IN THE CONSUMER DISPUTES REDRESSAL FORUM, PATHANAMTHITTA. Dated this the 23rd day of June, 2010. Present:- Sri. Jacob Stephen (President) Smt. C. Lathika Bhai (Member) Sri. N. Premkumar (Member) C.C.No.183/08 (Filed on 05.12.2008) Between: Anu. T. George, Managing Director, Vadakkemuriyil Granites, Chunkappara.P.O., Mallappally Taluk, Pathanamthitta, rep. by his- P/A holder Siby Sebastian, Manager, Vadakkemuriyil Granites, P.B.No.7, Chunkappara.P.O., Kottangal Panchayat. (By Adv. Abraham Mathew) ….. Complainant And: 1. General Manager, rep. by Cholamandalam M.S. General Insurance- Co. Ltd., Regd. Office, Dare House, 2nd Floor, No.2, NSC Bose Road, Chennai – 600 001. 2. Manager, Claims, Cholamandalam M.S. General Insurance- Co. Ltd., Regional Office, 2nd Floor, Acel Estate, Iyyattil Jn., Chittoor Road, Cochin – 682 011. (By Adv. Sailesh Kumar) ….. Opposite parties. O R D E R Sri. Jacob Stephen (President): The complainant has filed this complaint for getting a relief from the Forum. 2. The complainant’s case is that he was the Managing Director of Vadakkemuriyil Granites, a metal crushing Unit at Chunkappara during the period 28.4.08. Now the said unit is working in the name and style Amity Rocks Products Pvt. Ltd., wherein the complainant is also a director. On 14.2.08, the complainant have taken a workmen’s compensation policy from the opposite party for Rs.4,50,000/- valid from 15.2.08 to 14.2.09 by Policy No.CWC/0064365/000/00. The said policy is not for a definite strength of employees and the strength of the employees in the unit was 15. On 28.4.08 at about 11 a.m. one Viswanathan and on 6.5.08 one Babu, who are employees in the complainant’s unit met with an accidents during the course of their employment. Both of them were admitted in Mar Thoma Medical Mission Hospital, Angadi, Ranni immediately after the above said accidents. Viswanathan was discharged on 10.5.08 and Babu was discharged on 15.5.08 from the hospital after the treatment. Due to the accident left and right feet of the said Babu has been terribly crushed and an amount of Rs.5,518/- was spent by the complainant in total for the treatment and other expenses of the said Babu. The said Babu was working as a store keeper and his total emoluments was Rs.8,000/- per month. Due to the accident left leg of the above said Viswanathan got fractured. For the treatment and for other expenses the complainant had spent an amount of Rs. 36,187/- in total. Due to the said accidents, the insured employees were absent from their duty for so many days. The company had filed workmen compensation insurance claim for the both said workers to the opposite party. Though they have conducted an enquiry and took evidence through their investigator Safe Planet Service Pvt. Ltd., they have arbitrarily dismissed the claim vide their letter dated 11.7.08. The rejection of the complainant’s claim by the opposite parties is a clear deficiency of service and opposite parties are liable to the complainant as per the terms and conditions of the policy. Hence this complaint for the realization of Rs.45,505/-, the amount spent by the complainant in connection with the above said accidents with 12% interest along with cost of this proceedings. 3. The main contentions of the opposite parties is as follows:- They admitted the issuance of the policy. But it covers only 15 employees for the liabilities arising under the Workmen Compensation Act only. The total persons covered by the complainant under the said policy is not sufficient when compared to the actual pay roll of employees employed by the complainant during the accident. So there is a breach of conditions of the policy. Hence they are not liable to the complainant even if the liability comes within the purview of W.C. Act. The alleged accident in the course of their employment with the complainant is false and hence denied. The policy covers only disability or death caused to the workmen by accident arising out and in the course of their employment and medical expenses are not covered under the policy. Emoluments of the employees stated in the complaint and the expenses claimed by the complainant are false. The repudiation of the claim is legal and the complainant’s claim does not come within the purview of compensation provided by the Workmen’s Compensation Act. With the above contentions, opposite parties prays for the dismissal of the complaint, as there is no deficiency in their service. 4. On the basis of the above contentions, the only point to be decided is whether this complaint can be allowed or not? 5. The evidence of this complaint consists of the oral deposition of PW1 and DW1 and Exts.A1 to A16 and B1 series. After closure of the evidence, both sides were heard. 