Ltd, Rep. by its

Divisional Manager, Proddatur, Kadapa District.

4) Shriram Life Insurance Co. Ltd, Rep. by its

Branch Manager, branch Office, Proddatur,

Kadapa District. ….. Respondents.





O R D E R






1. Complaint filed under section 12 of the Consumer Protection Act 1986.



2. The brief facts of the complaint is as follows:- The husband of the complainant by name late Sirasani Jogi Reddy had taken one life insurance policy SHRI RAKSHA with double benefit on his life for Rs. 2,00,000/- from R4 vide policy No. NP 080600046866. This policy was commenced from 16-5-2006 late S. Jogi Reddy nominated his wife i.e. the complainant as his nominee to the above policy. The insured has remitted Rs. 24,450/- towards annual premium of the policy along with accident rider and FIB rider. As per the terms of the policy, in case of death of the insured at any time during the premium term, the nominee would be entitled to receive double assured sum including vested bonus.


The insured paid 2nd year premium of Rs. 24,634/- on 18-6-2007 to R4 by way of D.D. and obtained receipt. The husband of the complainant was admitted in ESI hospital, Hyderabad due to ill health on 16-7-2007 with the complaint of cellulites and fracture of right leg. He died on 24-7-2007 due to cardio respiratory arrest. The complainant made a claim to the respondents by furnishing all documents as required by them. But the complainant received repudiation letter dt. 17-3-2008 from R2.


In the said repudiation letter R2 stated that the claim of the complainant was repudiated on the ground of in correct information about pre-existing health problems of the insured. Immediately, the complainant approached R4 and requested him to settle her genuine claim. But there was no response from him. Having vexed with the negligence attitude of the respondents. The complainant got issued a legal notice dt. 10-6-2008 calling upon the respondents to pay double amount of sum assured. For which R1 issued a reply notice dt. 3-7-2008 alleging that insured was known patient of hyper tension with cellulites left leg and he suppressed the same at the time of taking policy. The insured had suffered from hyper tension and cellulites just before one month of his death and he came to know; that he had that disease only after investigations made by ESI hospital, Hyderabad.


The husband of the complainant had no intention to deceive respondents by this it is crystal clear that the insured had no knowledge about disease prior to taking of above insurance policy. Hence, the question of non-disclosure of pre-existing disease does not arise. Without any basis the respondents alleged that the insured had a history of hyper tension with cellulites. Before accepting the proposal of the insured i.e. late S. Jogi Reddy the respondents called for special medical reports of the insured. After thorough medical examinations and obtaining its repots, the respondents company had issued insurance policy for an amount of Rs. 2,00,000/- on the life of insured i.e. late S. Jogi Reddy husband of the complainant.


The husband of the complainant never suppressed any material facts, which is basis for issuance of policy. He suffered with alleged diseases only one month before his death. The insured never took medical treatment for any kind of disease prior to taking of the policy and he never suffered with such aliments prior to taking of policy as alleged by the respondents. Without application of mind, the respondents repudiated the genuine claim of the complainant. On flimsy grounds, the respondents cannot escape from their liability from settling the claim of the complainant. The services of the respondents are deficient in nature.


Hence, the complainant filed this complaint requesting this forum to allow the complaint and to pass orders in favour of the complainant directing the respondents a) to pay Rs. 4,00,000/- (Rs. 2,00,000/- + Rs. 2,00,000/-) towards double benefit assured amount together with vested bonus under policy No. NP 080600046866 along with 24% interest from the date of death of the insured i.e. from 24-7-2007 till the date of realization, b) to pay compensation of Rs. 50,000/- for causing physical stain and mental agony and c) to pay Rs. 2,000/- towards the cost of the complaint.



3. R1 filed a counter stating and denied all the allegations put forth in the complaint, except which are specifically admitted here and the averments which are not specifically admitted herein are deemed to be denied and the complaint is not maintainable either on facts or at law and the same is liable to be dismissed in limine. The daughters of the deceased, by name Saraswathi, is an employee of Shriram Chits (P) Ltd., at Proddatur and she arranged the subject policy in favour of her father which commenced from 16-5-2006. at the time of taking of the policy, the company has suggested the deceased to fill the proposal form with correct details regarding his health condition, pre-diseases, if any, habits etc., as required under the questionnaire of the proposal form.


Basing on the information provided in the proposal form only, the company has issued the subject policy in favour of the deceased in utmost good faith. The deceased has nominated his wife, Adminarayanamma as his nominee under the policy. Through a letter dt. 12-11-2007, the complainant has intimated the company that her husband / policy holder died on 24-7-2007 at ESI Hospital, Hyderabad. On that, the company has supplied concerned claim forms to her for processing the claim. However, it is an early death claim; and the company has conducted its regular investigation into the matter through their investigator, G. Rama Murthy, Hyderabad.


The investigation has revealed that the deceased was a known patient of Hyper tension with Cellulites (left leg) and further he was a patient of HIV positive which were not disclosed by the deceased policy holder at the time of taking of the policy. It is submitted that had the company been informed about the said pre-health problems before taking the policy, the same would not have been issued by the company. The primary duty of the proposer while taking the life insurance policy is to disclose about his / her health conditions, pre-disease, if any, habits of the life proposed for insurance. As the deceased, Sirasani Jogi Reddy has deliberately suppressed the material facts which were suppressed to be disclosed at the time of taking the policy, the contractor has now become void, unenforceable and not legally binding on the company.


Therefore, the company is not liable to pay any amount towards policy claim and other benefits. The company vide its letter dt. 4-6-2009 has applied to the ESI Hospital under RTI Act to provide the entire medical records pertaining to the treatment taken by the deceased policy holder. The Hospital authorities vide their letter dt. 4-7-2009 had intimated to the company that the deceased life assured was first time admitted into their hospital on 25-6-2007 and discharged on 14-7-2007 again he was admitted on 16-7-2007 and expired on 24-7-2007.


But they have not provided any medical records as requested and upon personal interaction by one of the official of the company, the Hospital authorities have informed that they cannot provide medical records to the third parties, since it is a case of HIV related. Hence, the burden lies on the complainant to produce the entire medical record of the deceased policy holder. The medical records submitted by the complainant itself disclose that the deceased was suffering from Hypertension with Cellulites left leg and also a patient of HIV positive. But the complainant intentionally did not speak out regarding the ailments of the deceased in her complaint and thereby tried to deviate the attention of the Hon’ble Forum.


In this case some curious points are there for observation of the Hon’ble Forum at the first instance, the deceased was got admitted into ESI Hospital, Hyderabad on 25-6-2007 with complaints of cough, pedal oedema and boils over left leg and he was discharged on 14-7-2007 at the request of the patient. The diagnosis was that he was suffering from Hypertenion, Cellulites (left leg) and HIV positive. Again, the deceased was taken to the same hospital on 16-7-2008 with the same complaints. The enquiries at the hospital have revealed that the deceased has fallen down in bath room on 18-7-2007 and received fractures to neck bone (humurus bone) and the neck of femur bone (right).


But the daughter of the deceased has stated that the deceased went out of the hospital to have a tea and he was hit by an auto and received fracture injuries. Thus it was found by the investigator that the family members of the deceased are trying to suppress some facts. It is a clear finding of the investigator that the patient/deceased has absconded from the hospital without intimating the doctors / staff on 23-7-2007 and returned by him on 24-7-2007. On routine rounds, he was found dead at 3.15 p.m on the same day. This is very unusual while the patient was treated as an in patient in a responsible hospital like ESI Hospital. One Dr. Ravi kiran has revealed before the Investigator that the deceased was a case of HIV positive.


Thus there are so many facts and circumstances which were suppressed by the deceased and his family members including the treatment. The complainant did not furnish the duly filled up claim forms which are requested by the company to be furnished by her through their letter dt. 22-11-2007. since she did not turn up, the company has sent another letter dt. 31-12-2007 and 14-1-2008 requesting her to send the same. Later, the complainant has sent the claim forms and on thorough scrutiny, the company has repudiated her claim vide their letter dt. 17-3-2008 aggrieved by the same, the complainant has got issued a legal notice dt. 10-6-2008 for which the company has issued a reply dt. 3-7-2008.


Thus in view of the above facts and circumstances, reasons, it is clear that the deceased has obtained the subject policy by suppressing the previous history of the diseases particularly HIV positive, might be under social stigma and due to fear that his status will be lowered in the eyes of his family members if the fact was disclosed. But the insurance is a contract and governed by the principal of “uberrima Fide” and the proposer applying for insurance policy is expected and bound to correctly furnish all material information regarding the health habits, family history, personal medical history etc., of the life proposed. In case of any default or hostile information, the contract will become void. Therefore, prayed the Hon’ble Forum may be pleased to dismiss the complaint against this respondent with exemplary costs in the interest of justice.



4. R3 filed a memo adopting the counter of R1.

5. R2 and R4 were called absent and set exparte on 18-8-2009.

6. On the basis of the above pleadings the following points are settled for determination.

i. Whether there is any negligence and deficiency of service on the part of the respondents?

ii. Whether the complainant is entitled to the relief as prayed for?

iii. To what relief?



7. On behalf of the complainant Ex. A1 to A9 were marked and on behalf of the respondent Ex. B1 to B11 were marked. Oral arguments were heard from both sides.



