BEFORE THE DISTRICT FORUM:KURNOOL

Present: Sri.K.V.H. Prasad, B.A., LL.B President                                                                                                             And                                                                                                                                                                                         Smt. C.Preethi, M.A.LL.B., Lady Member

Friday the 17th day of April, 2009

C.C.No. 114/08

Between:

V.Ramana Reddy,  S/o. Basi Reddy ,

H.No.49/50-28-A-10, Arora Nagar, Kurnool.                                                                         . … Complainant

Versus

1. Golden Multi Services Club of Golden Trust Financial Services, Represented by its Branch Manager,

U con Plaza , Kurnool-518 001.

2. Golden Multi Services Club of Golden Trust Financial Services, Represented by its Regional Manager,

16 R.N. Mukarjee Road, Kolkata-700 001.

3. National Insurance Company Limited, Represented by its Branch Manager,

D.No.40-344, Gandhi Nagar, Kurnool-518 001.

4. National Insurance Company Limited, Represented by its Senior Divisional Manager,

Division III 8, India Exchange Place (Gr Floor) Kolkata-700 001.                                     … Opposite parties

This complaint is coming on this day for orders in the presence of Sri.M.L.Sreenivasa Reddy , Advocate, for the complainant, and Sri.M. Azmathulla , Advocate for opposite party No. 1 and 2 and Sri.D.A.Anees Ahamed , Advocate for opposite party No. 3 and opposite party No. 4 is called absent set exparte and upon perusing the material papers on record, the Forum made the following.

ORDER

(As per Smt. C.Preethi, Lady Member)

C.C.No.114/08

1. This consumer complaint of the complainant is filed U/S 12 o f C.P.Act, 1986 seeking a direction on opposite parties to pay Rs.2,50,000/- with 18% p.a, Rs.15,000/- towards compensation for mental agony, Rs.10,000/- as cost of this case and any other relief or reliefs which the complainant is entitled in the circumstances of the case.

2. The brief facts of the complainants case is that the complainant is the member of opposite party No. 1 and 2 who had a tie up with opposite parties 3 and 4 under Personal Accident Insurance Policy covering members  of opposite parties 1 and 2. The opposite parties No. 3 and 4 issued a policy bearing No. 100300/47/01/9600022/03/96/30387 for Rs.5 lakhs covering the risk of the complainant from 08-02-2004 to 07-02-2016 and the complainant paid the necessary premium to opposite parties 3 and 4 through opposite parties 1 and 2. On 18-04-2007 the complainant received injuries and lost his right hand up to shoulder and a claim was submitted to opposite party No. 4 through opposite party No. 1 along with necessary documents and opposite party No. 4 sent a letter dated 18-12-2007 to the complainant requiring the complainant to comply certain necessary documents and the complainant on 03-01-2008 complied the said requirements , but the opposite parties did not settle the claim of the complainant and opposite party No. 4 sent another letter dated 04-04-2008requiring the complainant to clarify with regard to date of discharge from the hospital and the same was clarified by the complainant vide letter dated 18- 04-2008 , 02-05-2008 and 02-07-2008 . In spite of said compliance by the complainant the opposite parties did not settle the claim and hence the complainant resorted to the forum for releifs.

3. In support of his case the complainant relied on the following documents viz., (1) Xerox copy of policy No. 100300/47/01/9600022/03/96/30387 , (2) Xerox copy of disability certificate of the complainant , (3) xerox copy of charge sheet in Cr.No.61/07 of Kurnool Taluk, P.S. (4) Letter dated 13-03-2007 of OP.No.2 to OP.No.4, (5) letter of complainant to OP.No. 4 along with postal receipt and acknowledgement , (6) letter dated 12-12-2007 of complainant to OP No. 4 along with courier receipt , (7) letter dated 18-12-2007 of OP.No. 4 to complainant , (8) letter dated 27-03-2008 of complainant to OP NO. 4 along with courier receipt , (9) letter dated 04-04-2008 of OP.No4 to complainant , (10) reply to Ex.A9 along with courier receipt and acknowledgment , (11) letter dated 02-05- 2008 of complainant to OP.No.4, (12) letter dated 10-06-2008 of complainant to OP.No.4 along with courier receipt , (13) letter dated 02-07- 2008 of complainant to OP No.4 along with postal receipt, (14) acknowledgements for Ex.A13 , (15) acknowledgement for Ex.A13, (16) xerox copy of policy along with letter and conditions No. 100300/47/01/ 9600022/03/96/30387 , besides to the sworn affidavit of complainant in reiteration of his complaint averments and the above documents are marked as Ex.A1 to A16 for its appreciation in this case and replies to the interrogatories exchanged.

4. In pursuance to the notice of this forum as to this case of the complainant the opposite parties 1, 2 and 3 appeared through their standing counsel and contested the case by filing written version. The opposite party No. 4 remained absent throughout the case proceedings and were made exparte.