6. The point:- In order to prove the complainant’s case, the power of attorney holder of the complainant filed a proof affidavit narrating his case along with certain documents. On the basis of the proof affidavit of the power of attorney holder of the complainant, the P.A holder of the complainant was examined as PW1 and the documents produced were marked as Exts.A1 to A16. Ext.A1 is the photocopy of the policy in question attached with its terms and conditions. Ext.A2 is the photocopy of the medical bill dated 5.5.08 for Rs.34,117/- issued by the Ranny Mar Thoma Medical Mission Hospital in the name of Viswanthan. Ext.A3 is the photocopy of a cash receipt dated 15.5.08 for Rs.570 issued by the Ranny Mar Thoma Medical Mission Hospital in the name of one Viswanthan. Ext.A4 is the medical bill dated nil for Rs.5,518/- issued by the Ranny Mar Thoma Medical Mission Hospital in the name of one Babu. Ext.A5 is the photocopy of the discharge summary issued by Ranny Mar Thoma Medical Mission Hospital in connection with the treatment of Viswanthan. Ext.A6 is the discharge summary issued by Ranny Mar Thoma Medical Mission Hospital in connection with the treatment of Babu. Ext.A7 and A8 are photocopy of letters sent by the complainant to the opposite party intimating the accidents of the employees. Ext.A9 is the photocopy of the repudiation letter dated 11.7.08 issued by the opposite parties. Ext.A10 is the photocopy of the attendance register showing the absence of the insured employee Viswanathan. Ext.A11 is the photocopy of the attendance register showing the absence of the insured employee Babu. Ext.A12 and A13 are the photocopies of the workmen compensation insurance claim form submitted by the complainant in connection with the accident before the opposite parties. Ext.A14 is the photocopy of the statement given by the complainant before the opposite parties investigator, Safe Planet Services Pvt. Ltd. Ext.A15 is the photocopy of reminder letter dated 14.8.08 sent by the complainant to the opposite party for persuading the settlement of the claims. Ext.A16 is the photocopy of the certificate-dated 13.2.09 issued by Mar Thoma Medical Mission Hospital, Ranni showing the disability of the employee Viswanathan. PW1 was cross examined by the counsel for the opposite parties. 7. On the other hand opposite parties contention is that they have issued the policy for covering only 15 employees for the liabilities arising under the Workmen Compensation Act only. That the person covered by the above said policy is not sufficient when compared to the actual pay roll of employees employed by the complainant during the accident. This is a breach of the conditions of the policy by the complainant. The other contention is that as per the terms and conditions of the policy, opposite parties are liable only to pay compensation in case of death and disability. The complainant is claiming medical expenses. They also contended that the complainant has not proved that the injured are the employees of the complainant and they have met with accident in the course of their employment. More over, they have also challenged the locus standi of PW1 for filing and conducting this complaint. In order to prove the contentions of the opposite parties, 2nd opposite party filed a proof affidavit and on the basis of the proof affidavit he was examined as DW1 and the documents produced from the side of the opposite parties are marked as Exts.B1 and B2. Ext.B1 is the copy of the policy schedule issued to the complainant. Ext.B1(a) is the terms and conditions of the policy. Ext.B2 is the copy of the repudiation letter. DW1 was cross-examined by the counsel for the complainant. 8. On the basis of the contentions of the parties, we have perused the entire materials on records and found that there is no dispute between the parties with respect the issuance of Ext.A1 policy to the complainant by the opposite parties. The only dispute between the parties is that the complainant’s claim is not allowable on the basis of the terms and conditions of Ext.A1 policy. According to the complainant, they have taken the policy for covering their risk in case of any liability occurs under Workmen’s Compensation Act. In this case, two of the complainant’s workers met with accidents during the course of their employment with the complainant and the complainant have spent money for the treatment of the injured employees and the opposite parties are liable to the complainant for such expenses. But opposite parties contended that as per the policy schedule the insurance is only for 15 employees whereas the complainant had more than 15 employees as per the muster roll (Ext.A10 & A11) produced by the complainant, which is a violation of the terms and conditions of the policy. They also argued that the complainant is claiming treatment expenses whereas the opposite parties are liable only to pay compensation for death and disability as per the terms and conditions of the