A.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSIONAT HYDERABAD.
F. A. 1299/2009 against C.C. 59/2008, Dist. Forum, Nalgonda.
Between:
Nerlakanti Venugopal
S/o. Arjun, Age: 42 years
Govt. Teacher,
H.No. 4-5-71, Akkachalma
Nalgonda Town & Dist. *** Appellant/
Complainant
And
1. Kapil Health Club Pvt. Ltd.
Flat No. 101, 1st floor,
L.B.R. House, Picket Main Road
Secunderabad
2. Reliance General Insurance Company Ltd.
Regd. Office: 3rd Floor, Market Chambers
IV Nariman Point, Mumbai-400 021.
Divisional Regional Office:
Deccan Chambers, 4th Floor,
6-3-666/B, Somajiguda,
Hyderabd-500 082.
3. Kapil Chit Funds Pvt. Ltd.
H.No. 6-2-957/1, 1st Floor
N.R. Complex, Hyderabad Road
Nalgonda Town & Dist. *** Respondents/
Ops.
Counsel for the Appellant: P.I.P.
Counsel for the Resps: M/s. N. Amarnath, R1 & R3.
M/s. G. Ramachandra Reddy- R2.
CORAM:
HON’BLE SRI JUSTICE D. APPA RAO, PRESIDENT
&
SMT. M. SHREESHA, MEMBER
MONDAY, THIS THE TWENTY SIXTH DAY OF JULY TWO THOUSAND TEN
Oral Order: (Per Hon’ble Justice D. Appa Rao, President)
*****
1) Appellant is unsuccessful complainant.
2) The case of the complainant in brief is that R1 Health Club while enlisting the members extended the personal accident policy for 1 year in collaboration with R2 Reliance General Insurance Company. He joined as a member in R1 club. Accordingly insurance policy was issued by R2 covering the period from 30.9.2006 to 29.9.2007. While so on 20.5.2007 he met with road accident sustained fracture on the right leg. On a report the police registered a case in crime No 242/2007. He was shifted to government hospital, Nalgonda, and later to a private hospital where the doctors after treating him gave certificate mentioning 50% permanent disability. When he submitted the claim R2 offered only Rs. 30,000/- towards disability and Rs. 20,000/- towards medical expenses on the ground that it was only temporary disability and does not fall under the definition of permanent disability. There upon he got issued legal notice demanding compensation of Rs. 1 lakh covered under the policy towards permanent disability and Rs. 40,000/- towards medical expenses together with interest and costs for which they gave reply with false allegations. Therefore, he filed the complaint claiming the above said amounts.
3) R1 resisted the case. While admitting issuance of club membership to the complainant and coverage of group personal accident policy it denied its liability. It urged that it was only a facilitator. On receipt of claim from the complainant, it has forwarded the same to R2 insurance company which in turn settled the claim at Rs. 30,000/- towards injuries and Rs. 20,000/- towards medical expenses as per the terms of the policy. It alleged that having received the amount towards full and final satisfaction he is estopped from filing the complaint. At any rate, if there is any claim, it has to be settled by R2 insurance company. There was no negligence nor deficiency in service on its part and therefore prayed for dismissal of the complainant with costs.
4) R2 insurance company equally resisted the case. It contended that on receipt of documents from R1 it had settled the claim as per the terms and conditions of the policy. It had settled the claim strictly following the scope of coverage of policy. Having received the amount towards full and final satisfaction he is estopped from filing the complaint. The complainant was not entitled to the claim made by him. There was no deficiency in service on its part, and therefore prayed for dismissal of the complaint with costs.
5) The complainant in proof of his case filed his affidavit evidence and got Exs. A1 to A12 marked, while R1 filed the affidavit evidence of its Manager B. Srinivas and did not file any documents.
