Complaint is filed on 3-8-2009
Compliant disposed on 11-04-2011
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
MONDAY, THE ELEVENTH DAY OF APRIL, TWO THOUSAND ELEVEN
CONSUMER COMPLAINT NO. 122 OF 2009
Between:
Smt. Gajula Lasmavva, W/o. Rama Swamy, Age 58 years, Occ: Powerloom Worker, (Spindle Winding Machine Operator), R/o. H.No. 7-2-55, Subhashnagar, Sircilla 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 29-3-2011, 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 seeking direction to opposite parties to pay an amount of Rs.75,000/- towards sum assured under the policy and Rs.25,000/- towards compensation together with interest and costs.
2. The brief averments of the complaint are that the complainant is a Power Loom worker. There is a Group Insurance Scheme under the name of Janasri Bheema Scheme issued by the opposite party no.2 Insurance Company. Under the said scheme the opposite party no.2 undertook to pay an amount of Rs.75,000/- in case of accidental death or partial permanent disability of any member. The complainant became member of the said Insurance Scheme with effect from 1.6.2006. The Insurance Premium was paid by the opposite party no.1 under the scheme provided by the Government. On 6.10.2006 the complainant sustained an electric shock while working on Spindle Winding Machine at the Power Loom mill of Bhagyalaxmi Traders at Sircilla. As a result of this electric shock she fell unconscious and admitted in Hospital. The complainant spent huge amount for treatment and she is developed with Permanent Disability due to which she is unable to do any work. Since there is Insurance Coverage the complainant submitted a claim to the opposite parties to pay Rs.75,000/- on account of her permanent disability. The Employees Association Manikanta Karmika Sankshema Sangam, Sircilla also requested the opposite parties to pay the said amount, but the same was rejected on the ground that the complainant did not sustain permanent disability. Infact the Disability Certificate and Medical Reports clearly disclose that the complainant sustained permanent disability. When the opposite parties failed to pay the amount the complainant got issued a Legal Notice Dt: 27.1.2008 calling upon the opposite parties to pay the sum assured, but the opposite parties failed to pay the amount. Therefore, the complainant sought direction for payment of sum assured.
3. The opposite parties filed counter submitting that the complainant is a member of Janasri Bheema Scheme issued by the opposite party no.2 covering group members who are Power Loom workers aged between 18 to 59 years. As per the terms and conditions of the policy the Insurance Company undertook to pay sum assured in case of death or permanent disability of the member. The complainant did not sustain any permanent disability and her claim is not covered under the Insurance Scheme offered by the opposite party no.2. When the claim is received same was repudiated which is informed to the complainant, as such there is no deficiency of service on their part, hence, prayed for dismissal of the complaint.
4. The complainant filed her Proof Affidavit reiterating the averments made in the complaint and filed documents which are marked as Ex.A1 to A20. Ex.A1 is the acknowledgement of application with registration fee paid there in Dt: 13.5.2006. Ex.A2 is the resubmission of claim application by the complainant Dt: 8.8.2008. Ex.A3 is the photo copy of letter of witnessing the incident by owner of mill Dt: 21.2.2007. Ex.A4 is the is the photo copy of election identity card Dt: 15.12.1995. Ex.A5 is the Discharge Card issued by Aravinda hospital , Karimnagar dt. 21-10-2006. Ex.A6 is the photo copy of Scanning Report Dt: 18.10.2006. Ex.A7 & A8 are the Claim Applications Dt: 11.10.2006. Ex.A9 is the reminding letter by the President, Manikanta Karmika Sankshema Sangam, Sircilla Dt: 19.5.2008. Ex.A10 is the refusal letter of opposite party no.1 Dt: 28.5.2008. Ex.A11, A12 & A14 are postal receipts bearing nos.1030, 1031 & 2797. Ex.A13, A15 & A16 are the postal acknowledgement of opposite party no.1 & 2. Ex.A17 is the returned postal cover Ex.A18 is the copy of Legal Notice addressed to opposite parties Dt: 27.10.2008. Ex.A19 is the letter from opposite party no.2 addressed to counsel for complainant Dt: 19.12.2008. Ex.A20 is the original Medical Certificate in respect of persons with Mentally Handicapped Dt: 3.12.2008 issued by District Medical Board A.P.Vaidya Vidhana Parishad.
5. The Assistant Director of opposite party no.1 and Administrative Officer of opposite party no.2 filed their Proof Affidavits reiterating the averments made in the counter and filed documents which are marked as Ex.B1 to B4. Ex.B1 is the photo copy of Medical Report issued by Dr.T.Mohan Rao Dt: 31.1.2007. Ex.B2 & A10, Ex.B3 & A19 are one and the same documents. Ex.B4 is the photo copy of Master Policy NO.GI/JBY/416256.
6. The points for consideration are:
- Whether there is any deficiency of service on the part of opposite parties?
- If so, to what relief the complainant is entitled?