8. Point No. 1 & 2 Ex. A1 is the Xerox copy of policy bearing No. NP 080600046866 issued by the respondents in favour of S. Jogi Reddy. Ex. A2 is the Xerox copy of death certificate of the insured. Ex. A3 is the Xerox copy of repudiation letter dt. 17-3-2008 issued by R2. Ex. A4 is the Xerox copy of legal notice dt. 10-6-2008 issued by the complainant to the respondents. Ex. A5 are four postal receipts bearing Nos. 5077, 5078, 5079 and 5080. Ex. A6 are three postal acknowledgement cards. Ex. A7 is the original reply notice dt. 3-7-2008 issued by R1 to the complainant. Ex. A8 is the Xerox coy of medical certificate of cause of death issued by ESI Hospital, Hyderabad. Ex. A9 is the Xerox coy of hospital record issued by ESI Hospital, Hyderabad. Ex. B1 is the Xerox copy of proposal for insurance submitted by the deceased S. Jogi Reddy. Ex. B2 is the Xerox copy of death intimation letter dt. 12-11-2007 sent by the complainant. Ex. B3 is the Xerox coy of letter dt. 22-11-2007 sent by the respondents company.


Ex. B4 is the Xerox copy of letter dt. 31-12-2007 sent by the respondents company. Ex. B5 is the Xerox copy of letter dt. 14-1-2008 sent by the respondents company. Ex. B6 is the Xerox copy of claim forms, A, B and C. Ex. B7 is the Xerox copy of medical reports (Ex. A9) issued by ESI Hospital, Hyderabad. Ex. B8 is the Xerox copy of medical record of Osmania General Hospital, Hyderabad. Ex. B9 is the Xerox copy of investigation report dt. 11-2-2008 of G. Ramamurthy. Ex. B10 is the Xerox coy of letter dt. 4-6-2009 sent by the respondents company to the ESI Hospital, Hyderabad. Ex. B11 is the Xerox copy of reply letter dt. 4-7-2009 of the ESI hospital, Hyderabad addressed to the respondents.



9. As could be seen from the documentary evidence the husband of the complainant by name S. Jogi Reddy had taken the policy in question on his life from R4 for a sum assured Rs. 2,00,000/- with double sum assured bonus plus vested bonus if the death occurred at any time during the premium term. This policy was commenced from 16-5-2006 and the complainant is the nominee of this policy. The husband of the complainant was admitted in ESI hospital, Hyderabad on 16-7-2007 and found dead on 24-7-2007 as per Ex. A3, repudiation letter of R2 the claim of the complainant was repudiated on the ground of incorrect information furnished by the husband of the complainant about pre-existing heath problem of the insured.


Now the question is whether the husband of the complainant suppressed the pre-existing diseases willfully which are known to him as contended by the respondents. At the time of issuance of the policy in question the age of the insured was 57 years, as such the respondent company insisted for special medical reports and after through medical examinations the special reports on his medical history was obtained by the respondents company and issued insurance policy for amount of Rs. 2,00,000/- on the life of Jogi Reddy husband of the complainant.


It was in 2006 and the commencement of the policy was on 16-5-2006. The insured as per the contention of the complainant and documentary evidence on record was admitted in the hospital on 16-7-2007 and died on 24-7-2007. As per Ex. A8 immediate cause of death of death was cardio respiratory arrest due to pulmonary enbolisam antecedent cause was hyper tension and fracture of right femur. The learned counsel for the respondents contended that the deceased Jogi Reddy husband of the complainant was known patient of hyper tension with cellulites of lift leg were not disclosed by him at the time of taking policy. On this ground the claim was repudiated.


As could be seen from the medical records i.e. Ex. B8, medical certificate of cause of death issued by ESI hospital, Hyderabad the immediate cause of death was cardio respiratory arrest and 2nd one i.e. antecedent cause of hyper tension and the last item of cause of death was fracture of right femur. So as per Ex. A8 the hyper tension is 2nd cause and cellulites left leg was the 3rd cause. The main cause of death was cardio respiratory arrest and according to the complainant this was not known to the complainant at the time of submitting proposal forms in 2006.


The contention of the complainant is supported by the version of the respondents company that the husband of the complainant under went special medical tests before acceptance of the proposals and after specifying the respondents company that the insured husband of the complainant was not having any pre-existing disease as alleged by the respondents company. The respondents company accepted the proposal and issued the insurance policy in favour of the insured husband of the complainant. The contention of the respondent that the decease like cellulites (light leg) is a typical disease that will be there in the body and it will not be known at the initial stage and to surface the symptoms of this type of diseases it consumes minimum five years of time.


Even according to the contention of the respondents the disease cellulites of right leg slowly come out and it consumes five years of time, strengthen the case of the complainant because he underwent special medical tests at the time of proposals in the year 2006 and the medical reports are silent about cellulites right leg or any other pre-existing disease. By all probabilities the complainant may not be knowing about his pre-existing diseases at the time of proposals and in view of the documentary evidence, especially medical reports particularly Ex. A8 the complainant deserves consideration in her favour. The points are answered accordingly.



10. Point No. 3 In the result, the complaint is allowed, directing the respondents 1 to 4 jointly and severally liable to pay a sum of Rs. 2,00,000/- + Rs. 2,00,000/- (Rs. 4,00,000/- Rupees four lakhs only) towards double benefit assured amount along with vested bonus to the complainant, to pay Rs. 5,000/- (Rupees five thousand only) towards compensation for mental agony and to pay Rs. 2,000/- (Rupees two thousand only) towards costs, payable within 60 days from the date of receipt of this order. If the respondents 1 to 4 failed to pay the amount the complainant is entitled to receive interest @ 9% p.a. from the date of issue of the order.

Sh.Chaman Lal son of Sh. Beli Ram resident of village Suma Ropa Post Office Jari, Tehsil and District Kullu, H.P.





…Complainant





V/S

SRIRAM Finance company Limited Branch Office Ist Floor Banga complex NH-21 Gandhi nagar, Kullu Tehsil and District Kullu, H.P through its Branch Manager.



..Opposite party





ORDER.

This order shall dispose of a complaint under Section 12 of the Consumer Protection Act, 1986( hereinafter referred to as the “Act”) instituted by the complainant against the opposite party. The case of the complainant is that he is an agriculturist and had purchased a tractor bearing chassis No.345JOFO12172 and engine No.3102TIOF012016 from M/s Kisan Motors NH-21, Nerchowk District Mandi, H.P. The amount of the vehicle was Rs.4,05,000/- out of which the complainant had paid a sum of Rs.1,50,000/- as margin money and rest of the amount was financed by the opposite party. The complainant alleged that he could not register the vehicle about six months after the delivery of the vehicle as the opposite party had not supplied the requisite documents pertaining to the vehicle well in time and as such he was unable to ply the same as commercial vehicle.


The complainant further alleged that he has paid Rs.20,000/- to the opposite party towards the instalment of the tractor . The complainant also alleged that on 31-3-2008 at about 11 AM ,5-6 persons came to the place of the complainant and misbehaved and manhandled him and represented that they are the officials of the opposite party and explained that the complainant has failed to pay the monthly EMI of the financed tractor and forcibly took away aforesaid tractor alongwith its trolley and that too without intimating or giving notice to the complainant. It is submitted that the complainant has got the trolley manufactured at his own cost by spending Rs.50,000/-.


The complainant averred that he was ready to pay the instalments but without his knowledge and consent , the opposite party forcibly and illegally took away the tractor alongwith its trolley. The complainant further averred that he approached the opposite party and represented that he wanted to pay the monthly EMI but of no avail . With these allegations the complainant sought a direction to the opposite party to hand over the tractor with keys and to pay Rs.1,00,000/- as compensation for harassment and cost of the complainant .

2. The opposite party had filed reply and resisted the complaint by raising preliminary objections that this Forum has got no jurisdiction to try and decide this complaint, that the complainant is not a consumer nor the opposite party had rendered any service to the complainant and the transaction involved in the present case is purely of commercial nature and the same does not fall within the preview of the act , that the agreement was entered into at Bilaspur and vehicle was financed from Bilaspur Branch , , that the complaint is not maintainable in the present form, that the complicated questions of law and facts are involved requiring adducing of detailed evidence and also rendition of accounts and for adjustment of entries in the statement of account which can be decided by civil court , that the complainant had not came to the court with clean hands . On merits , the opposite party had admitted that the sale price of the vehicle was Rs.4,05,000/-.


It is submitted that the complainant had approached the opposite party at Bilaspur for the finance of aforesaid tractor in the month of December 2006 which was accepted by Branch Manager, Bilaspur and advanced a sum of Rs.2,80,000/- with financial charges i.e. Rs.90,300/- and agreement value was Rs. 3,70,300/- which was to be repaid in 35 instalments of Rs. 10,580/- as per agreement No.BSH/STFC/1720/SL on 26-12-2006.


It has further been averred that the complainant had paid margin money of Rs.1,25,000/- as per Annexure -1 and not Rs.1,50,000/- as alleged by him . The opposite party averred that the delivery of the vehicle was taken by the complainant from Kisan Motors , Ner chowk Mandi alongwith all sale documents and the supplying of documents did not arise . The opposite party had admitted that the complainant had paid Rs.20,000/- on 21-8-2007 but pleaded that the complainant had paid the aforesaid instalment after seven months of the execution of the agreement and thereafter did not pay any instalments towards purchase liability.