5. The written version of opposite parties 1 and 2 submits that as per the memorandum of understanding dated 01-01-2001 between opposite party No. 2 and opposite party No.4, the opposite party No. 4 agreed to provide accident insurance coverage to the members of opposite party No.1 under Group Personnel Accident Policy and the entire liability will be on opposite party No. 4 to settle the claim . If any claim form is received by opposite parties 1 and 2 from the beneficiary the same will be forwarded to opposite party No.4 for settlement of claim and opposite parties 1 and 2 has no role to play in the settlement of claim .It further admits that the complainant joined as a member with opposite parties 1 and 2 and they have no personal knowledge of accident and treatment taken by the complainant and lastly seeks for the dismissal of complaint, as there is no deficiency of service on part of opposite parties 1 and 2.

6. The written version of opposite party No. 3 submits that there is no deficiency of service on part of opposite party No. 3 , as the complainant is the member of opposite party No.1 and 2 club and there is no knowledge for opposite party NO.3 regarding the policy and the accident and treatment taken by the complainant . It also submits that as per the letter dated 18-12-2007 addressed by opposite party No. 4 to the complainant calling for certain documents and the same are not submitted by the complainant to opposite party NO. 4 in further goes to show that the clarification called by opposite party No. 4 was not complied by the complainant and even otherwise the claim has to prefer at Kolkatta as per policy terms and the forum has no jurisdiction to entertain the claim and lastly seeks for the dismissal of complaint against opposite party No.3.

7. In support of their case the opposite parties relied on the following documents viz., (1) memorandum of understanding between OP.No.2 and 4 dated 01-01-2001, (2) public intimation dated 17-07-2001 of OP.No.4, (3) letter dated 17-07-2001 of OP.No.4 to OP.No.2, (4) authorization letter dated 09-08-208 of OP.No.2 to OP.No.1., besides to the sworn affidavit of opposite party No.1 and 3 in reiteration of their written version averments and the above documents are marked as Ex.B1 to B4 for its appreciation in this case and replies to the interrogatories exchanged.

8. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties ?.

9. It is the simple case of the complainant that he is the member of opposite parties 1 and 2 club, and the members of opposite parties 1 and 2 club are covered under Janatha Personal Accident Policy for Rs.5,00,000/- issued by opposite party No. 4 and the complainant is covered under the said policy and a policy bond vide Ex.A1 was issued by opposite party No. 4 to the complainant . On 18-04-2007 the complainant met with an accident and his right hand was amputed upto shoulder . As per the policy terms and conditions , if a policy holder lost one entire hand , 50% of the assured amount shall be paid by the opposite party No. 4 to the complainant . The complainant put forth a claim with opposite party No. 2 and opposite party No. 2 forwarded the same to opposite party No. 4 vide Ex.A4. The Ex.A4 is the letter dated 13-07-2007 of opposite party No. 2 addressed to opposite party No.4, where in , it forwards the claim form submitted by the complainant along with all required documents to opposite party No. 4 and requests to process the claim. Thereafter, the complainant addressed letter dated nil and dated 12-12-2007 vide Ex.A5 and A6 to opposite party No.4 the same grievances as to the accident he met on 18-04-2007 and lost his right hand up to shoulder and requests to settle the claim as early as possible. The opposite party No. 4 replied vide Ex.A7 . The Ex.A7 is the reply of opposite party No. 4 to the complainant dated 18-12-2007, where in the complainant is requested to submitted certain documents. The complainant vide Ex.A8 dated 27-03-2008 complied the said requirements and further requests to settle the claim.

10. The opposite party No. 4 again on 04-04-2008 addressed a letter to the complainant stating that they have noticed a major discrepancy /irregularities in the documents i.e, the complainant got fractured on right hand on 18-04-2007 and was admitted in Government General Hospital, Kurnool on 18-04-2007 and discharged on 19-04-2007 . Where as the admission by the complainant in Yashodha Hospital , Hyderabad is on 18-04-2007 , and request to clarify the discrepancy. The complainant vide Ex.A10 dated 18-04-2008 and Ex. A11 dated 02-05-2008 replied to the discrepancy raised by the opposite party No. 4 . The Ex.A10 and A11 clarifies that in the charge sheet ( Ex.A3) the complainant was referred as LW.1 and one Bodda Polaiah was referred as LW.2 and it is stated in para 2 of said charge sheet that on 18-04-2007 LW.1 and LW.2 sustained injuries to the right hand and were admitted in Government General Hospital , Kurnool and LW.1 got discharged from the hospital and taken away to Hyderabad for better treatment, where his fractured right hand was amputed. The LW.2 after taking treatment was discharged on 19-04-2007 from the above it is clear that discharge date of 19-04-2007 is concerned to LW.2 Bodda Polaiah and not that of complainant , hence there is no discrepancy or ambiguity with regard to the discharge of complainant from Government General Hospital, Kurnool.

11. The query raised in Ex.A9 by opposite party No. 4 was answered by the complainant in Ex.A10 and A 11 as to the mistaken view taken by the opposite party No. 4 .In spite of that clarification there was no response from the opposite party No.4 to the complainant . The opposite party No. 4 who raised the query in Ex.A9 remained exparte to the case proceeding and the same is not being disputed by opposite party No. 4 by any contest and hence they remain un-rebuttal , there by there remaining any denial to Ex.A10 & A 11. Hence there are admitted.

