BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MYSORE-570023

CONSUMER COMPLAINT NO.95/2014

DATED ON THIS THE 24^th March 2017

      Present:  1) Sri. H.M.Shivakumara Swamy

B.A., LLB., - PRESIDENT   

    2) Smt. M.V.Bharathi                    

                                   B.Sc., LLB., -  MEMBER

                     3) Sri. Devakumar.M.C.                  

                                                          B.E., LLB.,    - MEMBER

Sri DEVAKUMAR.M.C,

Member

1.     The complainant has filed the complaint under section 12 of the C.P.Act, 1986, against the opposite parties, alleging deficiency in service and seeking a direction to pay Rs.3,75,000/- and Rs.1,00,000/- towards damages for the mental agony with cost and other reliefs.
2.     The complainant has taken a life insurance policy from opposite party company on 23.02.2008.  The sum assured was Rs.2,50,000/-.  The complainant, while working in his agricultural land, suffered injuries to his right eye, on 21.11.2011.  He took treatment at Mysore and Bangalore Hospital and incurred a sum of Rs.1,50,000/-.  The treating doctor certified that, the complainant has 30% visual capacity only.  The policy provided a sum assurance for accidental permanent total/partial disability benefit of Rs.2,50,000/-.  A claim was made under the policy.  The opposite party repudiated the claims.  Hence, the aggrieved complainant filed the complaint seeking reliefs.
3.     The opposite party No.1 in its version denies the allegation as false and submits the complaint is not maintainable for the following reasons.  It has admitted the issue of insurance policy, on receipt of the proposal form along with the premium amount.  The treating doctor has opined that, the complainant is having only 30% of visual capacity of his right eye, despite of surgery.  As such, the complainant never fall under the purview of permanent disability as per the policy terms and conditions.  So the opposite party repudiated the claims and there is no deficiency in service on their part and are not liable to pay any compensation as claimed and hence, prays for dismissal of the complaint with costs.
4.      The opposite party No.2 remained absent, despite of service of notice, hence placed exparte.
5.     To establish the facts, the complainant lead his evidence by filing affidavit and relied on several documents.  The opposite party No.1 also lead its evidence.  Both side parties filed written arguments.  Perusing the material on record, matter posted for orders.
6.      The points arose for our consideration are:-

1. Whether the complainant establishes the deficiency in service on the part of opposite parties in not settling the insurance claims and thereby he is entitled for the reliefs sought?
2.  What order?

7.    Our findings on the aforesaid points are as follows:

Point No.1 :- Partly in the affirmative.

Point No.2 :- As per final order for the following

:: R E A S O N S ::

8.    Point No.1:- The complainant got insured with opposite party No.1, on payment of premium of Rs.12,500/-p.a., since 23.02.2008.  The sum assured was Rs.2,50,000/.  The policy also provided a death benefit and/or accidental benefit to the insured to the tune of Rs.2,50,000/-.  The complainant suffered injuries on his right eye, while working in his agricultural land.  He obtained treatment at various hospitals at Mysuru and Bangalore, even then could not regain 100% visibility.  Only 30% visibility was regained, despite of various surgeries by the doctor.  The complainant made the claims under the policy for a sum of Rs.2,50,000/, which was repudiated by opposite parties. Hence, the complaint and sought for the reliefs.
9.    The opposite party No.1 contended that, it has issued the insurance policy, in accordance with the information and declaration furnished in the proposal form and on receipt of the premium amount, since 23.02.2008.  The policy was renewed periodically.  The opposite party No.1 never denied the treatment undergone by the complainant for his right eye.  However, contended that, since the complainant has not suffered a total permanent disability of his right eye, as reported by the treating doctor, he is not entitled for the reliefs sought under the policy.  Hence, the claim has been repudiated and contends, there is no deficiency in service on their part and prays for dismissal of the complaint, with costs.
10. On perusal of the documents available on record, it is established that, the complainant had taken an insurance policy from opposite party No.1 from 23.02.2008 for a sum assured Rs.2,50,000/-.  The policy was periodically renewed on payment of annual premium amount of Rs.12,500/-.  The complainant established that he suffered injuries to his right eye and had taken treatment at Mysore and Bangalore repeatedly.  The doctors opined that only 30% of visibility to the complainant.  According to the policy terms and conditions, the insured is entitled for a sum of Rs.2,50,000/-.  Further, the insured is entitled to receive an accidental permanent partial disability benefit, as there is loss of vision of his right eye, is more than 50% of disability.  In view of the same, considering the age of the insured and the extent and nature of the damage caused to the eye, we opine that the complainant is entitled to the sum assured as promised in the policy terms and conditions.  Denial of the policy claim amount by opposite party No.1 is not justified and the complainant is certainly entitled to the compensation for the deficiency in service committed by opposite party No.1 with cost of the proceedings.    Accordingly, point No.1 is answered partly in the affirmative.
11. Point No.2:- In view of the above observations, we proceed to pass the following

:: O R D E R ::

1. The complaint is allowed in part.
2. The opposite party No.1 is hereby directed to pay the sum of Rs.2,50,000/- along with interest at 10% p.a. from the date of filing the complaint, to the complainant, within 60 days of this order.  Failing which, the opposite party No.1 shall pay interest at 10% p.a. until compliance.
3. The opposite party No.1 shall pay Rs.2,000/- towards deficiency in service and Rs.2,000/- cost of the proceedings to the complainant within 60 days of this order.  In default, to pay interest at 10% p.a. on the total sum of Rs.4,000/-, until payment made.
4. In case of default to comply this order, the opposite party No.1 to undergo imprisonment and also liable for fine under section 27 of the C.P.Act, 1986.
5. Complaint is dismissed against opposite party No.2.
6. Give the copies of this order to the parties, as per Rules.

 (Dictated to the Stenographer transcribed, typed by her, transcript corrected by us and then pronounced in open court on this the 24^th March 2017)

                          (H.M.SHIVAKUMARA SWAMY) 

                                      PRESIDENT     

(M.V.BHARATHI)                           (DEVAKUMAR.M.C.)

      MEMBER                                         MEMBER