The opposite party had denied forcible possession of the vehicle in question and pleaded that the vehicle was handed over by the agent of the complainant to the company official as complainant was unable to pay the arrears pending against him . The opposite party further pleaded that the possession of the tractor was taken without trolley on 3-1-2008 and not on 31-3-2008. It has further been submitted that before taking possession of the vehicle several official notices for making the payment of the arrears were sent to the complainant and even legal notice dated 21-8-2007 Annexure -9 had also been issued but the complainant had never replied the notices nor paid the instalments .


It has further been averred that before taking possession of the tractor without trolley , information had been given to the concerned police ,hirer and guarantor The opposite party had submitted that the complainant had not paid the EMI of the tractor to the opposite party despite issuance of several notices for making arrear of instalments and the complainant had failed to comply with the terms and conditions of the Hire Purchase agreement . The opposite party had denied that the complainant approached it and made any request .


It has further been submitted that Gopi Chand agent of the complainant had signed the surrender letter and after taking possession of the vehicle the same was valued by Sh.Rajesh Sood Surveyor on 16-7-2008 and thereafter notice of sale / auction had been issued to the complainant on 17-7-2008 and opportunity was given to the complainant to deposit outstanding amount of Rs.1,89,958/- and as the complainant had not responded the notice , the vehicle was sold for Rs.1,75,000.-. Rest of the allegations have been denied . On these grounds the complaint had been sought to be dismissed with exemplary costs

3. The complainant had filed rejoinder reiterating the contents of the complaint and controverted the allegations made in the reply .

4. We have heard the ld. counsel for the parties and have carefully gone through the record.

5. The ld. counsel for the complainant had argued with full force that the opposite parties had snatched the vehicle forcibly on 31-3-2008 when 5-6 persons came to the place of the complainant , they misbehaved and manhandled the complainant and represented that they are the officials of the opposite party and forcibly took away the tractor in question alongwith its trolley. The ld. counsel for the complainant further argued that the above act on the part of the opposite party tentamounts to deficiency in service and he is entitled for re-possession of the vehicle .

6. On the other hand , the ld. counsel for the opposite parties had strenuously argued that as per the Hire purchase agreement , they had the authority to take the vehicle into possession in case of default of instalments and since the complainant had shown his inability to pay the due amount, therefore , the possession of the tractor without trolley was obtained from the agent of the complainant and as such there is no deficiency in service on its part and the complaint had been sought to be dismissed.

7. Therefore, the matter has to be scrutinized and examined with respect to the aforesaid contentions of the ld. counsel for the parties.

8 The first question which requires determination is as to whether the opposite party had forcibly taken the possession of the vehicle as alleged by the complainant or the vehicle was snatched by opposite party with the help of third parties . As per the complainant , on 31-3-2008 at about 11.AM 5-6 persons came to the place of the complainant and represented that they were officials of the opposite party and mishandled him and forcibly took away the tractor alongwith its trolley.


To the contrary is the version of the opposite party . As according to it, the complainant was unable to pay the arrears of instalments pending against him and the vehicle in question was handed over by the agent of the complainant to the company officials . The opposite party had placed on record photocopy of the surrender letter dated Nil addressed to the Manager of the opposite party. The perusal of the surrender letter shows that it has been signed by one Sh. Gopi Chand . The complainant in the rejoinder had specifically refuted that he had any acquaintance with aforesaid Gopi Chand .


Therefore, in this back ground , it was incumbent upon the opposite party to have proved that Sh.Gopi Chand was the agent of the complainant and that he had surrendered the vehicle to the opposite party on his behalf but no evidence had been produced by the opposite party to this effect. The opposite party could have filed the affidavit of Sh.Gopi Chand but the same had not seen the light of the day. Therefore, no benefit can be derived by the opposite party from the surrender letter in view of the fact that the vehicle has not been surrendered by the complainant himself There is no other evidence on record to suggest that the vehicle was taken into possession by the opposite party with the consent of the complainant.


The opposite party had also placed on record information which was stated to be given to the hirer , guarantor , S.H.O. Police station, Kullu SHO Police Station Bhunter but no credence can be attached to these documents because these are only photocopies. Moreover, no authenticated document like first information report or Daily diary report of the concerned Police Station has been placed on record by the opposite party to establish that the complainant himself had surrendered the vehicle or Sh. Gopi Chand has surrendered the vehicle with the consent of the complainant. Therefore, in view of the facts and circumstances of the case, it can safely be held that the opposite party had taken the possession of the vehicle forcibly by taking the assistance of third persons.



9. Now the question which arises for consideration before this Forum is as to whether the opposite party had a right to re-possess the vehicle in case of default of payment by use of force. The Hon’ble Supreme Court in the case titled Manager ICICI Bank Ltd vs Prakash Kaur and others AIR 2007 Supreme Court 1349 had held that recovery of the Bank Loans or seizure of the vehicles could be done only through legal means and the Bank cannot employ goondas to take the possession by force .


In the order passed by Hon’ble National Commission in Citicorp Maruti Finance and ltd vs S.Vijayalaxmi , III(2007)CPJ-161(NC) it has been held by the Hon’ble National Commission that the recovery of the loan or seizure of vehicle could be done only through legal means .and the Banks cannot employ muscle men to take the possession by force. In para No.23 and 24 of the aforesaid order it has been held as under:-

“23. From the aforesaid law laid down by the Apex Court as well as the High Court of Delhi, it is clear that even though the hire purchase agreement may give right to take possession of the vehicle , money lenders/ financial institution/ banks have no power to take possession by use of force and have to follow the statutory remedy which may be available under the law.

24.May be that the procedure of law is slow but that is no excuse for use of force for repossessing the vehicle. If the contention of the petitioner that

it can take possession of the vehicle by means of force is accepted ,the rule of jungle would prevail and might would be right.”

10 In the present case also, it cannot be said that the opposite party has taken the possession of the vehicle by following the statutory remedy available to it under the law and since the vehicle had been taken into possession by use of force , it was a clear cut case of unfair trade practice on the part of the opposite party in view of the decision of Hon’ble Apex court and the Hon’ble National Commission, cited supra.

11. The next question which requires consideration is that when the repossession of the vehicle is held to be unfair, what relief should be given to the complainant . Since the vehicle has been sold, therefore, no direction can be issued to the opposite party to return the same to the complainant. It has been admitted by the opposite party that the vehicle had been sold for Rs.1,75,000/- after taking possession and it was duly valued by Sh.Rajesh Sood, Loss Assessor on 16-7-2008 as per surveyor report Annexure -14, We have perused the valuation report of Sh. Rajesh Sood Annexure 14 but no weightage can be attached to it because it is not supported by any documentary evidence on record which could show that on what basis the value of the vehicle had been assessed at Rs.1,75,000/-.


No affidavit of the valuer has been placed on record by the opposite party in support of the valuation report. Moreover the valuation certificate Annexure 14 is only a photocopy and no reliance can be placed upon it for the purpose of assessing the value of the vehicle .



12. At this juncture , it would be relevant to refer to the case law Citicorp case cited supra where in the Hon’ble National Commission had taken note of the Code of Conduct prescribed by the petitioner bank before taking the possession of the vehicle and the Hon’ble National Commission also referred to relevant portion of the Code of Conduct which gives an elaborate procedure before taking the possession of the vehicle. In the aforesaid judgment it has been held in para no. 44 as under:-

44. It is to be stated that in this auction the consumer whose vehicle is seized has no voice or role to play. In any case , if an opportunity is given to the consumer, when his vehicle is likely to be sold at a particular price and option should be given to him to purchase the vehicle at the said price, then it is a transparent procedure. The procedure which is stated in the Conduct Book may appear to be attractive, but in practice it is not followed and causes loss to the consumer- because in many cases the bidders purchase vehicle at a throw away price. ”

13 In the present case also , there is no evidence on record to suggest that as to whether there is any procedure prescribed by the opposite party for selling the vehicles in public auction and if yes whether prescribed procedure had been adopted by it during the sale of the vehicle in question. There is no material on record to show that any prescribed procedure has been followed by the opposite party in selling the vehicle in question. No opportunity has been granted to the complainant to either purchase the vehicle at the sale price of Rs.1,75,000/- or to bring better buyers .


As per the notice issued by the opposite party to the complainant on 23-7-2007 Annexure -6 only a sum of Rs. 74060/- was out standing as arrears against the complainant but despite that the vehicle was sold at throw away price of Rs. 1,75,000/-. In our opinion, the opposite party had no right to sell the vehicle (the value of which was Rs.4.05,000/- excluding trolley on 27-12-2006 at the time of purchase by the complainant) in the meagre sum of Rs. 1,75,000/- only to the detriment of the complaint and the aforesaid act in selling the vehicle at throw away price amounts to unfair trade practice on the part of the opposite party especially in view of fact that after seizure of the vehicle , the complainant was willing to pay the out standing amount .


In our opinion the value of the vehicle would not come down to Rs.1,75,000/- from Rs.4,05,000/- within a period of two years from the date of its purchase. In a case titled Magma Leasing Ltd vs Bharat Singh 1 (2007) CPJ-200 it has been held by the Hon’ble Delhi State Consumer Disputes Redressal Commission that in such cases the cost of the vehicle shall be adjusted by depreciating the value at the rate of 5% per year in case of passengers vehicle and @ 10% per year in a case of commercial vehicle .Para No.10 and 11 of the order reads as



under:-

“10.Whenever the financer chooses to take possession of the vehicle, it has to refund the contribution made by the person concerned after adjusting the unpaid instalment till the date of seizure of the vehicle and not beyond that as no person can be deprived of the amount contributed toward the purchase price of the vehicle. By giving loan amount of Rs.3,90,000/- against the cost of Rs.5,89 lacs , financier cannot be allowed recovery of post dated cheques as the vehicle against which loan was advanced had been seized and the consumer is no more in possession of the goods for which he had raised the loan.

