Complaint filed on: 07-11-2017
Disposed on: 28-05-2018
BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM,
OLD DC OFFICE COMPOUND, TUMAKURU-572 101
CC.No.101/2017
DATED THIS THE 28th DAY OF MAY 2018
PRESENT
SMT.PRATHIBHA. R.K. BAL, LLM, PRESIDENT
SRI.BALAKRISHNA V.MASALI, MEMBER
Complainant: -
Muralidhar.B,
S/o. late Badappa,
Aged about 62 years,
Residing at Ojugunte,
Kotta post, Kasaba hobli, Sira taluk, Tumakuru district
(In person)
V/s
Opposite parties:-
- HDFC ERGO General Insurance Co. Ltd, Registered and corporate office, 6th floor, Leela Business park, Anderi, Kurla road, Anderi (East), Mumbai -59
- The Sr. Manager, Service centre, (Health Claims Services) HDFC ERGO General Insurance Co. Ltd. No.25/1, 2nd floor, building no.2, Shankaranarayana building, MG Road, Bengaluru
- The Manager,
HDFC Bank, BH Road, Tumakuru
(OP No.1 and 2 by advocate Sri.B.K.Chandrashekaraiah)
(OP No.3- Exparte)
ORDER
SMT.PRATHIBHA. R.K. PRESIDENT
This complaint is filed by the complainant against the OP No.1 to 3, under section 12 of the Consumer Protection Act, 1986. The complainant prays to direct the OP No.1 to 3 to pay compensation of Rs.15,00,000=00 along with 18% interest per annum and grant such other relief as prayed in the complaint, in the interest of justice and equity.
2. The brief facts of the complaint is as under.
The complainant has obtained Sarv Suraksha Policy No.2950201173653900000 from the OPs Insurance Company by paying premium amount of Rs.2483=00. The above said policy was valid from 10-9-2015 to 9-2-2017.
The complainant submitted that, on 6-11-2015 he met with an accident and he was admitted to the Forties Hospital, Nagarabhavi, Bengaluru for 15 days. And taken six months treatments in the above said hospital as an out-patient. The complainant further submitted that, for the above said treatment he was spent nearly Rs.10,00,000=00. After taken treatment the complainant submitted a claim form before the OPs Insurance Company by claiming 100% compensation for the complete removal of lower jaw as per the personal accident table benefits-A. And the complainant has also claimed for loss of hearing on both ears. Hence, the complainant has claiming 100% compensation as per the table benefits-A.
The complainant further submitted that, the OPs Insurance Company have not paid the full amount of hospital charges. In this regard, the complainant has approached the OPs on several times, but the OPs have paid only Rs.3,50,000=00 to the complainant’s account No.7402500100043601 in Karnataka Bank, Sira branch. The complainant further submits that, the OPs have not paid the full amount of the insured amount of Rs.15,00,000=00 to the complainant. Hence, the complainant has come up with the present complaint.
3. After service of the notice, the OP No.1 and 2 have appeared through this counsel and filed common objection. The OP No.3 did not appear before the form and he was called out absent and he has been placed ex-parte.
4. In the version, the OP No.1 and 2 contended that, the complaint is not maintainable either in law or on facts and it is liable to be dismissed in limine. The OPs denies allegations made in the complaint, except those which are expressly admitted.
The OP No.1 and 2 submitted that, the policy bearing No.2950201173653900000 is a Sarv Suraksha policy and the said policy was valid from 10-9-2015 to 09-2-2017 which was issued to the complainant.
The OP No.1 and 2 submitted that, the OPs have not liable to pay the claim is one being double claim as the complainant has already filed claim application for the injuries suffered in the alleged accident dated 6-11-2015 in MVC 1349/15 before the Sr.Civil Judge and MACT, Sira. The complainant has produced claimed medical bills incurred for the treatment taken and the Hon’ble Tribunal considering the medical bill produced, award the compensation to the complainant under all the heads provided under the IMV Act. Therefore the complainant is not entitled to claim medical expenses incurred again. Once claimed already in MVC 1349/15 before the Sr.Civil Judge and MACT Sira and award passed by Tribunal has been satisfied by the insurer of the offending vehicle. As such the claim being double claim, hence the complaint is liable to be rejected against the OPs.
