DISTRICT FORUM :: KADAPA Y.S.R DISTRICT
PRESENT SMT. K. SIREESHA, B.L., PRESIDENT FAC
SRI M.V.R. SHARMA, MEMBER.
Saturday, 01st March 2014
CONSUMER COMPLAINT No. 55/ 2013
M. Guruvi Reddy, S/o M. Guruvi Reddy, aged about 54 years,
Hindu, working as APSRTC Driver, Kadapa Depot,
residing at D.No. 5/159-a, Nabikot, R.B. Nagar,
Kadapa City, YSR District. ….. Complainant.
Vs.
1. Kapil Health Club Pvt. Ltd., Rep. by its
Senior Manager, Flat No. 101, LBR House,
Picket Road, Secunderabad.
2. Kapil Health Club Pvt. Ltd., Rep. by its
Branch Manager, D.No. 4/616-9,
Beside SBH RTC Branch, Kadapa.
3. United India Insurance Co. Ltd., Rep. by its
Branch Manager, Tarnaka Branch, 12-5-149/19/2,
Opp. To Tarnaka, Secunderabad – 500 017. ….. Respondents.
This complaint coming on this day for final hearing on 25-02-2014 in the presence of Sri V. Eswara Reddy, Advocate for complainant and respondents called absent and set exparte on 12-2-2014 and upon perusing the material papers on record, the Forum made the following:-
O R D E R
(Per Smt. K. Sireesha, President FAC),
1. Complaint filed under section 12 of the C.P. Act 1986.
2. The brief facts of the complaint are as follows:- The complainant is working as a driver in APSRTC, Kadapa depot. The complainant joined as a member in R1 & R2 company and the R2 branch office accepted the complainant’s membership and issued membership certificate bearing No.058-044-2223 in favour of the complainant and the scheme name is GHM -16F The R1 tie-up with the R3 for insured the R1 & R2 members group personal accident policy. The R2 collected the membership fee of Rs. 7,500/- from complainant and R2 sent membership fee of Rs. 7,500/- to the R1. The R1 tie up with the R3 company for insured the R1 company members during the period one year i.e. 4-6-2012 to 3-6-2013. The R1 company insured the complainant life with R3 company. In case the complainant death or received injuries in a accident during the period of one year from 4-6-2012 to 3-6-2013. The R3 issued the insurance certificate bearing No. 0003 to the complainant on behalf of the R1 and also issued Group Personal Accident policy Certificate bearing No. 050202/42/12/05/00000092 to the complainant for cover of the accident, death or injuries and inpatient hospitalization expenses due to accident. The complainant is the Health Member in R1 & R2 company and they were collected the premium from the complainant and insured his life through the R1 & R2 company with R3 company.
3. It is submitted that on 19-6-2012 the complainant was traveled in APSRTC bus bearing No. AP 04 Z : 0085 Kadapa depot as rest driver and his bus driver drove the bus in a rash and negligent manner and the bus hit to the stationed lorry near Martur on 20-6-2012 at about 2.25 a.m due to which the RTC bus driver by name Budda Sankar Reddy died on the spot, at the time the complainant was there in the bus as rest driver and he was also received grievous injuries due to accident i.e. injury over left frontal area, multiple Lower Ribs fracture on left side and B/L Hemothrorax surgical and emphysema and injury over right forearm. After the accident immediately he was shifted to Guntur city Hospital, Guntur for treatment and on 20-6-2012 he was admitted in the said hospital as inpatient for treatment and he spent of Rs. 42,000/- towards medicines and hospital expenses. The complainant took treatment as inpatient for a period of 7 days and also took treatment for period of one week as outpatient and he was stayed at Guntur and also took treatment as outpatient ill healding injuries about 2 months. Due to which the complainant unable to approach to the R2 branch or informed to the R1 to 3 office within 7 days as policy stipulated period within time. After 15 days the complainant came to Kadapa from Guntur. On 4-7-2012 the complainant approached to R2 branch Office Manager and submitted all records to R2 branch office for claiming inpatient hospitalization expenses of Rs. 20,000/- as per policy coverage column “C” amount. On 4-7-2012 the R2 received all documents from the complainant relating to the accident criminal records such as FIR, Hospital records and medical bills, and the R2 promised to the complainant as early as possible for settlement of medical expenses amount of Rs. 20,000/- mentioned in policy “C” schedule. The complainant approached many times to the R2 for settlement of inpatient medical expenses amount as per the policy but R2 not given proper answer to the complainant and the R2 told the complainant not responsible for approaching R1 & R3 and not come to my office. It is submitted that the complainant got issued legal notice on 7-1-2013 through his advocate to the R1 & R3 and same was received by them but they were not given any reply notice to the complainant till date or not settling the policy amount of Rs. 20,000/- as per policy. The complainant received injuries in a accident, due to which nonsettling the policy amount of Rs. 20,000/- to the complainant. The cause of action arose the R2 rece3ived the Kapil Health Club Plan Fee of Rs. 7,500/- from complainant at Kadapa, the complainant residing at Kadapa and the policy obtained through R2 office and he was received injuries in accident on 20-6-2012 and the complainant produced all relevant documents to the R2 on 15-6-2012 and got issued legal notice to the R1 & R3 and R2 office situated in Kadapa city within the jurisdiction of this Hon’ble Forum. A court fee of Rs. 100/- paid by way of I.P.O. it is therefore, prayed that the Hon’ble forum may be pleased to direct that (a) the respondents to pay Group Personal Accident Policy bearing No. 050202/42/12/05/00000092 policy “c” coverage inpatient hospitalization expenses amount of Rs. 20,000/- to the complainant with interest at the rate of 12 % per annum from the date of injuries caused by the bus accident of the complainant till the amount realization, (b) direct the R1 to R3 to pay a sum of Rs. 5,000/- to the complainant for mental agony caused to him due to deficiency of service on the part of the respondents and c) direct the R1 to R3 pay a sum of Rs. 5,000/- towards the cost of this complaint and order passed a such other relief or reliefs as the Hon’bel forum deems fit and proper under the circumstance of the case in the interest of justice.