11. In such a situation , financier has to adjust the value of the vehicle by way of depreciated value and the value at which it has auctioned or sold the vehicle. The value of such a vehicle cannot be fixed by the financier at its whims or caprice. Experience shows that one or two years old vehicles are sold at half or little more value to the known people or friends or for many other consideration. That is why we have taken a view that cost of the vehicle shall be adjusted by depreciated value @

5 % per year in case of passenger vehicle and @ 10% in case of commercial vehicle ”

16. In the present case , as per the complainant the vehicle in question was a commercial vehicle and the same was purchased by him on 27-12-2006 in the sum of Rs.4,05,000/- excluding trolley. The vehicle was taken into possession by the opposite party on 3-1-2008 and was sold for Rs. 1,75,000/-. The opposite party had not filed any documentary evidence to establish that on which date the said vehicle was auctioned. The complainant had purchased the vehicle in the month of December 2006 and the opposite party had seized the same on

3-1-2008 Therefore at that time of seizure of the vehicle, the age of the vehicle in question exceeded one year but did not exceed two years from the date of its purchase by the complainant . Hence , the cost of the vehicle at the time of its seizure has to be adjusted by calculating its market value by depreciating the amount at the rate of 20% ( i.e.10% per year) from Rs.4,05,000/- i.e. the actual purchase price of the vehicle by the complainant as the vehicle is admittedly a commercial vehicle .The complainant had also averred that he had got prepared the trolley by spending Rs.50,000/- and in this respect reliance has been placed on the Invoice of Him Trading Corporation dated 29-11-2006. No evidence has been led by the opposite party that tractor was taken into possession without trolley.


Therefore , in the absence of any evidence on record , it cannot be said that the opposite party had obtained the possession of the tractor without trolley. The opposite party had also admitted that the complainant had paid Rs.1,25,000/- as margin money and on 21-8-2007, the complainant had paid Rs.20,000/- towards payment of the instalments . Therefore, in view of the facts and circumstances of the case, it would be in the interest of justice if we direct the opposite party to adjust the sale proceed of the vehicle towards

the satisfaction of the dues by calculating its market value by deducting 20% of the amount from Rs.4,05,000 /- i.e. from the purchase price of the vehicle by the complainant The opposite party is further directed to adjust Rs.1,25,000/- the margin money ,Rs.20,000/- paid towards the payment of the instalments, Rs.50,000/- as costs of trolley after adjusting unpaid instalments till the date of seizure of the vehicle and not beyond that as the vehicle against which the loan was advanced had been seized and the complainant was no more in possession of the same for which he had raised loan as laid down by the Hon’ble Delhi State Consumer Disputes Redressal Commission in the case titled Magma Leasing Ltd vs Bharat Singh 1 (2007) CPJ-200, supra

15 The complainant had claimed Rs.1,00,000/-on account of harassment due to illegal act of the opposite parties besides cost of litigation. In this respect, it would be relevant to mention here that the entire action of the opposite party in selling the vehicle at throw away price of Rs.1,75,000/- was illegal and arbitrary in nature and the complainant had suffered humiliation before his neighbours, friends and relatives and also suffered mental pain and agony. Therefore, in such circumstances an amount of Rs. 25,000/- is granted on this score and Rs.5,000/- as costs of litigation in favour of the complainant.

16. In view of what has been stated hereinabove, the complaint of the complainant is allowed against the opposite party with directions as under:-

(i) The opposite party is directed to adjust the sale proceeds of the vehicle towards the satisfaction of the dues by calculating its market value by deducting 20% of the amount from Rs.4,05,000/- i.e. the purchase price of the vehicle by the complainant instead of Rs.1,75,000/- and also to adjust the margin money of Rs.1,25,000/-, Rs.20,000/- amount deposited on account of instalment and Rs.50,000/- as amount spent for preparation of trolley , after adjusting unpaid instalments till the date of seizure of the vehicle. It is further directed that the after adjustment of the amounts as aforesaid, if it is found that the excess amount has been paid by the complainant , the same shall be refunded to him.

(ii) The opposite parties are further directed to pay Rs.25,000/- on account of harassment, mental agony and pain and Rs.5 000/- as cost of litigation.

17 Copy of this order be supplied to the parties free of cost as per Rules.

18. File, after due completion be consigned to the Record Room.

Smt. Sirasani Adinarayanamma, W/o Sirasani Jogi Reddy,

aged about 52 years, R/a Chimalacheruvupalli Village,

Galiveedu Mandal, Kadapa District. ….. Complainant.

Vs.



1) Shriram Life Insurance Co. Ltd., Rep. by its

Executive Director, 3-6-478, 3rd follor, Anand Estate,

Liberty Road, Himayatnagar, Hyderabad.

2) Shriram Life Insurance Co. Ltd, Rep. by its

Asst. General Manager, Tirupati, Chittoor district.

3) Shriram Life Insurance Co. Ltd, Rep. by its

Divisional Manager, Proddatur, Kadapa District.

4) Shriram Life Insurance Co. Ltd, Rep. by its

Branch Manager, branch Office, Proddatur,

Kadapa District. ….. Respondents.








O R D E R






1. Complaint filed under section 12 of the Consumer Protection Act 1986.



2. The brief facts of the complaint is as follows:- The husband of the complainant by name late Sirasani Jogi Reddy had taken one life insurance policy SHRI RAKSHA with double benefit on his life for Rs. 2,00,000/- from R4 vide policy No. NP 080600046866. This policy was commenced from 16-5-2006 late S. Jogi Reddy nominated his wife i.e. the complainant as his nominee to the above policy. The insured has remitted Rs. 24,450/- towards annual premium of the policy along with accident rider and FIB rider.


As per the terms of the policy, in case of death of the insured at any time during the premium term, the nominee would be entitled to receive double assured sum including vested bonus. The insured paid 2nd year premium of Rs. 24,634/- on 18-6-2007 to R4 by way of D.D. and obtained receipt. The husband of the complainant was admitted in ESI hospital, Hyderabad due to ill health on 16-7-2007 with the complaint of cellulites and fracture of right leg. He died on 24-7-2007 due to cardio respiratory arrest. The complainant made a claim to the respondents by furnishing all documents as required by them. But the complainant received repudiation letter dt. 17-3-2008 from R2.


In the said repudiation letter R2 stated that the claim of the complainant was repudiated on the ground of in correct information about pre-existing health problems of the insured. Immediately, the complainant approached R4 and requested him to settle her genuine claim. But there was no response from him. Having vexed with the negligence attitude of the respondents. The complainant got issued a legal notice dt. 10-6-2008 calling upon the respondents to pay double amount of sum assured. For which R1 issued a reply notice dt. 3-7-2008 alleging that insured was known patient of hyper tension with cellulites left leg and he suppressed the same at the time of taking policy.


The insured had suffered from hyper tension and cellulites just before one month of his death and he came to know; that he had that disease only after investigations made by ESI hospital, Hyderabad. The husband of the complainant had no intention to deceive respondents by this it is crystal clear that the insured had no knowledge about disease prior to taking of above insurance policy. Hence, the question of non-disclosure of pre-existing disease does not arise. Without any basis the respondents alleged that the insured had a history of hyper tension with cellulites.


Before accepting the proposal of the insured i.e. late S. Jogi Reddy the respondents called for special medical reports of the insured. After thorough medical examinations and obtaining its repots, the respondents company had issued insurance policy for an amount of Rs. 2,00,000/- on the life of insured i.e. late S. Jogi Reddy husband of the complainant. The husband of the complainant never suppressed any material facts, which is basis for issuance of policy. He suffered with alleged diseases only one month before his death. The insured never took medical treatment for any kind of disease prior to taking of the policy and he never suffered with such aliments prior to taking of policy as alleged by the respondents.


Without application of mind, the respondents repudiated the genuine claim of the complainant. On flimsy grounds, the respondents cannot escape from their liability from settling the claim of the complainant. The services of the respondents are deficient in nature. Hence, the complainant filed this complaint requesting this forum to allow the complaint and to pass orders in favour of the complainant directing the respondents a) to pay Rs. 4,00,000/- (Rs. 2,00,000/- + Rs. 2,00,000/-) towards double benefit assured amount together with vested bonus under policy No. NP 080600046866 along with 24% interest from the date of death of the insured i.e. from 24-7-2007 till the date of realization, b) to pay compensation of Rs. 50,000/- for causing physical stain and mental agony and c) to pay Rs. 2,000/- towards the cost of the complaint.



3. R1 filed a counter stating and denied all the allegations put forth in the complaint, except which are specifically admitted here and the averments which are not specifically admitted herein are deemed to be denied and the complaint is not maintainable either on facts or at law and the same is liable to be dismissed in limine.


The daughters of the deceased, by name Saraswathi, is an employee of Shriram Chits (P) Ltd., at Proddatur and she arranged the subject policy in favour of her father which commenced from 16-5-2006. at the time of taking of the policy, the company has suggested the deceased to fill the proposal form with correct details regarding his health condition, pre-diseases, if any, habits etc., as required under the questionnaire of the proposal form. Basing on the information provided in the proposal form only, the company has issued the subject policy in favour of the deceased in utmost good faith.