12. From the above discussion, it is clear that the complainant clarified query raised by the opposite party No. 4 and thereafter there was no response from the opposite party No. 4 to reminder letter dated 10-06-2008 and 02-07-2008 vide Ex.A12 & A13. Hence there is clear deficiency of service on part of opposite party No. 4 and the complainant is certainly remaining entitled to the relief claimed.

13. Now the point is to what relief the complainant is entitled to :- The complainant in this case claimed Rs.2,50,000/- i.e, 50% of the assured amount under the policy in Ex.A1/A16 , as the complainant lost his entire right hand. The disability suffered by the complainant is not disputed by the opposite parties by placing any relevant cogent material on record. Therefore , under the Ex. A2 disability certificate, the disability to the complainant remaining proved. Hence, the complainant is remaining entitled to 50% of assured amount as per Clause 2.8 of terms and conditions on reverse of Ex.A16 policy ,in case of physical separation of one entire hand , the entitled amount is 50% of sum assured. 14. The opposite party No. 3 in its written version averments taken a defense in support to opposite party No. 4 that , the complainant did ;not respond to Ex.A9 properly , this defence appears to be baseless as any cogent material is placed in support of opposite party No. 3’s contention , as to non response of complainant in respect of Ex.A9’s contention.

15. The other plea taken by opposite party No. 3 is that this forum has no jurisdiction to entertain this complaint of the complainant , but no material is filed by opposite party No. 3 as to the excluding the jurisdiction of this forum . Hence, this plea of the opposite party No. 3 is also rejected.

16. To sum up, the complainant is perfectly remaining entitled to the 50% of sum assured as per Clause 2.8 of terms and conditions i.e, Rs.2,50,000/- and the said amount has to be paid by opposite parties No.3 and 4 to the complainant along with compensation of Rs.20,000/- for suffered mental agony at the deficient conduct of opposite parties 3 and 4 is not settling the claim and Rs.5,000/- as costs of the case as the opposite party No. 3 and 4 driven the complainant to the forum for reliefs. As no case is made out against opposite parties 1 and 2 case against opposite parties 1 and 2 is dismissed.

17. In the result, the complaint is dismissed against opposite parties 1 and 2 and allowed against opposite parties 3 and 4 , directed opposite parties 3 and 4 to pay to the complainant the 50% of assured amount i.e., Rs.2,50,000/- along with Rs.20,000/- as compensation for mental agony and Rs.5,000/- costs of the case, within one month from the date of receipt of this order. In default the opposite parties 3 and 4 shall pay the above award with 12Percent interest from the date of default till realization .

Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 17th day of April, 2009.

     Sd/-                                                                                                                                                                  Sd/-   

MEMBER                                                                                                                                                   PRESIDENT

APPENDIX OF EVIDENCE

Witnesses Examined

For the complainant :Nil                                                                              For the opposite parties :Nil

List of exhibits marked for the complainant:-

Ex.A1.   Xerox copy of policy No.100300 /47/01/ 96000022/03/96/30387.

Ex.A2. Xerox copy of disability certificate of the complainant .

Ex.A3. Xerox copy of charge sheet in Cr.No.61/07 of Kurnool Taluk, P.S.

Ex.A4. Letter dated 13-03-2007 of OP.No.2 to OP.No.4.

Ex.A5. Letter of complainant to OP.No.4 along with postal receipt and acknowledgement.

Ex.A6. Letter dated 12-12-2007 of complainant to OP.No.4 along with courier receipt.

Ex.A7. Letter dated 18-12-2007 of OP.No.4 to complainant.

Ex.A8. Letter dated 27-03-2008 of complainant OP.No.4 along with courier receipt.

Ex.A9. Letter dated 04-04-2008 of OP.No.4 to complainant.

Ex.A10. Reply to Ex.A9 along with courier receipt and acknowledgement.

Ex.A11. Letter dated 02-05-2008 of complainant to OP.No.4

Ex.A12. Letter dated 10-06-2008 of complainant to OP.No.4 along with courier receipt.

Ex.A13. Letter dated 02-07-2008 of complainant to OP.No. 4 along with postal receipt.

Ex.A14. Acknowledgements for Ex.A13.

Ex.A15. Acknowledgements for Ex.A13.

Ex.A16.Xerox copy of policy along with letter conditions. No.100300/47/01/96000022/03/96/30387.

List of exhibits marked for the opposite parties:

Ex.B1. Memorandum of understanding between OP.No. 2 and 4 dated 01-01-2001.

Ex.B2. Public intimation dated 17-07-2001 of OP.No.4.

Ex.B3. Letter dated 17-07-2001 of OP.No. 4 to OP.No.2.

Ex.B4. Authorization letter dated 09-08-2008 of OP.No.2 to OP.No.1

         Sd/-                                                                                                                                                             Sd/-

   MEMBER                                                                                                                                               PRESIDENT

// Certified free copy communicated under Rule 4 (10) of the

A.P.S.C.D.R.C. Rules, 1987//

Copy to:-

Complainant and Opposite parties

Copy was made ready on :

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