Complaint is filed on 3-8-2009
Compliant disposed on 27-7-2010
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM::AT:: KARIMNAGAR
PRESENT: HON’BLE SRI K. DEVI PRASAD, B.Sc., LL.B., PRESIDENT
SMT. E. LAXMI, M.A.,LL.M.,PGDCA (CONSUMER AWARENESS), MEMBER
SRI. K. CHANDRA MOHAN RAO, B.Com., LL.B., MEMBER
TUESDAY, THE TWENTYSEVENTH DAY OF JULY, TWO THOUSAND TEN
CONSUMER COMPLAINT NO. 120 OF 2009
Between:
Yeligeti Kailasam, S/o. Rama Swamy, Age 46 years, Occ: Powerloom worker, (Weaver), R/o. H. No. 8-4-54, Gandhinagar, Sircilla village and mandal of Karimnagar district.
… Complainant
AND
- The Textile Commissioner, Powerloom Service Centre, D.I.C., Campus, RTC Cross Roads, Musheerabad, Hyderabad. R/by Sri P. Shivannarayana, Asst. Director.
- The Life Insurance Corporation of India, P&GS Department, LIC Building, 3rd Floor, 153, Annasalai, Chennai, R/by its Personal Manager.
…Opposite Parties
This complaint is coming up before us for final hearing on 13-7-2010, in the presence of Sri T. Lakshmann Rao, Advocate for complainant and Sri P. Ashok, Advocate for opposite party no.1 and Sri J. Sriramulu, Advocate for opposite party no.2, and on perusing the material papers on record, and having stood over for consideration this day, the Forum passed the following:
:: ORDER::
1. This complaint is filed under Section 12 of C.P.Act, 1986 praying this Forum to direct the opposite parties to pay an amount of Rs.90,000/- in all counts along with interest to the complainant.
2. The brief facts of the complaint are that the complainant is a member of Group Insurance Scheme for Powerloom Workers (JBY) with registration no. JBY/425 Dt: 17.6.2004 with the opposite party no.1 at Sircilla whose life was covered under the JANASRI BHEEMA SCHEME Policy which was effective from 01.07.2004 with opposite party no.2. During the subsistence of said policy on 4.8.2004 the complainant met with an accident to his left eye while working on powerloom due to shuttle fly on his eye, and the complainant was taken to hospital immediately. He was referred to Head Quarters Hospital, Karimnagar and from there to Sarojini Devi Eye Hospital, Hyderabad. The complainant was admitted as in patient there and he got treatment from 4.8.2004 to 9.8.2004. But, even after good treatment the complainant has suffered permanent disability to his left eye, which was the result of the said accident the same was certified and attested under the certificate bearing no.18531/DHH/KNR/PHB/2004 Dt: 2.10.2004 issued by the A.P. Vaidya Vidhana Parishad, District medical Board, Karimnagar. As per the terms of Group Insurance Policy, the complainant is entitled to claim Rs.50,000/- towards the loss of his eye, as permanent disability under the JANASRI BHEEMA SCHEME. Therefore, the complainant personally and through Manikantha Karmika Sankshema sangham, Sircilla has claimed the Insurance amount within 6 months. But there is no response from the opposite parties.
3. Due to silence of the opposite parties, the complainant has been subjected to much mental agony. Hence, the complainant got issued Legal Notice through his advocate to the opposite parties on 3.12.2008. After receipt of the Legal Notice, opposite party no.2 sent a delayed response stating that the Disability claim of the complainant was in process by the competent authority for reconsideration of the said claim. But there after the opposite parties failed to pay the insurance claim covered under the Janasri Bheema scheme , hence filed this complaint.