7. Heard both sides.
8. This case is filed by the complainant seeking an order for payment of Rs.75,000/- towards sum assured under Janasri Bheema Scheme issued by opposite party no.2 as there is Insurance Coverage to the Power Loom workers. Under the said policy a member will get Rs.75,000/- in case of permanent disability sustained by her. A perusal of application under Ex.A2 discloses that on 8.8.2008 a claim is made to the opposite party no.1 for payment of the sum assured under the Insurance Policy as the complainant sustained permanent disability. The Medical Records under Ex.A5 and A6 discloses that she was admitted in Aravinda Hospital at Karimnagar on 18.10.2006 and remained till 21.10.2006. The complainant sustained an electric shock while working on a Spindle Winding Machine on 16.10.2006 at Bhagya Laxmi Traders as a result of which she is developed with partial permanent disability. To that effect a certificate is issued by Bhagyalaxmi Traders under Ex.A3. The complainant along with Manikanta Karmica Sankshema Sangam submitted a representation under Ex.A8 and A9 requesting them to pay the sum assured under the policy, but opposite party no.1 sent a letter under Ex.A10 that the injury sustained by her is not covered under the Insurance Policy issued by opposite party no.2.
9. A perusal of the disability certificate Ex.A20 issued by District Medical Board, A.P.Vaidya Vidhana Parishad discloses that the complainant became Mentally Handicapped and her disability is assessed at 55% to 60%. The opposite parties denied the claim of the complainant on the ground that the injury sustained by her is not covered under the policy and that there is delay in making the claim. Infact the letters submitted by the complainant and Employees Association it is clearly established that the complainant submitted a claim for payment of the sum assured. Opposite party no.1 and no.2 admitted that there is Group Insurance Coverage to the Power Loom workers and the complainant is also one of the members. Under the said Insurance Scheme member will be paid sum assured under the policy in case of staining disability. The Medical Insurance claim form under Ex.B1 issued by Dr.T.Mohan Rao of Aravinda Hospital certified that the complainant sustained electric shock and that there is internal Cerebral bleeding due to which she is getting headache and vomiting. The said doctor assessed the disability at minimum percentage and advised to take rest for 2 to 3 months. Considering the disability certificate under Ex.A20 and Medical Report of Dr.T.Mohan Rao it is established that the complainant is developed with some partial permanent disability. Considering the age of the complainant and electric shock sustained by her she sustained disability. As per the Insurance Policy the opposite party no.2 undertook to pay Rs.75,000/- in case of total disablement. As the complainant sustained 55% to 60% disability as per the Disability Certificate under Ex.A20, it would be just and reasonable to assess her loss at Rs.37,000/-. Having issued Insurance coverage the opposite parties are under an obligation to pay the sum assured under the policy, but inspite of submission of claims and service of Legal Notice under Ex.A18 the opposite parties failed to pay the sum assured under the policy and their failure constitutes deficiency of service. In view of the foregoing reasons, we direct the opposite parties to pay Rs.37,000/- towards the sum assured under the Group Insurance Policy with interest @ 7% along with Rs.1,000/- towards costs of the proceedings.
10. In the result the complaint is partly allowed directing the opposite parties jointly and severally to pay Rs.37,000/- towards the sum assured under the policy along with interest @ 7% P.A. from the date of filing the complaint i.e. 3.8.2009 and Rs.1,000/- towards costs of the proceedings within one month from the date of receipt of this order.
Typed to my dictation by Stenographer (DUR), after correction the orders pronounced by us in the open court this the 11th day of April, 2011.
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
NO ORAL EVIDENCE HAS BEEN ADDUCED ON EITHER SIDE FOR COMPLAINANTS:
Ex.A1 is the acknowledgement of application with registration fee paid there in Dt: 13.5.2006.
Ex.A2 is the resubmission of claim application by the complainant Dt: 8.8.2008.
Ex.A3 is the photo copy of letter of witnessing the incident by owner of mill Dt: 21.2.2007.
Ex.A4 is the is the photo copy of election identity card Dt: 15.12.1995.
Ex.A5 is the Discharge Card issued by Aravinda hospital , Karimnagar dt. 21-10-2006.
Ex.A6 is the photo copy of Scanning Report Dt: 18.10.2006.
Ex.A7 & A8 are the Claim Applications Dt: 11.10.2006.
Ex.A9 is the reminding letter by the President, Manikanta Karmika Sankshema Sangam, Sircilla Dt: 19.5.2008.
Ex.A10 is the refusal letter of opposite party no.1 Dt: 28.5.2008.
Ex.A11, A12 & A14 are postal receipts bearing nos.1030, 1031 & 2797.
Ex.A13, A15 & A16 are the postal acknowledgement of opposite party no.1 & 2.
Ex.A17 is the returned postal cover
Ex.A18 is the copy of Legal Notice addressed to opposite parties Dt: 27.10.2008.
Ex.A19 is the letter from opposite party no.2 addressed to counsel for complainant Dt: 19.12.2008.
Ex.A20 is the original Medical Certificate in respect of persons with Mentally Handicapped Dt: 3.12.2008.
FOR OPPOSITE PARTIES:
Ex.B1 is the photo copy of Medical Report issued by Dr.T.Mohan Rao Dt: 31.1.2007.
Ex.B2 & A10, Ex.B3 & A19 are one and the same documents.
Ex.B4 is the photo copy of Master Policy NO.GI/JBY/416256.
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