The deceased has nominated his wife, Adminarayanamma as his nominee under the policy. Through a letter dt. 12-11-2007, the complainant has intimated the company that her husband / policy holder died on 24-7-2007 at ESI Hospital, Hyderabad. On that, the company has supplied concerned claim forms to her for processing the claim. However, it is an early death claim; and the company has conducted its regular investigation into the matter through their investigator, G. Rama Murthy, Hyderabad. The investigation has revealed that the deceased was a known patient of Hyper tension with Cellulites (left leg) and further he was a patient of HIV positive which were not disclosed by the deceased policy holder at the time of taking of the policy.


It is submitted that had the company been informed about the said pre-health problems before taking the policy, the same would not have been issued by the company. The primary duty of the proposer while taking the life insurance policy is to disclose about his / her health conditions, pre-disease, if any, habits of the life proposed for insurance. As the deceased, Sirasani Jogi Reddy has deliberately suppressed the material facts which were suppressed to be disclosed at the time of taking the policy, the contractor has now become void, unenforceable and not legally binding on the company.


Therefore, the company is not liable to pay any amount towards policy claim and other benefits. The company vide its letter dt. 4-6-2009 has applied to the ESI Hospital under RTI Act to provide the entire medical records pertaining to the treatment taken by the deceased policy holder. The Hospital authorities vide their letter dt. 4-7-2009 had intimated to the company that the deceased life assured was first time admitted into their hospital on 25-6-2007 and discharged on 14-7-2007 again he was admitted on 16-7-2007 and expired on 24-7-2007.


But they have not provided any medical records as requested and upon personal interaction by one of the official of the company, the Hospital authorities have informed that they cannot provide medical records to the third parties, since it is a case of HIV related. Hence, the burden lies on the complainant to produce the entire medical record of the deceased policy holder. The medical records submitted by the complainant itself disclose that the deceased was suffering from Hypertension with Cellulites left leg and also a patient of HIV positive.


But the complainant intentionally did not speak out regarding the ailments of the deceased in her complaint and thereby tried to deviate the attention of the Hon’ble Forum. In this case some curious points are there for observation of the Hon’ble Forum at the first instance, the deceased was got admitted into ESI Hospital, Hyderabad on 25-6-2007 with complaints of cough, pedal oedema and boils over left leg and he was discharged on 14-7-2007 at the request of the patient. The diagnosis was that he was suffering from Hypertenion, Cellulites (left leg) and HIV positive. Again, the deceased was taken to the same hospital on 16-7-2008 with the same complaints.


The enquiries at the hospital have revealed that the deceased has fallen down in bath room on 18-7-2007 and received fractures to neck bone (humurus bone) and the neck of femur bone (right). But the daughter of the deceased has stated that the deceased went out of the hospital to have a tea and he was hit by an auto and received fracture injuries. Thus it was found by the investigator that the family members of the deceased are trying to suppress some facts. It is a clear finding of the investigator that the patient/deceased has absconded from the hospital without intimating the doctors / staff on 23-7-2007 and returned by him on 24-7-2007. On routine rounds, he was found dead at 3.15 p.m on the same day.


This is very unusual while the patient was treated as an in patient in a responsible hospital like ESI Hospital. One Dr. Ravi kiran has revealed before the Investigator that the deceased was a case of HIV positive. Thus there are so many facts and circumstances which were suppressed by the deceased and his family members including the treatment. The complainant did not furnish the duly filled up claim forms which are requested by the company to be furnished by her through their letter dt. 22-11-2007. since she did not turn up, the company has sent another letter dt. 31-12-2007 and 14-1-2008 requesting her to send the same.


Later, the complainant has sent the claim forms and on thorough scrutiny, the company has repudiated her claim vide their letter dt. 17-3-2008 aggrieved by the same, the complainant has got issued a legal notice dt. 10-6-2008 for which the company has issued a reply dt. 3-7-2008. Thus in view of the above facts and circumstances, reasons, it is clear that the deceased has obtained the subject policy by suppressing the previous history of the diseases particularly HIV positive, might be under social stigma and due to fear that his status will be lowered in the eyes of his family members if the fact was disclosed.


But the insurance is a contract and governed by the principal of “uberrima Fide” and the proposer applying for insurance policy is expected and bound to correctly furnish all material information regarding the health habits, family history, personal medical history etc., of the life proposed. In case of any default or hostile information, the contract will become void. Therefore, prayed the Hon’ble Forum may be pleased to dismiss the complaint against this respondent with exemplary costs in the interest of justice.



4. R3 filed a memo adopting the counter of R1.

5. R2 and R4 were called absent and set exparte on 18-8-2009.

6. On the basis of the above pleadings the following points are settled for determination.

i. Whether there is any negligence and deficiency of service on the part of the respondents?

ii. Whether the complainant is entitled to the relief as prayed for?

iii. To what relief?



7. On behalf of the complainant Ex. A1 to A9 were marked and on behalf of the respondent Ex. B1 to B11 were marked. Oral arguments were heard from both sides.



8. Point No. 1 & 2 Ex. A1 is the Xerox copy of policy bearing No. NP 080600046866 issued by the respondents in favour of S. Jogi Reddy. Ex. A2 is the Xerox copy of death certificate of the insured. Ex. A3 is the Xerox copy of repudiation letter dt. 17-3-2008 issued by R2. Ex. A4 is the Xerox copy of legal notice dt. 10-6-2008 issued by the complainant to the respondents. Ex. A5 are four postal receipts bearing Nos. 5077, 5078, 5079 and 5080. Ex. A6 are three postal acknowledgement cards.


Ex. A7 is the original reply notice dt. 3-7-2008 issued by R1 to the complainant. Ex. A8 is the Xerox coy of medical certificate of cause of death issued by ESI Hospital, Hyderabad. Ex. A9 is the Xerox coy of hospital record issued by ESI Hospital, Hyderabad. Ex. B1 is the Xerox copy of proposal for insurance submitted by the deceased S. Jogi Reddy. Ex. B2 is the Xerox copy of death intimation letter dt. 12-11-2007 sent by the complainant. Ex. B3 is the Xerox coy of letter dt. 22-11-2007 sent by the respondents company. Ex. B4 is the Xerox copy of letter dt. 31-12-2007 sent by the respondents company.


Ex. B5 is the Xerox copy of letter dt. 14-1-2008 sent by the respondents company. Ex. B6 is the Xerox copy of claim forms, A, B and C. Ex. B7 is the Xerox copy of medical reports (Ex. A9) issued by ESI Hospital, Hyderabad. Ex. B8 is the Xerox copy of medical record of Osmania General Hospital, Hyderabad. Ex. B9 is the Xerox copy of investigation report dt. 11-2-2008 of G. Ramamurthy. Ex. B10 is the Xerox coy of letter dt. 4-6-2009 sent by the respondents company to the ESI Hospital, Hyderabad. Ex. B11 is the Xerox copy of reply letter dt. 4-7-2009 of the ESI hospital, Hyderabad addressed to the respondents.



9. As could be seen from the documentary evidence the husband of the complainant by name S. Jogi Reddy had taken the policy in question on his life from R4 for a sum assured Rs. 2,00,000/- with double sum assured bonus plus vested bonus if the death occurred at any time during the premium term.


This policy was commenced from 16-5-2006 and the complainant is the nominee of this policy. The husband of the complainant was admitted in ESI hospital, Hyderabad on 16-7-2007 and found dead on 24-7-2007 as per Ex. A3, repudiation letter of R2 the claim of the complainant was repudiated on the ground of incorrect information furnished by the husband of the complainant about pre-existing heath problem of the insured. Now the question is whether the husband of the complainant suppressed the pre-existing diseases willfully which are known to him as contended by the respondents.


At the time of issuance of the policy in question the age of the insured was 57 years, as such the respondent company insisted for special medical reports and after through medical examinations the special reports on his medical history was obtained by the respondents company and issued insurance policy for amount of Rs. 2,00,000/- on the life of Jogi Reddy husband of the complainant. It was in 2006 and the commencement of the policy was on 16-5-2006. The insured as per the contention of the complainant and documentary evidence on record was admitted in the hospital on 16-7-2007 and died on 24-7-2007. As per Ex. A8 immediate cause of death of death was cardio respiratory arrest due to pulmonary enbolisam antecedent cause was hyper tension and fracture of right femur.


The learned counsel for the respondents contended that the deceased Jogi Reddy husband of the complainant was known patient of hyper tension with cellulites of lift leg were not disclosed by him at the time of taking policy. On this ground the claim was repudiated. As could be seen from the medical records i.e. Ex. B8, medical certificate of cause of death issued by ESI hospital, Hyderabad the immediate cause of death was cardio respiratory arrest and 2nd one i.e. antecedent cause of hyper tension and the last item of cause of death was fracture of right femur. So as per Ex. A8 the hyper tension is 2nd cause and cellulites left leg was the 3rd cause. The main cause of death was cardio respiratory arrest and according to the complainant this was not known to the complainant at the time of submitting proposal forms in 2006.


The contention of the complainant is supported by the version of the respondents company that the husband of the complainant under went special medical tests before acceptance of the proposals and after specifying the respondents company that the insured husband of the complainant was not having any pre-existing disease as alleged by the respondents company. The respondents company accepted the proposal and issued the insurance policy in favour of the insured husband of the complainant. The contention of the respondent that the decease like cellulites (light leg) is a typical disease that will be there in the body and it will not be known at the initial stage and to surface the symptoms of this type of diseases it consumes minimum five years of time.