4. Opposite party no.1 filed counter affidavit denying all the allegations made in the complaint and stated that the complainant being the member under JBY Scheme may be entitled for a claim, if any time when the policy is in full force the member sustain bodily injury resulting solely and directly from accident caused by outward and visible means and such injury shall within three months of its occurrence results in death/total permanent disability of the member then Corporation shall pay Rs.50,000/- and in case of partial permanent disability the Corporation shall pay a sum of Rs.25,000/-. It is clarified that LIC of India is liable to pay the beneficiary only in respect of total permanent disability or partial permanent disability and the following documents are required to be submitted in the event of disability due to accident along with the prescribed claim form.
i) Document evidence of accident
ii) Medical Certificate from the Registered Medical Practitioner certifying permanent total/partial disability due to accident stating loss of limb/s eyesight of the member.
5. The complainant submitted a claim for partial permanent disability on 12.10.2004. It was observed from the claim that Shri Yeligeti Kailasam has met with an accident on 4.8.2004 resulting injury in the left eye. The LIC of India, Chennai informed that there are no supporting documents in the prescribed form no.5279 and the same was informed to Shri Yeligeti Kailasam through Powerloom Service Center, Hyderabad. However, Shri Yeligeti Kailasam had submitted the necessary documents in form no.5279 only on 7.4.2005 and subsequently submitted the same. Since the necessary documents received the claim was forwarded to LIC of India by Regional Office of the Textile Commissioner, Chennai on 16.5.2005.
6. In response to the above disability claim of Shri Yeligeti Kailasam, LIC of India Chennai vide their letter Dt: 22.12.2005 have informed that the Competent Authority have rejected the case and it is not eligible for disability claim. Despite the above rejection of LIC, Regional Office of the Textile Commissioner once again requested to LIC to reconsider the claim. The LIC of India has considered the claim for the above partial permanent disability and settled vide their letter no. P&GS/JBY/U583093/416256 Dt: 15.09.2009 and issued a cheque no.011572 Dt: 17.9.2009 for Rs.25,000/- in favour of Shri Yeligeti Kailasam. The opposite party further submitted that there is no deficiency of service on their part. Hence, prayed for dismissal of the complaint.
7. The opposite party no.2 filed counter denying all the allegations made in the complaint and stated that as per the policy conditions, Disability Benefit claim is payable if the Corporation (LIC) is satisfied with the evidence submitted, that a member has suffered permanent Disability due to accident during the period he/she is covered under the scheme.
8. After verification of the documents filed by the complainant through Commissioner, Ministry of Textiles, the Panel Doctor of opposite parties opined that the claim is not admissible as per the conditions of the Policy. The payment of Rs.25,000/- in favour of complainant vide cheque no. 011572 Dt: 17.9.2009 has been sent to Ministry of Textiles. The opposite party no.2 has given reply to the letter Dt; 3.12.2008 to counsel for complainant vide letter Dt: 26.2.2009 stating that the related claim papers are in the process of verification by the competent authority for consideration of the above said claim. There was neither delay nor deficiency of service on the part of opposite parties. Hence, prayed for dismissal of the complaint.
9. Both parties have filed their Proof Affidavits reiterating the averments made in the complaint and counter. The documents filed by the complainant are marked as Ex.A1 to A24. The documents filed on behalf of opposite parties are marked as Ex.B1 to B17.