policy. They also argued that the complainant failed to prove the alleged accident and consequent treatment. But on a perusal of Ext.A1 (Ext.A1 and B1 series documents are one and the same) there is nothing to show that the complainant is not entitled to get the claim in question on the ground that he had more than 15 employees and his expenses are not in connection with death and disability. The documents produced by the complainant, which are marked in evidence clearly shows the occurrence of the accidents to the complainant’s employees during the course of their employment, hospitalization and treatment of the injured employees, payment of treatment expenses, submission of the claim forms and the repudiation of the claim by the opposite party. Opposite parties has not adduced any evidence to substantiate their contentions. So the repudiation of the claim of the complainant is a clear deficiency of service from the part of the opposite parties and hence opposite parties are liable to the complainant. In the absence of any evidence for the payment of interim relief and further treatment expenses and conveyance charges etc., the prayer for such reliefs are not allowable. Therefore this complaint can be allowed partly. 9. In the result, the complaint is allowed thereby the opposite parties are directed to pay Rs.40,205/- (Rupees Forty Thousand Two hundred and Five only) to the complainant with interest at the rate of 7% per annum from the date of filing this complaint till this date along with cost of Rs.2,500/- (Rupees Two Thousand Five hundred only) within 30 days from the date of receipt of this order failing which complainant is allowed to realise the whole amount ordered herein above from the opposite parties with interest at the rate of 10% from today till the whole realisation. Declared in the Open Forum on this the 23rd day of June, 2010. (Sd/-) Jacob Stephen, (President) Smt. C. Lathika Bhai (Member) : (Sd/-) Sri. N. Premkumar (Member) : (Sd/-) Appendix: Witness examined on the side of the complainant: PW1 : Siby Sebastian Exhibits marked on the side of the complainant: A1 : Photocopy of the policy attached with its terms and conditions. A2 : Photocopy of the medical bill dated 5.5.08 for Rs.34,117/- issued by the Ranny Mar Thoma Medical Mission Hospital in the name of Viswanthan. A3 : Photocopy of a cash receipt dated 15.5.08 for Rs.570 issued by the Ranny Mar Thoma Medical Mission Hospital in the name of Viswanthan. A4 : Photocopy of medical bill dated nil for Rs.5,518/- issued by the Ranny Mar Thoma Medical Mission Hospital in the name of one Babu. A5 : Photocopy of the discharge summary issued by Ranny Mar Thoma Medical Mission Hospital in connection with the treatment of Viswanthan. A6 : Discharge summary issued by Ranny Mar Thoma Medical Mission Hospital in connection with the treatment of Babu. A7 : Photocopy of letter dated 28.4.08 sent by the complainant to 1st opposite party intimating the accident of Viswanathan. A8 : Photocopy of letter dated 6.05.08 sent by the complainant to 1st opposite party intimating the accident of Babu. A9 : Photocopy of the repudiation letter dated 11.7.08 issued by the 1st opposite party to the complainant. A10 : Photocopy of the attendance register showing the absence of the insured employee Viswanathan. A11 : Photocopy of the attendance register showing the absence of the insured employee Babu. A12 & A13 : Photocopies of the Workmen Compensation Insurance Claim Form submitted by the complainant in connection with the accident before the opposite parties. A14 : Photocopy of the statement given by the complainant before the opposite parties investigator, Safe Planet Services Pvt. Ltd. A15 : Photocopy of reminder letter dated 14.8.08 sent by the complainant to the opposite party for persuading the settlements of the claim. A16 : Photocopy of the certificate-dated 13.2.09 issued by Mar Thoma Medical Mission Hospital, Ranni showing the disability of the employee Viswanathan. Witness examined on the side of the opposite parties: DW1 : Venkadesh Exhibits marked on the side of the opposite parties: B1 : Photocopy of Schedule Workmen Compensation B1(a) : Terms & Conditions of the policy B2 : Photocopy of letter dated 11.7.2008 sent by the 2nd opposite party to the complainant. (By Order) Senior Superintendent Copy to:- (1) Siby Sebastian, Manager, Vadakkemuriyil Granites, P.B.No.7, Chunkappara.P.O., Kottangal Panchayat. (2) General Manager, Cholamandalam M.S. General Insurance- Co. Ltd., Regd. Office, Dare House, 2nd Floor, No.2, NSC Bose Road, Chennai – 600 001. (3) Manager, Claims, Cholamandalam M.S. General Insurance- Co. Ltd., Regional Office, 2nd Floor, Acel Estate, Iyyattil Jn., Chittoor Road, Cochin – 682 011. (4) The Stock File.
| | HONORABLE LathikaBhai, Member | HONORABLE Jacob Stephen, PRESIDENT | HONORABLE N.PremKumar, Member | | 