Even according to the contention of the respondents the disease cellulites of right leg slowly come out and it consumes five years of time, strengthen the case of the complainant because he underwent special medical tests at the time of proposals in the year 2006 and the medical reports are silent about cellulites right leg or any other pre-existing disease. By all probabilities the complainant may not be knowing about his pre-existing diseases at the time of proposals and in view of the documentary evidence, especially medical reports particularly Ex. A8 the complainant deserves consideration in her favour. The points are answered accordingly.



10. Point No. 3 In the result, the complaint is allowed, directing the respondents 1 to 4 jointly and severally liable to pay a sum of Rs. 2,00,000/- + Rs. 2,00,000/- (Rs. 4,00,000/- Rupees four lakhs only) towards double benefit assured amount along with vested bonus to the complainant, to pay Rs. 5,000/- (Rupees five thousand only) towards compensation for mental agony and to pay Rs. 2,000/- (Rupees two thousand only) towards costs, payable within 60 days from the date of receipt of this order. If the respondents 1 to 4 failed to pay the amount the complainant is entitled to receive interest @ 9% p.a. from the date of issue of the order.

C.C.No.81 of 2008
BETWEEN:
Kanthamneni Venkata Ramana,

W/o. Krishna Simha,

R/o. Garnepudi (Post), via Paladugu,

Sathenapalli Mandal,

Guntur Distirct. … Complainant
AND

Shriram Life Insurance Company Ltd.,

Rep. by its Manager,

III floor, Gayatri Complex,

Sainagar, Near Benz Circle,

Eluru Road, Vijayawada. … Opposite party




This complaint coming up before us for final hearing on 10-11-09 in the presence of Sri T.Durga Prasad, Advocate for complainant and of Sri L.Vijaya Kumar, Advocate for opposite party, upon perusing the material on record, hearing both sides and having stood over till this day for consideration, this Forum made the following:

O R D E R

Per Sri T.ANJANEYULU, PRESIDENT:

This complaint is filed under section 12 of Consumer Protection Act, 1986 by the complainant against the opposite party for payment of insured sum under two policies with compensation of Rs.20,000/- and legal expenses.

The brief facts of the case are that:

The complainant namely Smt.Kanthamneni Venkata Ramana is the legally wedded wife of one late Kanthamneni Krishna Simha who died on 11-10-07 at Nethaji Nagar, Jakeer Hussian Nagar, Nellore due to heart attack, leaving complainant behind him as his legal heir. During his life time the said, Kanthamneni Krishna Simha obtained two policies from opposite party vide policy No.LN100700105032 for Rs.1,50,000/- commencing from 12-07-07 and its due date is 12-07-01 and another policy No.LN100700074226 for Rs.3,00,000/- commencing from 05-05-07 and its due date is 05-05-2021 and those two policies were in force. In those two policies, the said Kanthamneni Krishna Simha shown the name of complainant as nominee. After death of her husband, the complainant approached opposite party several times to settle the claim covered under two policies to her, as she is the nominee and legally wedded wife of deceased. But the opposite party did not choose to settle the same on one or other pretext.

Finally the complainant got issued legal notice dt.10-03-08 demanding the opposite party to settle the claim covered under the aforesaid two policies to complainant. The opposite party received the same and kept quiet. Due to attitude and behavior of opposite party the complainant suffered a lot mentally and financially. The attitude of opposite party amounts to deficiency of service. Therefore, the opposite party is liable to compensate the complainant for her mental agony. Hence, the complaint.

The opposite party filed its version denying all the allegations made in the complaint and call upon the complainant to prove them strictly. It is also stated that this Forum has no jurisdiction either to entertain or try this case for the following among other reasons. The complainant cannot be described as a consumer, since she does not fulfill any of the requirements of the definition of consumer within the meaning of Section 2(1)(d) of Consumer Protection Act, 1986.

It is true that late Kanthamneni Krishna Simha during his life time, after knowing the benefits, has opted a policy of “Shri Plus” with opposite party, for a sum assured amount of Rs.1,50,000/- which has commenced on 05-05-07.

It is further submitted that in the month of January, 2008 Smt.K.Venkata Ramana has informed that her husband Krishna Simha died on 11-10-07 but she did not reveal the cause of death. Then the officials of opposite party have requested her to give death intimation of her husband by mentioning the cause of death, which is mandatory for the purpose of process of claim. But the complainant did not furnish the same till date for the best reasons known to her and surprisingly filed present complaint with false and frivolous allegations. Immediately, after receiving summons from Forum, the opposite party has initiated process and conducted their preliminary investigation. The investigation officers have personally handed over the claim forms A, B, C & E to a person by name Kanthamneni Laxminarsamma on 24-06-08, at the address mentioned in policy documents and the same are duly acknowledged. But the complainant failed to submit filled claim forms till date. The complainant instead of following the due procedure of law has filed the present complaint before this Forum without any basis and with false allegations, which is noting but defaming the opposite party. There are no bonafides on the part of complainant in filing the complaint. She did not approach the Forum with clean hands. As such she is not entitled for the same. Therefore, it is prayed to dismiss the complaint.

Both sides have filed their respective affidavits. On behalf of complainant Ex.A1 to A6 are marked. On behalf of opposite party Ex.B1 to B4 are marked.

Now the points for determination are that

1. Whether there is any deficiency of service on the part of opposite party in not settling the claim under two policies obtained by the deceased for sum of Rs.1,50,000/- and Rs.3,00,000/- respectively under Shri Plus Scheme?
2. Whether the complainant is entitled for the amounts as sought for?
3. To what relief?

POINT No.1

The complainant claims that her husband Kanthamneni Krishna Simha has obtained two policies vide Ex.A1 and A2 for sum of Rs.1,50,000/- and Rs.3,00,000/- respectively. These two policies on record do establish the fact that late Kanthamneni Krishna Simha has obtained policies for the above referred sum. They also mentioned date of commencement of policy and its maturity date. The complainant is also shown as nominee being the wife of insured in relation. But unfortunately, the husband of complainant namely Kanthamneni Krishna Simha died on 11-10-07 within a short period after obtaining those two policies. This is evident from Ex.A3 death certificate issued by Municipal Corporation, Nellore. The complainant has also intimated this fact that her husband died on 11-10-07 due to heart attack. It is claimed that she personally approached opposite party and informed about the same and also requested for settlement of claim. As the opposite party not responded to her request, she got issued legal notice dt.10-03-08 vide Ex.A4, it is also acknowledged by opposite party vide Ex.A6.

Though the complainant alleges about obtaining two policies by her late husband for total sum of Rs.4,50,000/- (Rs.1,50,000/- + Rs.3,00,000/-), the opposite party admit about one policy i.e., for Rs.1,50,000/- but keep silent about other policy for Rs.3,00,000/-. He did not specifically deny about the same. Anyway this cannot be disputed in view of two policies filed by complainant before this Forum vide Ex.A1 and A2.

The main ground sought to be alleged is that in the month of January, 2008 the complainant said to have informed them that her husband died on 11-10-07 but she did not reveal the cause of death. This goes to show that even prior to issue of legal notice itself, it is brought to the notice of opposite party by the complainant about death of her husband. The opposite party alleges further that the complainant did not reveal cause of death of her husband and on the other hand issued legal notice and thereafter approached this Forum. It is further alleged by them on receipt of summons from this Forum they have initiated the process and conducted preliminary investigation about the cause and their officers said to have handed over claims forms A, B, C & E to a person known as Kanthamneni Laxminarsamma on 24-06-08, at the address shown in policy documents. They rely upon Ex.B1 to prove the same. It is a white paper and written in English that ‘received claim form A, B, C, & E’ at the top of page and after a gap of 4-5 inches at the right hand corner there appears signature of person known as Kanthamneni Laxminarsamma in Telugu language.

They have also marked blank claim forms of A, B, C & E vide Ex.B2 in order to show as to what information to be furnished by claimant for settlement of claim. Further they have also filed policy document vide Ex.B3. According to opposite party as per preliminary investigation report dt.01-08-08 received from one Sri G.Rama Murthy, surveyor/investigator, they came to know that the deceased has committed suicide. As such they rely upon clause 15 of policy document which reads as follows:

“If the life assured committed suicide, whether sane or insane, within one year from the date of commencement of risk under the policy, the policy shall be void and no claim will be payable.”

They further rely upon clause 21 to show that in case of death of life assured claimant shall submit the following documents to the satisfaction of the company

(a) Claim forms which will be issued by the company upon receipt of information of death of the life assured

(b) Original policy document

(c) Proof of death

(d) Proof of title

(e) Proof of accident / disability

(f) Medical treatment prior to date of death

(g) Employer’s certificate if applicable



Thus according to preliminary investigation report, the sum assured under two policies is not liable to be paid to the complainant since the deceased has committed suicide within a period of one year. On the other hand, it is also their claim that the information required under clause 21 of policy documents has got to be furnished in form numbers A, B, C & E by showing cause of death and since it is not submitted they could not further process the claim.

It is an admitted fact from para 5 of version of opposite party that in the month of January, 08, the complainant has informed about death of her husband and thereafter issued legal notice dt.10-03-08. The complainant put forth that she has been going around the office of opposite party ever since her husband died and it failed to settle the same. In the complaint and as well as in affidavit, she has mentioned the cause of death as heart attack. Even if it is taken to be true as alleged by opposite party that for the first time they came to know about death of deceased in the month of January, 2008. Admittedly they have not responded till the month of January, 2008 wherein they felt to appoint an investigator and supply copies of claim forms to the person known as Kanthamneni Laxminarsamma at the addressed noted in policy document. This woman appears to be mother of deceased as per information provided in investigation report. By that time the claim forms were handed over, this complaint is already filed before this Forum on 10-04-08. Thus it is seen that there is any amount of delay either in processing claim or in handing over the claim forms to the concerned. When policy document shows the name of complainant as nominee, there is no point in handing over them to the mother of deceased.