10. Ex.A1 is the photo copy of acknowledgement GIS for Powerloom WORKERS (JBY). Ex.A2 is the photo copy of Application for Group Insurance Scheme for Powerloom Workers (for Janasri bima Yojana (JBY). Ex.A3 is the photo copy of prescription issued by Sri Kanakadurga Eye Hospital Dt: 4.8.2007. Ex.A4 is the photo copy of Medical Certificate of complainant issued by Govt of A.P., Andhra Pradesh Vaidya Vidhana Parishat. Ex.A5 is the photo copy of Medical Certificate of complainant Dt: 16.12.2004. Ex.A6 is the copy of letter from Superintendent, Sarojini Devi Eye Hospital, Hyderabad addressed to the Assistant Director, Powerloom Service Centre, Hyderabad Dt: 3.2.2005. Ex.A7 & A8 are the photo copy of Claim Applications. Ex.A9, A10 & A11 are the photo copy of letters from eye witness to incident addressed to Assistant Director, Powerloom Service Centre, Hyderabad Dt: 12.10.2004. Ex.A12 is the photo copy of Claim Form under Group Insurance Scheme for Powerloom Workers (JBY). A13 is the photo copy of letter from Assistant Director, Powerloom Service Centre, O/o. Textile Commissioner, Hyderabad Dt: 5.4.2005. Ex.A14 is the photo copy of Voter Identity Card of complainant. Ex.A15 is the copy of letter from Manikantha Karmika Samkshema Sangham addressed to Textile Commissioner, Hyderabad Dt: 19.6.2007. Ex.A16 & A17 are the postal receipts. Ex.A18 is the photo copy of reminder addressed to opposite party Dt; 19.4.2005. Ex.A19 & A20 are the postal receipts. Ex.A21 & A22 are the postal acknowledgement cards. Ex.A23 is the Legal Notice issued by counsel for complainant addressed to opposite parties Dt: 3.12.2008. Ex.A24 is the repudiation letter from opposite party mo.2 Dt: 26.02.2009.
11. Ex.B1 is the photo copy of receipt for Rs.25,000/- from complainant Dt: 5.10.2009. Ex.B2 is the copy of letter from opposite party no.2 to opposite party no.1 Dt: 22.12.2005. Ex.B3 is the photo copy of reply from opposite party no.1 to opposite party no.2 Dt: 4.5.2007. Ex.B4 & A12, B5 & A8, B6 & A6, B7 & A7, B8 & A5, B9, B10 & A10, B11 & A4, B12 & A14, B13 & A2, B14 & A3 are one and the same documents. B15 is the copy of letter from opposite party no.2 addressed to opposite party no.1 in respect of cheque for Rs.25,000/- Dt; 15.9.2009. Ex.B16 is the copy of Janashree Bima Yojana Master policy G.I./JBY No.416256. Ex.B17 is the copy of letter from opposite party no.2 addressed to counsel for complainant Dt: 26.2.2009.
12. The point for consideration is whether there is any deficiency of service on the part of opposite parties, if so, to what relief the complainant is entitled?
13. The case of the complainant is that he has sustained disability in the accident and he is the member of the Power Loom Workers Group, which group was insured under Janasri Bheema Kiran Policy, as such he is entitled to compensation of Rs.50,000/-
14. The opposite party no.2 LIC of India while admitting about the policy obtained by the Workers Group disputed the claim of Rs.50,000/- on the ground that the policy amount of Rs.25,000/- is to be paid under the policy obtained by Powerloom Workers Group in case if a worker sustains partial and permanent disability in an accident. The complainant has filed the Disability Certificate Ex.A4 it discloses that LE – Total absence of sight and disability is of 40%. Originally the complainant furnished the claim form which is marked as Ex.A12. The complainant furnished documents asked there in and after receipt of documents opposite party no.2 neither repudiated the claim nor paid the amount. Therefore, the notice under Ex.A23 was issued to opposite parties.
16. Opposite party no.2 contends that the complainant even if entitled is only entitled to permanent partial disability since there is no certificate showing that the complainant sustained permanent disability, so as to pay Rs.50,000/-. As per the schedule of the policy general conditions total permanent disability/death of the member the Corporation shall pay sum of Rs.50,000/-, during course of arguments it is informed to the Forum by the learned counsel for the Insurance Company that now the amount of Rs.50,000/- is enhanced to Rs.75,000/- from 15.8.2006 and for partial/permanent disability the Corporation shall pay Rs.25,000/- (which is now enhanced to Rs.37,500/- from 15.8.2006).
