BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM ::
KADAPA Y.S.R DISTRICT
PRESENT SRI V.C. GUNNAIAH, B.Com., M.L., PRESIDENT
SMT. K. SIREESHA, LADY MEMBER
SRI M.V.R. SHARMA, MEMBER
Tuesday, 26th July 2016
CONSUMER COMPLAINT No. 02 / 2016
1. Sangam Bhagyamma @ Sangam Mariyamma,
W/o Late Sangam Ratnam Raju, aged about 41 years,
House wife, residing at D.No. 2/81,
Konda Sunkesula Village and Post, Peddamudiam Mandal,
Kadapa District.
2. Sangam Nagalakshmi, D/o Late Sangam Ratnam Raju,
aged about 14 minor and hence Rep. by her natural guardian
mother namely Sangam Bhagyamma @ Sangam Mariyamma,
Residing at D.No. 2/81, Konda Sunkesula Village and Post,
Peddamudiam Mandal, Kadapa / YSR District. ….. Complainants.
Vs.
The Branch Manager, The Bajaj Allianz Life Insurance Co. Ltd.,
Dwaraka Towers, 7 roads, Kadapa District. ………Respondent
This complaint coming on this day for final hearing on 19-7-2016 in the presence of Sri G.M.B. Murali Krishna, Advocate for Complainant and Sri D.V.S. Prasad, Advocate for Respondent and upon perusing the material papers on record, the Forum made the following:-
O R D E R
(Per Smt. K. Sireesha, Member),
1. Complaint filed under section 12 of C.P. Act 1986.
2. The brief facts of the complaint are as follows:- It is submitted that one Sangam Ratnam Raju obtained a policy with Bajaj Life insurance Company with policy bearing No. 0265476533 for an amount of Rs. 1,00,000/- and subsequently he paid the premium dt. 24-4-212 and hence, the said policy was effected immediately i.e. on 24-4-2012 itself and hence, the period of policy starts with 24-4-2012 and there by ends on 23-4-2013. Even though the policy was obtained for an amount of Rs. 1,00,000/-, but minimum death benefit will be covered for an amount of Rs. 2,00,000/- as per the terms and conditions of the said policy. So according to terms and conditions of the said policy, if any risk happened to the policy holder then the insurance company has to pay an amount of Rs. 2,00,000/- to the legal heirs of the said Ratnam Raju. Un fortunately the said ratnam raju was expired on 25-3-2013 and in those circumstances it is the bounded duty of the respondent life insurance company to pay an amount of Rs. 2,00,000/- to the legal heirs of the said Ratnam Raju.
3. It is further submitted that as per the terms and conditions of the policy, the policy itself was named and styled as a personal accident insurance policy which means the sum assured to be paid to the legal heirs of the deceased. The said Ratnam raju at the time of obtaining policy kept his wife as a nominee and the policy certificate discloses the same with naked eye. In spite of several demands and requests made by the petitioner, the respondent not turn up positively and not paid assured sum and respondent have been forced the petitioner to take appropriate steps through court of law.
4. It is further stated that the petitioner No. 1 husband was died on 25-3-2013 and hence the petitioner No. 1 further states that she has approached number of times and made oral as well as written submissions with all relevant documents showing that her husband died, but respondent have not turn up and yield up positively to settle the assured sum under the said policy. It is further states that when respondent have not settle the assured claim in favour of petitioner which goes to shows that there is a deficiency of services and in those circumstances the petitioners are forced to file a litigation for proper remedy through court of law.
5. Thus the said Ratnam Raju died and unexpectedly on 25-3-2013 during the subsistence of the aforementioned policy leaving behind petitioners as his legal heirs to succeed to his estate. As per the terms and conditions of the aforesaid policy, the petitioners being the legal heirs of the deceased Ratnam Raju and hence, they are entitled to the benefits covered under the aforesaid policy.