Now coming to the report submitted by investigator on 01-08-08 speaks volumes about history of case including the facts about commencement of policy, we have gone through the entire repot, we find some information is relevant and some information is irrelevant. Surprisingly, the investigator also speaks about policy No.LN100700074226 for sum of Rs.1,50,000/- but he does not give any repot about other policy for Rs.3,00,000/-. In the preamble itself it is stated by the investigator that “this is a case of death claim where in influential relatives of the deceased have misused their official power and managed the authorities and a suicide committed by the insured is being shown as sudden death”

Further the report shows that the deceased is a native of Guntur District and not highly educated. His sister Smt.Sakunthala is said to be working as Municipal Commissioner at Kavali Municipality. The deceased has also not on regular employment. Therefore, his sister brought him to Kavali to stay with her in the year 2003 and to place him in some employment. As the things did not work well, he left to Nellore in the year 2005. In Nellore he has taken two acres of land on lease and started sugar cane cultivation. Besides this he was also in real estate business under partnership with some of his cousins, who were employed with M/s.Janachaitanya Constructions. The deceased married Venkata Ramana (complainant). This report also speaks that in the month of April, 2007 Smt.Rajya Lakshmi, a friend and colleague of Smt.Sakunthala said to have approached her to encourage and made a request to have insurance coverage for her brother. Smt.Sakunthala has already obtained life policies on her own and asked the development officer and the agent to cover her brother. Accordingly, they left two sets of papers with Smt.Sakunthala. Thereafter a month filled proposals were submitted. In that no valid reason is shown for giving address at Kavali instead of giving correct address at Nellore, occupation also wrongly mentioned as private job though he was engaged in agriculture and doing some real estate business. It is also noted that in the month of January, 2008, the company has received information from claimant that her husband died on 11-10-07, but the cause of death was not revealed. One advocate said to have approached the officers of company at Repalle and offered sum for settlement of claim but the officers of company refused to receive the same. In the month of January, company has received notice from District Consumer Forum, Guntur, at this juncture investigator was appointed. He has approached the address given at Kavali and met the mother of deceased. During interaction, the mother of deceased said to have stated that her son committed suicide and asked him to talk with Smt.Sakunthala, her daughter who was working at Hyderabad by that time. When this investigator tried to contact her on phone, she said to have abused him and did not give any information about death of her brother. After lot of persuasion, the mother of deceased was made to accept the claims forms. After making hectic efforts, he said to have got contact number of claimant and on giving ring she refused to give information particularly about cause of death of her husband. The investigator said to have contact Smt.Rajya Lakshmi, family friend of deceased, but she refused to give any information. On the same day he received phone call from the sister of deceased namely Smt.Sakunthala and she abused him and also threatened him with dire consequences.

Considering all theses aspects, he came to conclusion that the deceased committed suicide and his sister managed the Government Officials by misusing her power by influencing police and seen to it that no FIR was registered.

Basing on such report, which was received subsequent to filing this complaint, the opposite party claims that the complainant did not furnish required information as under claim forms A, B,C & E. First of all we are reluctant to pale reliance on preliminary investigation report submitted by surveyor. It does not prove a fact as to nature of death of insured. No weight can be attached to it in absence of any supporting material in this regard. The sister of deceased namely Smt.Sakunthala has been blamed very much by the investigator about her alleged influence and misuse of power as Municipal Commissioner, which is uncalled for. We do not think, the police would be under pressure and influence of the officer of a level of Municipal Commissioner. In the circumstances of family history of deceased and his nature of occupation etc., the sudden death of deceased due to heart attack cannot be ruled out. Therefore, we observe that the opposite party shall not be guided by this kind of report made by the investigator. Thus there is deficiency of service on their part in not initiating the process though they received information about death long back in the month of January, 2008. The delay caused in the matter is no way explained, further more as seen from the above material on record, the opposite party admits about one insurance policy of Rs.1,50,000/- but silent about other policy. These facts do exhibit their carelessness. This amounts to deficiency of service.

POINTS 2 & 3

There cannot be any doubt that the complainant suffered mental agony and pain for non settlement of policy amount of her late husband as she being a nominee. Therefore, the opposite party shall pay suitable compensation for the same. We feel it appropriate to award Rs.10,000/- as compensation and Rs.1,000/- towards legal expenses for the deficiency committed in initiating and processing the claim. The point is answered accordingly.

In the result, the complaint is disposed of with the following directions:

1. The complainant shall submit the required information in the claim forms to the extent applicable to her and as to the death of her husband (since model claim forms are on record). The opposite party shall process the claim forms as soon as they receive from complainant and pay insured amount under two policies vide Ex.A1 and A2 i.e., sum of Rs.4,50,000/- with interest @ 9% p.a. from the date of complaint till the date of realization.
2. The opposite party is further directed to pay an amount of Rs.10,000/- towards compensation for mental agony, pain and suffering of complainant apart from legal expenses of Rs.1000/-.
3. The amounts ordered in item No.2 shall be paid within a period of six weeks from the date of receipt of copy of this order, failing which it shall carry interest @ 9% p.a. till the date of realization.

Dictated to Junior Steno, transcribed by her, corrected by us and pronounced in the open Forum, this the 11th day of November, 2009.

Consumer Complaint No: 574/2008
Between:

Sri Doddi Apparao, S/o Simhachalam (late), Hindu, aged 24 years, R/o D.No.1-48, Thimmaraju Peta, Munagapaka Mandal, Visakhapatnam District. … Complainant
A n d :

The Divisional Manager, Shriram Life Insurance Company Limited, 2nd Floor, D.No.1-83-27/1, Plot No. MIG-53, Sector-5, Double Road, M.V.P.Colony, Visakhapatnam-17. … Opposite Parties

This case is coming on for final hearing on 8-12-2009 in the presence of Sri Adari Apparao, Advocate for the complainant and of Sri.A.Venkateswa Rao, Advocate for the opposite party and having stood over till this date, the Forum delivered the following

: O R D E R :
(As per the Honourable Lady Member on behalf of the Bench)

1. The complaint filed under section 12 of the C.P Act alleging that the complainant’s father Doddi Simhachalam S/o Appanna, obtained the Life Insurance Policy from the opposite party vide policy No.LN110700114117, dated 26-10-2007 for the assured sum of Rs.1,50,000/-. The term of the policy is 15 years commencing from 26-10-2007 to 26-10-2022 and the complainant was duly nominated as a nominee under the policy.

2. The complainant further averred that the complainant’s father was bitten by a snake on 30-4-2008 and the insured was shifted to Anakapalle for treatment and the doctor treated the complainant’s father and later he was shifted to his residence. It is further averred that on 1-5-2008 the insured died on account of the snake bite and as the complainant was not aware of the insurance policy, he did not give any police report or conducted the postmortem. Later the complainant informed the opposite party about the death of the insured through letter dated 27-6-2008 and requested to settle the insurance claim in the capacity of the nominee and when the opposite party sent the claim form, the complainant submitted the same along with covering letter on 7-8-2008, but the opposite party having received the same failed to settle the same and hence filed the complaint.

3. The opposite party filed the counter by resisting the version of the complainant and stated that the Forum has no jurisdiction to entertain the complaint that the complainant is not a consumer and that there is no deficiency in service. The opposite party admitted to issuance of the policy to the complainant’s father and stated that at the time of taking the policy, the deceased was supplied with a proposal form regarding his health condition, preexisting health problems if any and habits etc. etc. as per questionnaire No.25 of the proposal form and that the opposite party with a bonafied belief accepted the risk and issued the policy in good faith.

4. The opposite party admitted to the representation made by the complainant intimating the death of the complainant’s father. The opposite party stated that the Head Office of the opposite party has sent a letter dated 26-7-2008 to submit the “A,B and C” forms and the complainant in pursuance of the letter sent form ‘A’only and did not submit the forms B and C and other required documents and as such a second reminder letter dated 15-09-2008 was sent and the complainant having received the letter did not choose to submit the required documents and as such the opposite party sent a closure letter on 4-10-2008. The Opposite party stated that in the mean time they have conducted regular investigation and came to know that the deceased was suffering from alcoholic liver disease (ALD) for a long time and the same was confirmed by the local persons who are acquainted with the diseased.

5. The opposite party further stated that the death of the deceased is not due to snake bite and the complainant has not submitted any medical records in support of his contentions and vehemently denied the death of the deceased is only due to the snake bite. Further the opposite party stated that the complainant has not submitted the FIR or the postmortem certificate to establish the cause of death and the complainant has woven a story of snake bite only with a fraudulent intention to have undue advantage and submitted that the death is due to previous health problems and as the deceased failed to disclose the previous condition, besides there are several latches on the part of the complainant sought for dismissal of the complaint.

6. The complainant has not filed any evidence affidavit dispite granting several adjournments and imposing the costs. There was no representation for the complainant and hence it is treated as no evidence for the complainant. The opposite party filed the evidence affidavit. Ex.B1 to Ex.B10 are marked for the opposite party. Written arguments are filed by both the parties perused the material on record and the written augments filed by both parties.