17. In view of the said conditions since the complainant sustained disability of 40% and due to loss of LE – Eye sight, he has sustained partial permanent disability. Therefore, the complainant is entitled to Rs.25,000/- assured amount towards accident benefit claim. During pendency of this C.C. the opposite party no.2 paid an amount of Rs.25,000/- on 17.9.2009 directly to the complainant which is admitted by the complainant towards the partial permanent disability. Therefore, as already the amount is paid the complainant is entitled to Rs.1,000/- as compensation and costs of Rs.500/-.
18. In the result the complaint is partly allowed directing the opposite parties to pay jointly and severally Rs.1,000/- as compensation and costs of Rs.500/- to the complainant within one month from the date of receipt of this order.
Dictated to Stenographer and transcribed by her, after correction the orders pronounced by us in the open court this the 27th day of July 2010.
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MEMBER MEMBER PRESIDENT
NO ORAL EVIDENCE HAS BEEN ADDUCED ON EITHER SIDE FOR COMPLAINANT:
Ex.A1 is the photo copy of acknowledgement GIS for Powerloom WORKERS (JBY).
Ex.A2 is the photo copy of Application for Group Insurance Scheme for Powerloom Workers (for Janasri bima Yojana (JBY).
Ex.A3 is the photo copy of prescription issued by Sri Kanakadurga Eye Hospital Dt: 4.8.2007.
Ex.A4 is the photo copy of Medical Certificate of complainant issued by Govt of A.P., Andhra Pradesh Vaidya Vidhana Parishat.
Ex.A5 is the photo copy of Medical Certificate of complainant Dt: 16.12.2004.
Ex.A6 is the copy of letter from Superintendent, Sarojini Devi Eye Hospital, Hyderabad addressed to the Assistant Director, Powerloom Service Centre, Hyderabad Dt: 3.2.2005.
Ex.A7 & A8 are the photo copy of Claim Applications.
Ex.A9, A10 & A11 are the photo copy of letters from eye witness to incident addressed to Assistant Director, Powerloom Service Centre, Hyderabad Dt: 12.10.2004.
Ex.A12 is the photo copy of Claim Form under Group Insurance Scheme for Powerloom Workers (JBY).
Ex.A13 is the photo copy of letter from Assistant Director, Powerloom Service Centre, O/o. Textile Commissioner, Hyderabad Dt: 5.4.2005.
Ex.A14 is the photo copy of Voter Identity Card of complainant.
Ex.A15 is the copy of letter from Manikantha Karmika Samkshema Sangham addressed to Textile Commissioner, Hyderabad Dt: 19.6.2007.
Ex.A16 & A17 are the postal receipts. Ex.A18 is the photo copy of reminder addressed to opposite party Dt; 19.4.2005.
Ex.A19 & A20 are the postal receipts.
Ex.A21 & A22 are the postal acknowledgement cards.
Ex.A23 is the Legal Notice issued by counsel for complainant addressed to opposite parties Dt: 3.12.2008.
Ex.A24 is the repudiation letter from opposite party mo.2 Dt: 26.02.2009.
FOR OPPOSITE PARTIES:
Ex.B1 is the photo copy of receipt for Rs.25,000/- from complainant Dt: 5.10.2009.
Ex.B2 is the copy of letter from opposite party no.2 to opposite party no.1 Dt: 22.12.2005.
Ex.B3 is the photo copy of reply from opposite party no.1 to opposite party no.2 Dt: 4.5.2007.
Ex.B4 & A12, B5 & A8, B6 & A6, B7 & A7, B8 & A5, B9, B10 & A10, B11 & A4, B12 & A14, B13 & A2, B14 & A3 are one and the same documents.
B15 is the copy of letter from opposite party no.2 addressed to opposite party no.1 in respect of cheque for Rs.25,000/- Dt; 15.9.2009.
Ex.B16 is the copy of Janashree Bima Yojana Master policy G.I./JBY No.416256.
Ex.B17 is the copy of letter from opposite party no.2 addressed to counsel for complainant Dt: 26.2.2009.
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MEMBER MEMBER PRESIDENT
