(ORDER BY SRI P.V. KRISHNA MURTHY, PRESIDENT)
1. The brief averments of the complainant as are follows:- The complainants are wife and children of late Ramanaiah, an attender in the roads and buildings department at Giddalur. Late Ramanaiah was covered by an insurance policy during his life time with the opposite parties. The opposite parties are the employees of the insurance company. Ramanaiah died due to cardiac failure on 21.03.2009. The first complainant submitted a claim with relevant documents. The opposite parties have not settled the claim. The complainant got issued a legal notice also. The first complainant is the nominee in the insurance policy. Hence, the complaint for payment of the sum assured with the death benefits, costs and compensation.
2. The opposite party No.1 remained ex-parte.
3. The brief averments of the counter of 2nd opposite party are as follows:- The late Ramanaiah has not died due to cardiac failure as alleged by the complainant. Late Ramanaiah obtained an insurance policy Shri Plus for a sum assured of Rs.75,000/-. The premium payable was Rs.10,000/- on annual mode. The policy commenced from 13.11.2008 and runs for a period of 15 years. The first complainant was nominated as, nominee. The company received information of the death of Ramanaiah through the complainant. The opposite party sent an investigator by name G.Ramamurthy along with claim form to the complainant for processing the claim. The complainant submitted forms A, B, C and E. The claim form-B was sent in blank. No medical certificate was filed to prove the version of the complainant. No postmortem was conducted. No cause of death. The company came to know from the investigator that the insured died by falling down from a wall. Since form-B was not submitted in a proper way, the company closed the claim. There is doubt with regard to death of the deceased. There is no negligence. Hence, the claim may be dismissed.
4. The brief averments of the counter of 3rd opposite party are as follows:- The complainant suppressed material facts. A contract of insurance is a contract of utmost good faith. The deceased obtained an insurance policy from the opposite parties. The opposite party sent an investigator with claim forms. The complainant has not submitted the claim form in a proper way. The legal notice contains baseless allegations. The company closed the claim as form B was not properly submitted. The company came to know that the deceased died by falling from a wall with a height of 4 feet. It is unbelievable. The investigation report revealed that the assured was habituated to smoking and drinking. The cause of death is not correct. The first complainant gave a different version with regard to the death of the deceased. No medical records were filed. There is no negligence and deficiency of service. The opposite parties are not liable to the claim. Hence, the claim may be dismissed.
5. Now the point for consideration is whether the opposite parties committed any deficiency of service?
6. On behalf of the complainants, the first complainant filed her affidavit and marked Exhibits A1 to A7. On behalf of the opposite parties, the Assistant General Manager filed his affidavit. Exhibits B1 to B9 were marked for the opposite parties.
7. Point: The complainants are the wife and children of the deceased Ramanaiah who took an insurance policy from the opposite parties. Ex.B1 is the policy. The opposite parties admitted the policy. It was also admitted that the first complainant is the nominee to receive the insurance benefits from the opposite parties, in the event of the death of the assured. The opposite parties repudiated the claim on the ground that the complainants version with regard to the death of the assured was unbelievable. The complainants contended that the deceased died due to cardiac failure. However the complainants have not filed any material to show that the deceased die due to cardiac problem. Ex.A5 is the claim form B. The doctor in column no.5 held that the death was due to congestine cardiac failure (CCF). The contents of Ex.A5 are against the stand of the opposite parties. The opposite parties are relying upon Ex.B3 and Ex.B7. Ex.B3 is a letter of the complainant to the opposite parties stating that her husband fell from a wall and died due to head injury. Ex.B7 is a letter of the complainant to the investigator along with the copy of the claim form B, Ex.B8 this claim form is different from the claim form under Ex.A5. The column no.5 of Ex.B8 is blank. Column no.5 of the document relates to the cause of death. However in that letter (Ex.B7), the first complainant stated that the assured died by falling from the wall while he was adjusting awhile.
8. At any rate, the death of the deceased was not a suicide. Smoking and drinking were also mentioned in Ex.B8. There is no other evidence with regard to it. The above habits are not linked directly to the cause of death as pleaded by the complainants. Assuming that the deceased died by falling from wall, the above habits will not cause of death directly. The stand of the opposite party with regard to the repudiation of the policy is not clear. A mere suspicion is of no help in rejecting a claim. The opposite parties by repudiating the claim committed a deficiency of service. The opposite parties are liable to refund the insurance amount to the complainants equally, (Rs.25,000/- each) with interest @ 9% from the date of the complainant till realization. The claim for costs and compensation is rejected since the complainants did not provide the required information to the opposite parties, with regard to the death. The point is answered accordingly.
9. In the result, the complaint is allowed, ordering the opposite parties to pay the sum assured of Rs.75,000/- to the complainants equally (Rs.25,000/- each) with interest @9% from the date of complaint till realization. The amount of the minors shall be invested in Andhra Bank, Court Street, Ongole till they attain majority, permitting the first complainant to draw the annual interest and spend the same for the welfare of the minors. The claim for the relief is dismissed. Dictated to the Shorthand-writer, transcribed by her, corrected by me and pronounced in the open Forum this the 24th day of November, 2015. Sd/-xxxx Sd/-xxxx MEMBER PRESIDENT APPENDIX OF EVIDENCE Witnesses Examined for the complainant Pw.1 30.07.2015 Daddanala Chennamma @ Alasandalapalli, Chennamma, W/o. Late Daddanala Ramaiah, Aged about 27 years, Attender, R&B Office, Giddalur. Witnesses Examined for the opposite parties Rw.1 17.08.2015 Mr.E. Sridhar, S/o. E.J. Lingam, aged 51 years, working as Assistant General Manager in M/s. Shriram Life Insurance Company Limited., having its registered office plot no.31 & 32, 5th Floor, Ramky Selenium, Beside Andhra Bank Training Centre Financial District, Gachibowli, Hyderabad-500. DOCUMENTS MARKED FOR COMPLAINANT: Ex.A1 03.04.2009 Death certificate issued by village Secretary, Rajupalem. Ex.A2 27.04.2009 Proper person certificate issued by Tahsildar, Komarolu. Ex.A3 19.07.2010 Office copy of lawyer notice. Ex.A4 19.07.2010 Postal receipts and acknowledgement. Ex.A5 - Medical attendants certificate. Ex.A6 24.10.2008 Deposit acknowledgement receipt. Ex.A7 - Xerox copy of acknowledgement. DOCUMENTS MARKED FOR OPPOSITE PARTIES :- Ex.B1 24.10.2008 Original policy bond Ex.B2 24.10.2008 Original policy document Ex.B3 - Letter to the 1st opposite party by the complainant. Ex.B4 03.04.2009 Death certificate of Ramanaiah. Ex.B5 06.07.2009 Letter to the investigator by the complainant. Ex.B6 09.07.2009 Investigation report on death claim. Ex.B7 06.07.2009 Letter to the investigator by the complainant. Ex.B8 21.03.2009 Medical Attendants certificate (claim form B). Ex.B9 31.10.2009 Letter to the complainant by the 3rd opposite party. Sd/-xxxx PRESIDENT Copies to:
1. The complainant.
2. 1st opposite party.
3. 2nd and 3rd opposite parties. Date when free copy was issued: Dis.No. /2015, Dated: