IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Wednesday the 28th day of February, 2018
Filed on 10.02.2016
Present
- Smt. Elizabeth George (President)
- Sri. Antony Xavier (Member)
- Smt.Jasmine.D. (Member)
in
C.C.No.49/2016
between
Complainant:- Opposite Party:-
- Sri.Madhavan Kutty 1. Divisional Manager
Veliyil House United India Insurance
Pollethai.P.O Sharadha shopping Complex
Mararikkulam, Alappuzha Mullackal, Alappuzha
(Adv. Jose. Y. James) (Adv. S. Premalatha)
- Sri. James Zacharia
Fix well Caps
Zacharia Bazar
Alappuzha 688 001
O R D E R
SMT. ELIZABETH GEORGE (PRESIDENT)
The case of the complainant is as follows:-
Complainant was a permanent employee of a factory owned by the 2nd complainant and the factory workers were insured with the opposite party under the Group Personnel accident policy, during the period from 17/6/2015 to 16/6/2016. On 11/8/2015 while the complainant was working in the factory an accident occurred and due to the accident he lost his right thumb completely. Due to the said permanent disability he lost the job. Complainant preferred the claim form along with medical report before the opposite party but opposite party paid only Rs. 15000/-instead of the assured amount of Rs. 1,50,000/-. Aggrieved by the act of the opposite party, the complaint is filed.
2. Version of the opposite party is as follows:-
Opposite party had issued a Group Personal Accident Policy to the manufacturing unit called Fixwell caps in the name of the 2nd complainant for a total sum of Rs. 12,00,000/- lakhs for the period from 17.6.2015 to 16/6/2016. In the policy schedule it is clearly stated that for loss of one phalanax, of thumb percentage of capital sum insured is 10%. Thus as per the schedule, opposite party has paid 10% of the capital sum insured ie. Rs. 15,000/- to the complainant as per the cheque No. 925558 dated 3/12/2015 which was accepted by the complainant and the amount was credited to his account and copy of the receipt is produced. There is no deficiency in service on the party of the opposite party.
3. Complainant was examined as PW1 documents produced were marked as Ext.A1 to A2. The 2nd complainant was examined as PW2. Dr. was examined as CW1; the opposite party was examined as RW1 documents produced were marked as Ext.B1 to B5.
4. The points came up for considerations are:-
- Whether there is any defect or deficiency in service on the part of the opposite party?
- Whether the complainant is entitled to get reliefs and costs?
5. It is an admitted fact that opposite party had issued a group personnel accident policy to the 1st complainant’s manufacturing unit called “Fix Well Caps” for the period from 17/6/2015 to 17/6/2016. On 11/8/2015 the 2nd complainant while he was working in the factory there was an accident and he lost his right thumb completely. According to the complainant he was unable to perform any job as bottle cap maker who needs a right thumb for metal cap manufacturing. In order to prove that the complainant produced disability certificate and it marked as Ext.A6. The opposite party rejected the claim of the complainant holding that as per the policy conditions for loss of thumb – one phalanx percentage of capital sum insured is 10% and as per the scheme opposite party has paid 10% of the capital sum insured that is Rs. 15,000/- to the complainant. According to the complainant he accepted the said amount with protest. The copy of the policy is produced and it marked as Ext.B5. The disability certificate issued by the medical board is also produced and marked as Ext.A6. As per the disability certificate the degree of disability found is 60%. The Ortho Specialist Doctor as a member of Medical board was examined as CW1. While cross examining him, he categorically stated that “Once it is lost it cannot be reimplanted. “Thumb so it is clear that the complainant who was suffering from 60% disability would not be in a position to do job in the same manner as he was doing before the incident. In the medical report Ext.B4 produced by the opposite party it is reported by the doctor that the complainant will not be able to pursue his duties due to the injury sustained. From the above discussion we are of opinion that since the complainant sustained 60% disability he would not in the position to do the job that he already done. In the decision reported in 2011 (3) CPR 107 Hon’ble National Commission held that 40% physical disability virtually a permanent disability. In the instant case complainant sustained 60% disability. So he is entitled to get the insured amount as per the policy issued by the opposite party. The repudiation of the claim of the complainant by the opposite party amounts to deficiency in service.
In the result the complaint is allowed. Opposite party is directed to pay the balance amount of Rs.1,35,000/-(Rupees One lakh thirty five thousand only) with 8% interest from the date of complaint till realization. The opposite party is further directed to pay Rs. 2000/- (Rupees Two thousand only) towards cost of Proceedings to the complainant.
Dictated to the Confidential Assistant transcribed by her corrected by me and pronounced in open Forum on this the 28th day of February, 2018. Sd/- Smt.Elizabeth George (President) :
Sd/-Sri. Antony Xavier (Member) :
Sd/-Smt.Jasmine.D. (Member) :
Appendix:-
Evidence of the complainant:-
PW1 - Madhavankutty .P.K(Witness)
PW2 - James Zacharia(Witness)
Ext.A1 - OP ticket
Ext.A2 - Certificate dtd. 29-9-2015
Ext.A3 - Copy of Cheque
Ext.A4 - Policy details
Ext.A5 - Medical Report
Ext.A6 - Disability Certificate.
Ext.CW1 - Dr.Maneesh Steephan
Evidence of the opposite party:-
RW1 - Bindu.B (witness)
Ext.B1 - Copy of Policy terms and conditions
Ext.B2 - Copy of claim form
Ext.B3 - Copy of claim disbursement voucher
Ext.B4 - Copy of Medical Report
Ext.B5 - Photo graph to the complainant.
// True Copy //
By Order
Senior Superintendent
To
Complainant/Opposite parties/S.F.
Typed by:- br/-
Compared by:-