6. The petitioners became helpless having lost her sole bread winner i.e. the deceased Sangam Ratnam Raju. It is submitted that the petitioner’s herein submitted a death claim form along with all the certificates including policy and also death certificate and requesting the respondent authorities to settle the claim but the respondent company repudiated the claim for submitting the legal heir certificate. It is further stated that the petitioners have submitted the family member certificate as well as notary affidavit showing the details of family members. The petitioner No. 1 also submitted a notary affidavit stating that he was called as a Sangam Bhagyamma @ Sangam Miriyamma. It is further stated that there are no any legal heirs apart from the petitioners herein. No any person or any legal heir approached the respondent insurance company claiming the death claim of the said Ratnam Raju, so for and it goes to shows that there was no any legal heir to the deceased Sangam Ratnam Raju, it is further stated that even though there is no ambiguity regarding the death claim of deceased Sangam Ratnam Raju, but also the respondent company not settled the death claim for the deceased and in order o knock away the said amount and with evil desire, repudiated the genuine claim of the petitioners herein.
7. it is further submitted that after the repudiation of the said claim, the petitioners herein were also approached the insurance ombudsman to settle the genuine death claim of the deceased but the said authorities of the insurance ombudsman not settled the claim and given a direction to approach the other forum other court for appropriate relief. In those circumstances the petitioners herein have been forced to approach the Hon’ble forum for appropriate relief. Hence, the complaint.
8. The Complainant therefore, prays that the Hon’ble court be pleased to direct the respondent (a) to pay Rs. 2,00,000/- together with interest at 24% p.a. from the date of policy till the date of realization of the amount, (b) to pay Rs. 50,000/- towards compensation for rendering deficiency of service, (c) to pay Rs. 50,000/- towards damages for menial agony and suffering (d) grant Rs. 10,000/- towards cost of this complaint and (e) grant such other and further reliefs as the Hon’ble forum deems fit and proper in the interest of justice.
9. Counter filed by the Respondent that the Complainants is neither just nor maintainable either in law on facts. The Complainants are put to strict proof of all the allegations made in the complaint except those that are not specifically admitted herein by this Respondent.
10. The present complaint filed by the Complainants seeking to award the sum assured under the insurance policy No. 0165476533 owing to the death of the Life assured Sangam Ratnam Raju, who died on 25-3-2013 is not maintainable and the same is devoid of merits and truth. It is submitted that this Respondent admits the issuance of the above insurance policy in favour of the Life Assured Sangam Ratnam Raju which covers w.e.f 24-4-2012 for a sum of Rs. 1,00,000/- with annual premium for a period of16 years and that the Life Assured under the above insurance policy nominated his wife Mariyamma. S. aged 35 years as his nominee.
11. It is submitted that the Life Assured died on 25-3-2013 and that the Complainant No. 1 intimated the death of the Life Assured in the month of May 2013 and on receipt of the death intimation, this Respondent company intimated the Complainant No. 1 to submit the documents for processing the death claim. The Complainant No. 1 submitted the required details in piece meal and that this respondent company on careful perusal / scrutiny of the documents furnished by the cms, under a letter dt. 12-11-2013 addressed to the Complainant No. 1 to produce the succession certificate from a competent court of law having jurisdiction, since the documents furnished by the Complainants reveals that the Complainant No.1’s name is mentioned as Sangam Bhagyamma (Ration card), where as in the policy the nominee’s name is mentioned as Mariyamma S., as such for clarification and for payment of the sum assured is paid to a proper and correct person, a succession certificate is mandatory. In spite, of the above letter addressed to the Complainants, they have failed to furnish succession certificate and on the other hand, the Complainants have approached insurance ombudsman complaining against this respondent for non – payment of the sum assured and that the insurance ombudsman after detailed enquiry directed the Complainants to produce the succession certificate from competent court of law for payment of the sum assured.
12. It is submitted that the Complainants having failed to obtain and produce the succession certificate as intimated by this Respondent coupled with the direction of the insurance ombudsman, approached this Hon’ble forum with unclean hands throwing blame on this respondent that the sum assured under the above insurance policy was not paid. It is submitted that the object / aim of this respondent demanding to produce the succession certificate from a competent court of law is that the insured sum is paid to a proper person. In the instance case, the complainants failed to produce any document confirming her name as Mariyamma and that the documents so produced stands in the name of Bhagyamma and that the self styled documents of the Complainants mentioning her name as S. Bhagyamma @ S. Mariyamma does not prove herself as named as Mariyamma, who is nominated under the insurance policy. This respondent is astonished why the Complainants are sharking to produce the succession certificate rather than approaching this Hon’ble forum with all false pleas.
