Date of Filing: 02/07/2011
Date of Order: 20/08/2011
BEFORE THE I ADDITIONAL DISTRICT CONSUMER DISPUTES REDRESSAL FORUM SESHADRIPURAM BANGALORE - 20
Dated: 20th DAY OF AUGUST 2011
PRESENT
SRI.H.V.RAMACHANDRA RAO,B.SC.,B.L., PRESIDENT
SRI.KESHAV RAO PATIL, B.COM., M.A., LL.B., PGDPR, MEMBER
SMT.NIVEDITHA .J, B.SC.,LLB., MEMBER
COMPLAINT NO. 1216 OF 2011
S. Siddaiah,
Aged About 40 years,
S/o. late. Siddanagaiah,
R/at: No.52, 14th ‘C’ Cross,
Vrushabhavathinagar,
Nanjappa Layout, Kamakshipalya,
Bangalore-560 079.
(Rep. by Advocate G.S.Manjunath) Complainant.
-V/s-
M/s. Accident Relief Care (India) Pvt Ltd.,
No.48/1, Vaishnavi Badri, 5th Main Road,
Near SBI Bank, Jayamahal Extension,
BANGALORE-560 046.
Rep. by its Director.
(Rep. by Advocate Sri.A.S.Ponnanna) Opposite party.
BY SRI.H.V.RAMACHANDRA RAO, PRESIDENT
ORDER
The brief antecedents that lead to the filing of the complainant made Under Section 12 of the Consumer Protection Act, seeking direction to the opposite party to pay a sum of Rs.90,192/- together with interest at the rate of 18% on Rs.40,192/- from 02.04.2011 until payment, are necessary:-
The complainant is one of the members of the opposite party, bearing No.KU123940164. The opposite party has issued a Special Contingency Policy Certificate bearing No.07040046103900000692 of United India Insurance Company Limited, Divisional Office, Bangalore, and it was valid between 16.12.2010 to 15.12.2011 which covers hospitalization expenses including OPD expenses for treatment of injuries sustained. On 02.04.2011 the complainant met with an accident, as a result the complainant sustained severe injuries and the right chest injury wherein 6th and 7th RIB was fractured, the first aid treatment was given at Harsha Hospital and later he was admitted to Premier Sanjeevini Hospital, Tumkur Road, Bangalore on the same day and he was discharged on 10.04.2011. As the complainant continued to have severe paid he approached Dr. Prabhu, Orthopadician, Forties Hospital wherein doctor diagnosed that the complainant also sustained fracture of 8th and 9th ribs on the right side. He was treated for 45 days. The complainant had incurred in all Rs.40,192/-. When a claim was made to the opposite party, they declined to reimburse the medical expenses of Rs.35,732/-. Hence a notice was issued to the opposite party on 02.05.2011. Hence the complaint.
2. In this case the opposite party engaged the service of an advocate on 30.07.2011. Subsequently the counsel for the opposite party took time on two occasions and later he was absent and cost was also not paid and no version was filed. Subsequently when the case was posted for evidence and arguments, on which day the complainant’s counsel has filed the affidavit. Even then neither the opposite party nor his counsel were present. Hence complainant was heard.
3. The points that arise for our consideration are:-
- Whether there is deficiency in service?
- What order?
4. Our findings on the above points are:-
Point (A):In the Positive
Point (B) : As per the final order
For the following:-
REASONS
POINT (A) to (B):-
5. Reading the complaint in conjunction with the documents on record, it is established that the complainant is the member of the opposite party and the opposite party has issued Special Contingency Policy Certificate bearing No.07040046103900000692 of United India Insurance Company Limited which was valid between 16.12.2010 to 15.12.2011 which covers the hospitalization expenses including OPD expenses for treatment of the injury sustained in the accident and also it covers death due to accident.
6. It is also established that on 02.04.2011 while the complainant was moving in his motorcycle bearing No.KA-04-EW-6984 near Bagalur on Bangalore-Hyderabad Highway, the vehicle met with an accident since it skids on the road and complainant sustained injuries.
7. It is further seen that the 6th and 7th right side ribs were fractured in the first instance and later on it was noticed that the 7th and 9th ribs on the left side was also fractured and the complainant was treated at Harsha Hospital, Premier Sanjeevini Hospital, and by Dr.Prabhu of Forties Hospital. It is seen that the complainant has spent Rs.40,192/- towards the hospitalization and medical expenses. It is also stated and sworn to by the complainant that when he has raised the claim but the opposite party has declined to pay the amount, he has issued notice to the opposite party. None of these facts are denied by the opposite party. All these statements are fully corroborated by the documents produced. There is no illegality or irregularity in the claim of the complainant. The opposite party has declined to pay the amount. Hence it is deficiency in service. If the opposite party had any valid reason it should have certainly put its records showing the justification for rejecting the claim that has not been done. Hence we hold the above points accordingly and proceed to pass the following:-
ORDER
1. The complaint is Allowed-in-part.
2. The opposite party is directed to pay Rs.40,192/- to the complainant together with interest at the rate of 12% per annum from 02.04.2011 until payment within 30 days from the date of this order.
3. The opposite party is also directed to pay Rs.2,000/- to the complainant towards cost of this litigation.
4. The opposite party is directed to send the amounts as ordered at Serial Nos. 2 & 3 to the complainant through DD by registered post acknowledgment due and submit the compliance report to this Forum with necessary documents within 45 days from the date of this order.
5. Return the extra sets filed by the parties to the concerned as under Regulation 20(3) of the Consumer’s Protection Regulation 2005.
6. Send a copy of this order to both parties free of costs, immediately.
(Dictated to the Stenographer, transcribed and typed by him, corrected and then pronounced by us in the Open Forum on this the 20th Day of August 2011)
MEMBER MEMBER PRESIDENT