7. The point for consideration is:

Whether the complainant complied with requisite formalities for settlement of claim and in its absence whether the opposite party can be found fault with?

8. There is absolutely no dispute about the issuance of the policy in favour of the deceased i.e the complainant’s father and the death of the insured. The contention of the opposite party that the Forum has got no jurisdiction to entertain the complaint and that the complainant is not a consumer is not tenable for the reason that section 2(1)(d)(ii) includes beneficiary of such services other than the person who hires or avails of the services…. Further section 2(1)(o) deals with the term service where under the insurance services of the opposite parties were included therein specifically and as such we hold that the complainant is a consumer and the dispute is a consumer dispute and as such this Forum has got jurisdiction to adjudicate the dispute on hand.

9. Coming to the facts of the complaint with regard to the snake bite and the death of the deceased due to snake bite on 1-5-2008, we are of the considered opinion that the complainant has miserably failed to fulfill the obligations on his part. The complainant did not even chose to contest the version of the opposite party, as to the non submission the requisite “B and C” forms, and the documents by the complainant.

10. The complainant has not examined the doctor, who has treated insured on 30-4-2008 and did not even state the name of the doctor who has treated insured and it is needless to state that no FIR or postmortem were conducted even according to the complainant and in the absence non-submission of the requisite documents, we hold that there is no deficiency in service rendered by the opposite party.

11. Admittedly the complainant did not submit the requisite forms to the opposite party in order to settle the insurance claim nor the complainant proved his version with respect to the nature of death and this being summary procedure, in the absence of clear cut evidence by the complainant, we are of the considered opinion that there is no negligence on the part of the opposite parties in not settling the insurance claim.

12. In the result, we dismiss the complaint and each parties are directed to bear their own costs. Advocate fee is fixed at Rs.2,000/- (Rupees two thousand only).

Dictated to the Shorthand Writer, transcribed by him, corrected and pronounced by us in the open Forum on this the 14th Day of December, 2009.
.

Consumer Complaint No: 431/2008
Between:

Budda Nalini, D/o, late Varalakshmi, Hindu, aged 22 years, residing at D.No.17-14-141, Gavarapalem, Anakapalle, Visakhapatnam District Pin-531 002

… Complainant
A n d :

1. M/s. Shriram Life Insurance Company Limited, represented by its Divisional Manager, Diisional Office, D.No.1-83-27/1, Plot No.M-1, Sector-V, M.V.P. double road, Visakhapatnam.

2. M/s. Shriram Life Insurance Company Limited, represented by its Regional Manager, Registered Office at D.No.3-6-478, 3rd floor, Anand Estates, Liberty Road, Himayat Nagar, Hyderabad-500029.

… Opposite Parties

This case is coming on for final hearing on 16-09-2009 in the presence of Smt.P.Leelavathi, Advocate for the complainant and of Sri.A.Venkateswa Rao, Advocate for the opposite parties No.1 & 2 and having stood over till this date, the Forum delivered the following

: O R D E R :


(As per the Honourable Lady Member on behalf of the Bench)

1. The brief facts of the complaint is that the complainant’s mother obtained the Life Insurance policy from the opposite parties on vide policy No.LN110700112667, dated 24-10-2007 for the assured sum of Rs.1,50,000/- (Rupees one lakh and fifty thousand only). The term of the policy is 15 years commencing from 24-10-2007 to 24-4-2022 with accident shield and in the event of death occurring before the end of the policy term, 1% of family income benefit rider sum assured per month is payable till the end of the policy term are for a period of ten years whichever is higher. The premium payment is Rs.5,000/- (Rupees five thousand only) on half yearly intervals and that the complainant is nominated as a nominee under the policy.

2. The complainant further averred that the complainant’s mother was bitten by a stray dog on 12-11-2007 and received injuries and she was shifted to area hospital, Anakapalle and took treatment and later used the medicines at home as per the advice of the doctor. When the insured condition became serious on 15-11-2007, she was taken to private hospital for special treatment, but she died on 15-11-2007 and later the same was informed to Gram Panchayat who, after verification issued the death certificate. The complainant then averred that when she came to know of the policy the death was informed to the first opposite party and requested for settlement of the insurance claim and the same was received by the second opposite party on 8-11-2008 but the opposite parties neither settled the claim nor refused the same till date etc. etc.

3. The second opposite party filed the counter and the first opposite party adopted the counter filed by the second opposite party. The second opposite party resisted the version of the complaint and stated that the Forum has no jurisdiction to entertain the complainant, that the complainant is not a consumer and that there is no deficiency in service. The second opposite party admitted to issuance of the policy to the complainant’s mother and as to the representation of the complainant intimating the death of the complainant’s mother. The second opposite party stated that they have sent a letter dated 29-3-2008 along with the claim forms “A,B and C” to the complainant by registered post with acknowledgement due to the address mentioned in the policy documents and in the intimation letter, but the same has returned with endorsement has no such “door No.” and as such the second opposite party once again sent another letter dated 19-6-2008 and once again the same has returned with similar remarks.

4. The second opposite party further stated that in the absence of fulfilling the due procedure for processing the claim, the policy amount cannot be released to the complainant and as the complainant failed to submit the claim forms, which is a must without which no amount is payable to the complainant and the complainant without consulting the opposite parties has filed the complaint with false and frivolous allegations besides there are several latches on the part of the complainant and sought to dismiss the complaint.

5. The second opposite party further filed additional counter by stating that subsequent to filing of the complaint, the second opposite party gave the “A,B and C” forms to the complainant through one of their investigator on 18-4-2009 and the same was acknowledged by the husband of the insured, but till date the claim forms were not yet returned to the opposite parties and further stated that upon enquiries; the opposite parties came to know that the deceased was an ill health person and was on regular treatment under the guidance of one of their relative doctor and due to the long standing ill health, the family of the deceased hatched a plan to take a life insurance plan on her life and after her death due to the ill the family of the deceased had created a dog bite story without any substantial proof.

6. The second opposite party further stated that after receipt of the enquiry report dated 21-4-2009, consulted sri Shiridi Sai hospital at Anakapalle, where the deceased alleged to have taken the treatment when her condition became serious on 15-11-2007 and the said doctor N.Prasada Rao, gave in writing that he gave first aid deceased and that the deceased told that she was bitten by the dog and the said doctor has not conducted any investigation to come to a conclusion as to the cause of injury is due to dog bite and was not sure of the death of the insured due to the dog bite etc. etc.

7. The complainant filed the evidence affidavit reiterating the contention made in the complaint. Ex.A1 to Ex.A7 was marked for the complainant the second opposite party filed the evidence affidavit. Ex.B1 to Ex.B9 are marked for the opposite parties. Heard the arguments on both sides. Written arguments in support of the opposite parties was also filed. Perused the material on record and the versions of the both parties.

8. There is absolutely no dispute about the issuance of the policy in favour of the deceased i.e the complainant’s mother and the death of the insured. The contention of the opposite parties that the Forum has got no jurisdiction to entertain the complaint and that the complainant is not a consumer is not tenable for the reason that section 2(1)(d)(ii) included beneficiary of such services other than the persons who heirs or avails of the services …. Further section 2(1)(o) deals with the term service whether we are under the insurance services of the opposite parties were included there in specifically and as such we hold that the complainant is a consumer and the dispute is a consumer dispute and as such this Forum has got jurisdiction to adjudicate the dispute on hand.

9. Coming to the facts of the complaint with regard to the dog bite and the death of the deceased due to dog bite on 15-11-2007 and preferring the claim with the opposite parties, we are of the opinion that the complainant has miserably failed to fulfill the obligations on her part. It is no doubt that the complainant has not submitted the requisite “A,B and C” forms, which was given to the husband of the deceased subsequent to the filing of the complaint. The letters sent to the complainant through registered post were also returned with endorsement has “no such door number” and the said envelops were also filed before us. Further the report of the investigator and the letter issued by Dr.N.Prasada Rao who alleged to have treated the insured supports the version of the opposite parties.

10. The complainant on the other hand has miserably failed to prove the Ex.A2 to E.A4 documents filed in support of the complaint except the affidavit of the complainant, the complainant has not substantiated the contents of the complaint and the documents filed in support of the complaint. During the arguments the complainant’s counsel stated that the complainant’s mother died at home. It is not understood when the complainant averred that the complainant’s mother was serious and she was taken to the private hospital for special treatment, but why she was not admitted in the hospital? Above all this being unnatural death, there is no FIR postmortem report, which are requisite in the case of unnatural death were made.

11. Admittedly the complainant did not submit the requisite forums to the opposite parties in order to prefer the insurance claim nor proved the version of the complainant with respect to the nature of death and this being the summary procedure, in the absence of clear cut evidence by the complainant, we are of the considered opinion that there is no negligence on the part of the opposite parties in not settling the insurance claim.

12. In the result, we dismiss the complaint and each parties are directed to bear their own costs. Advocate fee is fixed at Rs.2,000/- (Rupees two thousand only).

Dictated to the Shorthand Writer, transcribed by him, corrected and pronounced by us in the open Forum on this the 11th Day of December, 2009.

Dear sir

I m PRAMOD KUMAR TRIPATHI workiong as a D.O. at lucknow branch, I did not receipt my salary of Dec. and jan.


request you to kindly clarify the resion why should not relise my salary as soon as earlyer.


Thanks

Pramod Kumar Tripathi
pramodtripathi0@gmail.com
To- sk choudhury, President-corporate
to- altamash javed