13. It is submitted that absolutely there is no deficiency of service on the part of this Respondent in not settling this claim. The present complaint is barred by limitation therefore this complaint is liable to be dismissed forthwith. This Respondent reserves their right to file additional counter if fresh facts comes to the notice of this Respondent. Viewed from any angle, there are no merits in this complaint. This Respondent, therefore prays that the Hon’ble forum may be pleased to dismiss the complaint with exemplary costs in the interest of justice.
14. On the basis of the above pleadings the following points are settled for determination.
- Whether the complainant is eligible for compensation as prayed by him or not?
ii. Whether there is negligence or deficiency of service on the part of the Respondent or not?
iii. To what relief?
15. On behalf of complainant Exs. A1 to A23 were marked and on behalf Respondents no documents were marked.
16. Point Nos. 1 & 2. It is very clear from Ex. A1 i.e. insurance policy obtained by the deceased Sangam Ratnam Raju, and mentioned nominee name as Mariyamma. S. It is very clear that the deceased died on 25-3-2013 under Ex. A2. After death of the deceased Sangam Ratnam Raju, the Complainant No. 1 approached the Respondent for death claim under Ex. A5. The Respondent issued a letter under Ex. A12 stating that to settle the death claim of the deceased the succession certificate from court of law competent jurisdiction is necessary as the name of the nominee is totally different from the original name of the Complainant mentioned in the insurance policy by the deceased Sangam Ratnam Raju. Ex. A22 clearly proves that the complaint was time barred; the complaint should be within one year from the date of last denial. As seen from the evidence on record, averments in the complaint and counter, it is very clear that there is life insurance policy and the deceased mentioned the nominee name as Mariyamma.S. All the documents filed by the Complainant No. 1 shows that her name was S. Bhagyamma. So the Respondent is directed the Complainant No. 1 to produce succession certificate from the court of law to settle her claim. The Complainant did not do so. Hence, the Complainant is not eligible for compensation as prayed for at the same time there is no deficiency of service or negligence on the part of the Respondent.
17. Point No. 3. In the result the complaint is dismissed without costs.
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open Forum, this the 26th July 2016.
MEMBER MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses examined.
For Complainant : NIL For Respondents : NIL
Exhibits marked for Complainant: -
Ex. A1 Policy copy issued by the Respondent copany.
Ex. A2 Death certificate issued by panchayat secretary, Peddamudium, dt. 1-4-13
Ex. A3 Family member certificate issued by Tahsildar, Peddamudium, dt. 29-1-14.
Ex. A4 P/c of notary affidavit issued by T. Ramlingeswara Raju, dt. 6-5-13.
Ex. A5 P/c of death claim statement.
Ex. A6 P/c of claim consent letter, dt. 6-5-2013.
Ex. A7 P/c of burial / cremation letter dt. 6-5-2013.
Ex. A8 P/c of death claim discharge form dt. 6-5-2013.
Ex. A9 P/c of medical attending certificate.
Ex. A11 P/c of hospital treatment.
Ex. A12 P/c of letter issued by the Respondent company, dt. 12-11-2013.
Ex. A13 P/c of reminder letter issued by the Respondent company dt. 25-7-2014.
Ex. A14 P/c of the house hold card, dt. 28-3-2016.
Ex. A15 P/c of vote identity card of the Complainant No. 1, dt. 15-12-1995.
Ex. A16 P/c of letter issued by the insurance ombudsman, dt. 24-7-2014.
Ex. A17 P/c of letter issued by Respondent dt. 6-5-2013.
Ex. A18 P/c of employer certificate death claim dt. 6-5-2013.
Ex. A19 Certificate from usual family doctor, dt. 6-5-2013.
Ex. A20 Letter issued by red dt. 24-4-2014.
Ex. A21 Letter endorsed by Respondent dt. 25-7-2014.
Ex. A22 Letter endorsed by ombudsman, dt. 11-7-2014.
Ex. A23 P/c of acknowledgement card.
Exhibits marked on behalf of the Respondents.
MEMBER MEMBER PRESIDENT
Copy to :-
- Sri G.M.B. Murali Krishna, Advocate for Complainant
- Sri D.V.S. Prasad, Advocate for Respondent.
B.V.P.
