Heard learned counsel for the appellant. None appears for the respondent.
2. This appeal is filed U/S-15 of erstwhile Consumer Protection Act,1986(herein-after called the Act). Hereinafter, the parties to this appeal shall be referred to with reference to their respective status before the learned District Forum.
3. The case of the complainant, in nutshell is that complainant had opened an account under AGOGP Scheme with OP No.2. Complainant has also purchased a policy from OP No.1 on payment of Rs.45/- per person per annum. It is alleged inter-alia that on 18.08.2014 the complainant met accident for which there was multiple fracture. He has undergone complicated surgery in a private hospital at Visakhapatnam and same fact was reported to Sadar PS,Koraput. It is alleged that complainant has furnished all documents to OP No.2 who forwarded same to OP No.1. The OP No.1 insisted disablement certificate issued by District Medical Board and the complainant applied for said certificate with District Medical Board but OP No.3 did not intimate anything. It is further submitted that the complainant on 17.11.2015 submitted another application before the CDMO and basing on that the OP No.3 issued a letter mentioning 25 % disability. The complainant submitted the said letter with OP No.1 but no action has been taken by it. Hence, the complaint was filed.
4. The OP No.1 filed written version denying all the allegations and contended that the present case is falling under the jurisdiction of MACT and hence the case is not maintainable under this Act. It is stated by the OP No.1 that after survey they have repudiated the case of the complainant on 13.01.2016. Therefore, they have no deficiency in service on their part.
5. OP No.2 filed written version denying the allegations and submitted that the duty of OP No.2 is to forward insurance claim with related documents to OP No.1, who is to scrutinize same to settle the claim but for OP No.2 he has no deficiency in service on their part.
6. OP No.3 filed written version denying all the allegations. According to him the complainant was brought to the DHH,Koraput as an outdoor patient and he was admitted in special cabin as an indoor patient. After necessary treatment, the complainant was referred to MKCG Medical College & Hospital,Berhampur for further treatment. Thereafter the complainant was shifted to Visakhapatnam for treatment. It is further averred that the complainant registered his name through online and appeared in person before the District Medical Board,Koraput who found complainant disabled to the extent of 25 % only. The complainant requested the medical board to give the certificate of disability for 40 % but the medical board did not agree. Thus, there is no deficiency in service on the part of the OP No.3.
7. After hearing both the parties, learned District Forum dismissed the complaint.
8. Learned counsel for the appellant submitted that learned District Forum has committed error in law by not considering the written version filed by the Ops with proper perspectives. According to him the complainant has got 25 % disability but further contended that due to accident his foot has been reduced to 2 inches and as such the complainant getting pain for such disability and they have only considered the case to the extent it is required. Learned counsel for appellant submitted that learned District Forum ought to have considered that the medical certificate of 25 % disability should be treated as permanent disability to 100 % because the complainant being a lawyer to the best of his ability is not discharging duty. Accordingly he is entitled to the compensation available under the scheme. Therefore, he submitted to set-aside the impugned order by allowing the appeal.
9. Considered the submission of learned counsel for the appellant, perused the DFR and impugned order.
10. It is admitted fact that during currency of the policy the complainant met accident and sustained loss. The medical report is clear to show that complainant has 25 % disability lucomoto which is partial. The scheme does not allow such type of disability for awarding any compensation. The doctor can not be saddled with liability to enhance percentage of the disability unless there is such disability. Therefore, we find no error in the judgment and accordingly it is confirmed and the appeal stands dismissed. No cost.
Free copy of the order be supplied to the respective parties or they may download same from the confonet or website of this Commission to treat same as copy of order received from this Commission.
DFR be sent back forthwith.