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. 119 OF 2009
Between:
Erabathini Rajalingam, S/o. Gouraiah, Age 50 years, Occ: Powerloom worker, (Weaver), R/o. H. No. 8-4-68, Gandhinagar, Sircilla village and mandal of Karimnagar district.
… Complainant
AND
- The Textile Commissioner, Power loom 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.PSC/HYD/ROCHN/SEPT-03/JBY/320 & AGIS/229 Dt: 11.9.2003 with the opposite party no.1 at Sircilla whose life was covered under the JANASRI BHEEMA SCHEME Policy which was effective from 01.10.2003 with opposite party no.2. During the subsistence of said policy on 5.5.2004 the powerloom weight beam was accidentally fell on his right foot and he was grievously injured. The injury developed to severe form of the septic and as such the complainant was referred to Adithya Hospital, Hyderabad where his right leg was inevitably amputated upto the knee. Thereby the complainant lost his right leg. As per the terms of Group Insurance Policy, the complainant is entitled to claim Rs.50,000/- towards the loss of limb, as permanent disability under the JANASRI BHEEMA SCHEME. Therefore, the complainant personally and through Manikantha Karmika Sankshema sangham, Sircilla has claimed the Insurance amount on 21.4.2006 and on 14.6.2006 by complying the objections along with the Medical Certificate. But there is no response from the opposite parties.
3. Due to silence of the opposite parties since 2 years, the complainant has been subjected to much mental agony. Hence, the complainant got issued Legal Notice through his advocate to the opposite parties on 27.10.2008. After receipt of the Legal Notice, 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.
As per the Medical Certificate the complainant had his right leg amputation on 3.6.2004 and the Regional Office of the Textile commissioner has forwarded the claim to LIC of India, Chennai for settlement under partial permanent disability. Since the complainant had lost one limb, he is entitled for lodging claim under partial permanent disability for which he may be entitled for rs.25,000/- and not Rs.50,000/- as claimed by the complainant. The opposite party further submitted that there is no deficiency of service on their part as they facilitated the complainant to lodge his claim with all necessary documents and forwarded to LIC for necessary action at their end. Hence, prayed for dismissal of the complaint.
5. 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.
6. 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 opposite party further stated that the disability claim of the complainant was informed after 2 years of the occurrence. As per the rules and regulations of the admissibility of Disability Benefit Claim, occurrence of the incident/disability should have been communicated to LIC of India within 180 days of its occurrence. Hence the disability claim of complainant was not considered and the same was informed to Counsel for complainant. There was neither delay nor deficiency of service on the part of opposite parties. Hence, prayed for dismissal of the complaint.
7. 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 A18. The documents filed on behalf of opposite parties are marked as Ex.B1 to B4.
8. Ex.A1 is the photo copy of acknowledgement Card. Ex.A2 is the photo copy of Discharge Card issued by Aditya Hospital, Hyderabad Dt: 16.6.2004. Ex.A3 is the letter from the Assistant Director, Powerloom Service Centre, Hyderabad addressed to President, Manikantha Karmika Sankshema Sangam Dt: 21.2.2006. Ex.A4 is the letter from the Assistant Director, Powerloom Service Centre, Hyderabad addressed to complainant Dt: 1.5.2006. Ex.A5 is the letter from Bhagya Laxmi Traders, Sircilla addressed to Commissioner of Textiles & Powerlooms, Service Centre, Hyderabad Dt: 23.3.2006. Ex.A6 is the photo copy of claim form of complainant Dt: 21.4.2006. Ex.A7 is the photo copy of claim form of complainant Dt: 21.4.2006. Ex.A8 is the photo copy of Group Insurance Policy for Powerloom Workers of complainant. Ex.A9 is the photo copy of Medical Certificate of complainant issued by Govt of A.P., Andhra Pradesh Vaidya Vidhana Parishat. Ex.A10 is the photo copy of letter from Manikantha Karmika Samkshema Sangham addressed to Govt. of India, Ministry of Textiles, O/o. Textile Commissioner, Hyderabad Dt: 14.6.2006. Ex.A11 is the photo copy of letter from Manikantha Karmika Samkshema Sangham addressed to Assistant Director, Powerloom Service Centre, O/o. Textile Commissioner, Hyderabad Dt: 16.2.2007. Ex.A12 & A14 are postal receipts. Ex.A13 & A15 are postal acknowledgement cards. Ex.A16 is the unserved cover with endorsement of refused. Ex.A17 is the Legal Notice issued by counsel for complainant addressed to opposite parties. Ex.A18 is the repudiation letter from opposite party mo.2 Dt: 27.12.2008.