6) The Dist. Forum after considering the evidence placed on record opined that the certificate issued by the medical board shows that the disability was 50% only to the ankle of right leg. Since Op2 has paid Rs. 30,000/- towards disability and Rs. 20,000/- medical expenses in terms of certificate insurance Ex. A3 the complainant was not entitled to any more amount and accordingly dismissed the complaint.
7) Aggrieved by the said decision, the complainant preferred the appeal contending that the medical board had categorically confirmed that the disability was 50% and it cannot be termed as temporary disability, and therefore prayed that compensation as claimed by him be granted.
8) The point that arises for consideration is whether the order of the Dist Forum is vitiated by mis-appreciation of fact or law?
9) It is an undisputed fact that R2 Reliance General insurance company gave Ex. A3 Group Personal Accident policy he being a member of R1 valid from 30.9.2006 to 29.9..2007 vide Ex. A3. Earlier he had sustained fracture of left leg got 40% of the insured amount for permanent disability for which he filed C.D. 53/2007. Again he met with accident on 20.5.2007, for which a case in Crime No. 242/2007 was registered vide Ex. A4. He had taken treatment. The medical officer who examined the complainant noted that he had “ 1) deforming right leg, blunt bruises 2) lacerotin 3) abrasion ½’ x ½’ on left hand 4) abrasion ½’ x ½’ on left shoulder and forehead. It was mentioned as grievous. A charge sheet Ex. A6 was filed after investigation against the driver of Hero Honda.
10) Importantly the medical board for physically handicapped, Nalgonda examined him on 3.9.2007 opined that the disability was 50% being permanent fracture, foot drop….. vide Ex. A7 and another medical board certificate Ex. A20 dt. 14.7.2009 a repetition of very same disability mentioned in Ex. A7.
11) In Ex. A3 Group Personal Accident Policy the scope of coverage of the amounts assured were made a mention as under :
a) Accident death Rs. 2 lakhs
b) Permanent total disablement Rs. 1 lakh
c) Permanent partial disablement Rs. 1 lakh
d) In-patient hospitalization expenses Rs. 20,000/-
following an accident
“If accidental injury shall within 12 calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of use or the actual loss by physical separation of the following, the percentage of the capital sum insured of Rs. 1 lakh as indicated below shall be payable.
% of capital sum insured.
Loss of toes - all great 20%
Great - both phalanges 5%
Great - both phalanx 2%
Other than great if more than toe lost each 1%
Loss of hearing - both ears 50%
Loss of hearing – one ear 15%
Loss of four fingers and thumb of one hand 40%
Loss of four fingers 35%
Loss of thumb - both phalanges 25%”
Evidently the injury that was sustained by the complainant is covered by the said definition. It cannot be termed as permanent total disability. It is not a case where the injury was total and irrevocable. The medical board certified that the disability was 50%. At clause 3 under “permanent partial disability they contemplate payment of 50% of the amount.” Undoubtedly, he had permanent partial disability of 50% as confirmed by the medical board. It cannot be said that it is a temporary disability. The medical board did not say that it was temporary disablement. What all they stated is that it was 50% permanent partial disablement. Since the capital sum insured was Rs. 1 lakh under the above head, he was entitled to Rs. 50,000/- being permanent partial disability vide Ex. A7 & A8. The complainant however, failed to prove that it comes under permanent total disability entitled to claim Rs. 1 lakh. His injury does not fall under the above said clause, which we have mentioned earlier.
12) It is important to note that the complainant has received an amount of Rs. 50,000/- from R2 insurance company in terms of Ex. A3 insurance certificate. That apart for the very same accident an amount of Rs. 50,000/- was awarded in F.A. 1298/2009 payable by another insurance company. Therefore the complainant is not entitled to any more amounts for the very same disability. We do not see any mis-appreciation of fact or law by the Dist. Forum in this regard. There are no merits in the appeal.
13) In the result the appeal is dismissed. No costs.
1) _______________________________
PRESIDENT
2) ________________________________
MEMBER
Dt. 26. 07. 2010.
*pnr
“UP LOAD – O.K.”
