State Consumer Disputes Redressal Commission
Shriram Life Insurance Company ... vs Smt. Lakshmi, Bobbili, Vizianagaram ... on 30 May, 2013
A. P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION : AT HYDERABAD FA.No . 17 of 2012 against CC.No. 90 of 2011 on the file of District Forum, Vizianagaram. Between : The Assistant General Manager, Shriram Life Insurance Company Ltd., Head Office 3-6-478, III Floor, Anand Estate, Liberty Road, Himayatnagar, Hyderabad. .. Appellant/Opposite party And Smt. Lakshmi W/o Rajaratnam Naidu, 45 years, Occ: House hold, R/o Electrical Sub Station, Bobbili town, D.No.44-9011, Bobbiuli Municipality, Vizianagaram Dist. .. Respondent/Complainant Counsel for the Appellant :M/s KRR Associates Counsel for the Respondent : Notice served. None appeared. Coram : Sri R. Lakshminarasimha Rao, Honble Member
And Sri T. Ashok Kumar, Honble Member Thursday, the Thirtieth Day of May, Two Thousand Thirteen Oral Order : ( Per Sri T. Ashok Kumar , Honble Member ) ****
1. This is an appeal preferred by the opposite party against the orders passed by the District Consumer Forum, Vijayanagaram in CC.No.90/2011 dated 21.11.2011. For convenience sake, the parties as arrayed in the complaint are referred to as under:
2. The brief facts as set out in the complaint are that the complainants son by name Abotula Deepak took a policy No.LN1108000061344 for a sum of Rs.1,80,000/- on his life with the opposite party Company and paid the amount to the said Company. Her son died on 21.12.2008 on the spot in the bath room of his house having slipped and fell down and the said fact was intimated to the opposite party requesting to settle and pay policy amount to her being the nominee under the said policy. Thereafter the complainant received an intimation dt.8.6.2009 from the opposite party stating that they will settle the matter after submitting the claim forms. Accordingly the complainant sent the claim form along with original policy documents.
But the opposite party did not settle the claim and evading the payment without any valid reasons.
The said acts of the opposite party amount to deficiency in service and hence the complaint seeking for a direction to the opposite party to pay the policy amount of Rs.1,80,000/- with interest at 24% p.a from the date of policy till the date of realization and Rs.20,000/- towards damages with costs.
3. The opposite party resisted the complainant and in the counter filed by the opposite party it is stated that late Abotula Deepak during his life time has taken a policy for Rs.1,80,000/- by paying installment premium amount of Rs.24,000/- on yearly mode. The said policy commenced on 13.6.2008 and the term of the policy is 15 years.
The life assured has nominated his mother i.e the complainant as his nominee under the said policy. At the time of taking the policy, the opposite party has supplied one proposal form and requested the life assured to fill all the columns with correct details.
Basing on the information furnished by the life assured the opposite party has accepted the risk on his life and issued the subject policy in all good faith. The complainant has intimated the Company that her son died on 21.12.2008. Immediately, the opposite party through its investigator has personally handed over the concerned claims forms to the nominee on 6.3.2009 and requested her to submit the properly filled in claim forms along with relevant documents to process the death claim. Simultaneously the investigator has conducted his preliminary enquiry into the death of the claim. Since there was no response from the complainant in resubmitting the filled in claim forms, the opposite party has sent a reminder letter dt.23.4.2009.
Subsequently the complainant has submitted the claim forms in the month of May, 2009. Again by letter dt.8.6.2009 the opposite party requested the complainant to forward the filled-in claim form B. Since the complainant has not co-operated with the opposite party by following due procedure by submitting the required documents, having no other option the opposite party has temporarily closed the claim. However the opposite party has informed the complainant that the claim will be re-opened and will be processed upon receipt of required information as sought earlier.
But till date the complainant did not revert in following the due procedure and filed the complaint with false and frivolous allegations and thus prayed to dismiss the complaint.
4. Both sides filed their evidence affidavits reiterating the facts stated in the complaint and counter respectively. Ex. A-1 to A6 were marked for the complainant and Exs.B-1 to B-11 were marked for the opposite party respectively.
5. Having heard the counsel on both sides and considering the evidence on record, the District Forum directed the opposite party to pay the insured amount of Rs.1,80,000/- with interest at 12% p.a from the date of death till the date of realization , and further directed to pay compensation of Rs.5,000/- with costs of Rs.3,000/-. The advocate fee is fixed at Rs.1,000- which was included in the costs.
6. Aggrieved by the said order, the opposite party filed this appeal and reiterated the contents of written version and contended that the investigator in his investigation found out that the insured was chronic alcoholic and he had died of alcohol abuse and the accidental death is created by the parents of the insured to have a wrongful claim. The investigator also found out that even if the death is because of the alleged accident, there was no external visible injury reported nor there was any police complaint made for the alleged accidental death as it is mandatory for accidental deaths and that no post mortem examination was conducted into the alleged death of the insured and thus prayed to allow the appeal and set aside the order passed by the District Forum.
7. During the pendency of the appeal, the appellant filed an application FA.IA.No.1029 of 2013 to receive the Investigator report dt.9.3.2009 of Sri G. Rama Murthy. The said petition was allowed by an order dt.23.4.2013 and the Investigator report is marked as Ex.B-12.
8. Heard the counsel for the appellant/opposite party. Even though sufficient time was granted to the counsel for the complainant/respondent, there was no representation. Hence the matter was reserved for orders on available material
9. Now the point for consideration is whether the order of the District Forum is vitiated either in law or on facts.
10. POINT : There is no dispute that one Abotula Deepak, son of the complainant, took Shri Plus (SP) policy bearing No. LN1108000061344 for a sum of Rs.1,80,000/- on his life with the OP company by paying the requisite premium showing the complainant as his nominee and that while the policy was in force he died on 21.12.2008. According to the complainant, he died as he slipped and fell down in the bath room and that in spite of intimation the OP did not settle the claim and pay the assured amount to her. Whereas Op contended that the deceased life assured was a chronic alcoholic and died on account of it but it is not accidental one as alleged by the complainant and that the complainant did not submit any documents evidencing the accident and therefore the claim was temporarily closed.
11. The complainant did not place any dependable documentary evidence on record showing that the deceased life assured died accidentally slipped and fell down in the bath room. Had really the life assured accidentally died, certainly the complainant would have lodged a complaint with police and would have got conducted inquest over the dead body to know apparent cause of death of the life assured, and also there would have been a post mortem report showing cause of death as the said accidental fall. In the absence of the said evidence it is difficult to believe the self serving evidence of the complainant in the said context it is much more so when Op pleaded that the life assured was a chronic alcoholic and that he died on account of alcoholic abuse. Ex N-12 supports the same. It is for the complainant to prove her case with dependable evidence to claim the assured amount. She did not assign any reasons as to what prevented her from giving complaint to police regarding the alleged accident. According to the complainant, before ambulance came to shift the deceased life assured, he died. If it is true at least she should have got filed evidence of the ambulance operator in the said context so also the fact of booking the ambulance with documentary or other evidence but she did not do so.
Thus absolutely there is no dependable evidence on record to hold that the deceased life assured died accidently.
In view of the above discussion, order of the District Forum is not sustainable and is liable to be set aside by allowing the Appeal.
12. In the result, the appeal is allowed, order of the District Forum is set aside. Consequently the complaint stands dismissed. Parties shall bear their own costs throughout.
MEMBER MEMBER DATED : 30.05.2013.