9. Ex.B1 is the photo copy of death claim settlement from opposite party no.2 forwarded to Ministry of Textiles, Chennai Dt: 23.1.2007. Ex.B2 is the photo copy of letter from opposite party no.2 addressed to Deputy Director, Ministry of Textiles, Bangalore Dt; 15.1.2009. Ex.B3 is the photo copy of Policy with terms and conditions. Ex.B4 & A2 are one and the same documents.
10. 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?
11. The case of the complainant is that he 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/-
12. 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 amount of Rs.25,000/- is to be paid under the policy obtained by the Powerloom Workers Group in case if a worker sustains partial and permanent disability in an accident. The complainant has filed the Discharge Card Ex.A2 in which it discloses the amputation of right leg and further the Medical Certificate issued by Medical Board under Ex.A9 reveals that disability on account of amputation of the right foot is 60%. Originally the complainant furnished the claim form which was returned for furnishing particulars along with the letter and that letter is marked as Ex.A4. As per this letter the complainant furnished documents as asked there in and after receipt of documents, the opposite party no.2 neither repudiated the claim nor paid the amount. Therefore, the notice under Ex.A17 was issued to opposite parties. The claim was repudiated through Ex.A18 i.e. letter Dt: 27.12.2008 on the ground that as per the rules and regulations for the admissibility of disability benefit claim, the occurrence of the accident/disability should have been communicated to opposite party no.2 within 180 days of its occurrence.
13. It is clear from the documents filed, the complainant has furnished the claim form documents required to settle the claim as such under Ex.A4 opposite party no.2 has asked the complainant to furnish the other particulars as required for giving response. Upon receipt of the letter the complainant has furnished the documents as asked.
14. Opposite party no.2 contends that the complainant even if entitled is only entitled towards permanent partial disability since no certificate is filed to show 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/-).
15. In view of the said conditions since the complainant sustained disability of 60% and due to amputation of right foot he has sustained partial permanent disability and the accident occurred prior to 15.8.2006. The complainant is entitled to receive Rs.25,000/- towards accident benefit claim. The complainant is also entitled to Rs.1,000/- towards compensation and Rs.500/- towards costs.
16. In the result the complaint is partly allowed directing the opposite parties to pay jointly and severally Rs.25,000/- assured amount towards Accident Benefit under JANASRI BHEEMA SCHEME Policy and Rs.1,000/- towards compensation and Rs.500/- as costs 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 Card.
Ex.A2 is the photo copy of Discharge Card issued by Aditya Hospital, Hyderabad Dt: 16.6.2004.
Ex.A3 is the letter from the Assistant Director, Powerloom Service Centre, Hyderabad, Dt: 21.2.2006.
Ex.A4 is the letter from the Assistant Director, Powerloom Service Centre, Hyderabad addressed to complainant Dt: 1.5.2006.
Ex.A5 is the letter from Bhagya Laxmi Traders, Sircilla Dt: 23.3.2006.
Ex.A6 is the photo copy of claim form of complainant Dt: 21.4.2006.
Ex.A7 is the photo copy of claim form of complainant Dt: 21.4.2006.
Ex.A8 is the photo copy of Group Insurance Policy for Powerloom Workers of complainant.
Ex.A9 is the photo copy of Medical Certificate of complainant issued by Govt of A.P., Andhra Pradesh Vaidya Vidhana Parishat.
Ex.A10 is the photo copy of letter from Manikantha Karmika Samkshema Sangham, Dt: 14.6.2006.
Ex.A11 is the photo copy of letter from Manikantha Karmika Samkshema Sangham, Dt: 16.2.2007.
Ex.A12 & A14 are postal receipts.
Ex.A13 & A15 are postal acknowledgement cards.
Ex.A16 is the unserved cover with endorsement of refused.
Ex.A17 is the Legal Notice issued by counsel for complainant addressed to opposite parties.
Ex.A18 is the repudiation letter from opposite party mo.2 Dt: 27.12.2008.
FOR OPPOSITE PARTIES:
Ex.B1 is the photo copy of death claim settlement from opposite party no.2 forwarded to Ministry of Textiles, Chennai Dt: 23.1.2007.
Ex.B2 is the photo copy of letter from opposite party no.2 addressed to Deputy Director, Ministry of Textiles, Bangalore Dt; 15.1.2009.
Ex.B3 is the photo copy of Policy with terms and conditions.
Ex.B4 & A2 are one and the same documents.
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MEMBER MEMBER PRESIDENT