The OP No.1 and 2 further submitted that, the complainant has earlier produced a permanent total disablement certificate issued by forties hospital through Dr.Mahesh.A who had assessed the disability at 30%. The complainant the further obtained a revised disability certificate dated 18-2-2016 from Govt. General Hospital, Sira issued by District Surgeon Dr.S.Sridhara. The OP No.1 and 2 have assessed the disability on the medical records of forties hospital, Bengaluru i.e. 55% disability for the whole body. The company considered the said disability certificate. The amount was remitted to the complainant account No.7402500100043601 Karnataka Bank on 26-1-2016. Hence, the complainant cannot make any additional claim and the said complaint is liable to be dismissed against the OP No.1 and 2. The OP No.1 and 2 are denies all allegations made in the complaint in toto. The OP No.1 and 2 are denies that the complainant suffering from mental shock and agony apart from loss of income incurred and unable to discharge his duty as he was discharging earlier and permanently disabled from hearing as the ear is un hearing properly in discharge his profession. Hence, the complaint is liable to be rejected and there is no deficiency in service on the part of the OP No.1 and 2. Hence the OP No.1 and 2 have prayed to dismiss the complaint with cost, in the interest of justice and equity.
5. In the course of enquiry in to the complaint, the complainant and OP No.1 and 2 have filed their affidavit evidence reproducing what they have stated in their respective complaint and objection. The complainant has produced document which were marked as Ex-C1 to C6. We have heard the arguments of both parties and we have gone through the oral and documentary evidence of both sides meticulously.
6. Based on the above materials, the following points will arise for our consideration.
- Whether the complainant has proved there is deficiency in service on the part of the OPs?
- What Order?
7. Our findings on the above points are;
Point no.1: In the negative
Point no.2: As per the final order below
REASONS
8. On perusal of the averments of the complaint, objection of the OPs and affidavit evidence of both parties, it is an admitted fact that, the complainant obtained Sarv Suraksha policy No.295020117363900000 from the OP No.1 and 2 Insurance Company by paying premium amount of Rs.2,483=00 and the said policy was valid from 10-9-2015 to 09-02-2017. It is also an admitted fact that, at the time of accident, the said policy was in force. The complainant has claimed 100% compensation for the complete removal of lower jaw and loss hearing 75% as per the personal accident table benefits-A. To substantiate the above said facts, the complainant has produced Ex-C1 to C6.
9. Per-contra, the OP No.1 and 2 submitted that, the complainant has filed MVC No.1349/15 before the Sr. Civil Judge at MACT, Sira. The complainant by producing medical bills claimed the amount. Considering the said medical bills, the Hon’ble Tribunal has passed an order under all the heads provided under MVC Act including disability heads. Hence, the complainant is not entitled for the above said amount. As such, the claim is one being double claim and the complainant again claimed by producing another doctor certificate, who is not the doctor treated to the complainant. Hence, the complainant is not entitled for claiming the amount.
10. On perusal of the documents produced by the complainant i.e. Ex-C-6/MVC No.1349/2015 filed before the Sr. Civil Judge and Addl. MACT at Sira. In the above said MVC case, the OPs are not party in the said case. The complainant has claimed an amount against the New India Assurance Co. Ltd and Balaraju S/o. Papanna. The Hon’ble Sr.Civil Judge and Addl. MACT at Sira have passed an order against these two persons and not against the OP No.1 and 2. Moreover, the complainant is claiming in this complaint for his personal accident claim against the HDFC Agro Gen. Insurance Co. Ltd. i.e. OP No.1 and 2 for “removing of lower jaw and loss of hearing of both ears”. The complainant is not claiming the medical bill amount.
11. The second contention raised by the OP No.1 and 2 stating that, Dr.Mahesh.A who assessed the disability at 30%. Further the complainant obtained revised disability certificate dated 18-2-2016 from the Govt. Hospital, Sira issued by the District Surgeon Dr.S.Sreedhar. Based on the medical records of Fortis Hospital, Bengaluru assessed the disability at 55% for the whole body and considering the said disability certificate toward permanent total and partial disability, the OP No.1 and 2 have paid Rs.2,75,000=00. Hence the complainant cannot made additional claim in this regard.
12. The complainant in his affidavit stated that, the OP No.1 and 2 have paid Rs.3,50,000=00 to the complainant’s account No.740250010004361601. Further the OP No.1 and 2 have also submitted in their affidavit stating that, they have paid the permanent total and partial disability of Rs.,2,75,000=00. Of-course the OP No.1 and 2 have paid the amount to the complainant towards permanent total and partial disability. Once, the OP No.1 and 2 have paid the amount under permanent total and partial disability heads, the complainant once again cannot claim the amount under the same benefit. Hence, we do not find any good grounds to allow the present complaint. Accordingly, we answer this point in the negative. In the result, for the foregoing reasons, we proceed to pass the following order;
ORDER
The complaint filed by the complainant is hereby dismissed. No cost.
Supply free copy of this order to both parties.
(Dictated to the Stenographer, got it transcribed and corrected, pronounced in the Open forum on this, the 28th day of May 2018).
MEMBER PRESIDENT