4. R1 to R3 called absent and set exparte on 12-2-2014.
5. On the basis of the above pleadings the following points are settled for determination.
i. Whether the complainant is entitled to the relief as prayed for?
ii. Whether there is negligence or deficiency of service on the part of there Respondents?
iii. To what relief?
6. On behalf of the complainant PW1 was examined and Ex. A1 to A10 were marked.
7. Point Nos. 1 & 2. It is very clear that the complainant is member of R1. The complainant had taken Group Personal Accidental policy bearing No. 050202/42/12/05/00000092 from R3 under Ex. A2. Ex.A3 FIR clearly proves that the accident was occurred within the jurisdiction of Martur Police Station on 20-6-2012 the FIR lodged by Martur Police under Cr. No. 100/2012. Ex. A4 clearly proves that the complainant underwent treatment at Guntur city hospital, Guntur from 20-6-2012 to 26-6-2012. Ex. A5 is the final submitted by Martur Police station in the court of Additional Munsif Magistrate, Addanki. Ex. A7 clearly shows that the complainant had spent Rs. 42,000/- towards medicines and hospital expenses at Guntur city hospital. From the above all exhibits it is very clear that the complainant sustained injuries in the accident dt. 20-6-2012. Under Ex. A2 in obligation clause it is very clearly mentioned that if any accident to the insured or his legal heirs has informed the company within 7 days from the date of accident. Here the complainant was inpatient at City Hospital, Guntur from 20-6-2012 to 26-6-2012 and he was out patient for some days and he went for treatment in the same hospital as per complaint. The complainant had sustained grevious injuries and he did not informed the respondents within 7 days as per averments of the complaint. But the accident is true. There will be obligation of 7 days to intimate the occurrence of the accident to the company. There should be some humanitarian grounds also. As the complainant paid Rs. 7500/- towards membership of the R1 company and the respondents are blaming the complainant and created complication and refused the claim. There is the matter of one week delay only in the intimation of the occurrence of the accident. The complainant send legal notice to the respondents on 7-1-2013 under Ex. A8. But there is no response from the respondents. From the above all documentary evidence it is very clear that the complainant had sustained grevious injuries and he had spent an amount of Rs. 42,000/- towards medical and hospital expenses and he is eligible for compensation as prayed by him. At the same time it is very clear that there is gross negligence and deficiency of service on the part of the respondents.
8. Point No. 3 In the result, the complaint is allowed, directing the respondents 1, 2 & 3 are jointly and severally liable to pay Rs. 20,000/- (Rupees Twenty Thousand only) towards medicines and hospital expenses, Rs. 3,000/- (Rupees three thousand only) towards mental agony and Rs. 2,000/- (Rupees two thousand only) towards costs of the complaint to the complainant within 45 days of date of receipt of orders.
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open Forum, this the 01st March 014
MEMBER PRESIDENT FAC
APPENDIX OF EVIDENCE
Witnesses examined.
For Complainant
PW1 M. Gurivi Reddy, dt. 25-2-2014.
For Respondents : NIL
Exhibits marked for Complainant : -
Ex. A1 P/c of Kapil Health Club Plan Certificate bearing no. 05800044-2223 issued by R1.
Ex. A2 Group personal Accident Policy bearing
No. 050202142/12/05/00000092 issued by the R3.
Ex. A3 True copy of FIR as Crime No. 100/2012 of Martur P.S. dt. 20-6-2012
Ex. A4 True copy of wound certificate of the complainant.
Ex. A5 True copy of the final report of Martur P.S.
Ex. A6 Original discharge summary of the complainant issued by the Guntur
City Hospital, dt. 26-6-2012.
Ex. A7 True copy of Hospital Estimation letter of Rs. 42,000/- towards medicines and hospital expenses.
Ex. A8 Office copy of legal notice dt. 7-1-2013.
Ex. A9 Postal receipts (Two).
Ex. 10 Postal acknowledgement cards (two).
Exhibits marked for Respondents: - NIL
MEMBER PRESIDENT FAC
Copy to :-
1) Sri V. Eswara Reddy, Advocate for complainant.
2) Kapil Health Club Pvt. Ltd., Rep. by its Senior Manager,
Flat No. 101, LBR House, Picket Road, Secunderabad.
3) Kapil Health Club Pvt. Ltd., Rep. by its Branch Manager, D.No. 4/616-9, Beside SBH RTC Branch, Kadapa.
4) United India Insurance Co. Ltd., Rep. by its Branch Manager, Tarnaka Branch, 12-5-149/19/2, Opp. To Tarnaka, Secunderabad – 500 017.
B.V.P.
