BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL
FORUM, FEROZEPUR.
C.C. No.258 of 2014
Date of Institution: 4.7.2014
Date of Decision: 24.12.2014
Varinder Kumar son of Mulkh Raj, resident of Village Gidderan Wali, Tehsil Abohar, District Fazilka.
....... Complainant
Versus
Iffco Tokio Insurance Company, Office at Gaushala Road, Abohar, Tehsil Abohar, District Fazilka, through its Area Manager Roshan Lal Sethi.
........ Opposite party
Complaint under Section 12 of the Consumer Protection Act, 1986.
* * * * *
PRESENT :
For the complainant : Sh. Vishal Arora, Advocate
For the opposite party : Sh. J.S. Kamboj, Advocate
QUORUM
S. Gurpartap Singh Brar, President
S. Gyan Singh, Member
ORDER
GURPARTAP SINGH BRAR, PRESIDENT:-
Brief facts of the complaint are that in the month of January 2008, the complainant had purchased bags of fertilizer from Iffco Center, Abohar and on purchase of the said bags, accidental insurance of Rs.1,00,000/- was provided to the complainant. On 4.2.2008, the complainant received severe injuries in a road accident and he remained admitted in the I.C.U. for a period of one year. Right leg of the complainant
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has been amputated. Approximately twenty five operations have been conducted on the person of the complainant and he has spent about Rs.32,00,000/- on his treatment. An FIR No.12 dated 5.2.2009 was also registered in Police Station, Khuian Sarvar regarding the said accident on the statement of the complainant after a period of one year. The complainant had approached the opposite party for accidental claim in the year 2010 and the then Area Manager of the Insurance Company got signatures of the complainant on blank printed proformas for disbursement of the amount of accidental claim and also he also collected bill, policy and other documents on the pretext that he will forward the accident claim to the Head Office, but the accident claim has not been paid to the complainant. The complainant also moved applications in July 2010 in this regard, but without any result. The complainant approached and requested the opposite party many a times to pay the accident claim, but no claim has been paid to the complainant. The complainant is being harassed at the hands of the opposite party. Hence this complaint for a direction to the opposite party to pay the amount of accident claim along with interest, with Rs.50,000/- as compensation for harassment and mental agony.
2. Upon notice, the opposite party appeared and filed its written reply to the complaint, wherein it has been pleaded that the
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opposite party is having collaboration with the IFFCO Fertilizer to protect the farmers and the opposite party launched Sankat Haran Gramin Bima Yojana Scheme. Under this scheme, one “Sankat Haran” bima cover for Capital Sum Insured of Rs.4000/- per each and every purchase of IFFCO Fertilizer bag by any farmer, subject to total maximum capital sum insured of Rs.1,00,000/- to one farmer under this policy. As per the policy, in case of bodily injury, which solely and directly causes insured person death, loss of limb or permanent total disablement within 12 months of injury, then the opposite party pays 100% of capital sum insured i.e. Rs.4000/- of per bag upto the maximum limit of Rs.1,00,000/- i.e. total 25 bags in case of death to the insured person or his nominee and in case of loss of sight (both eyes, loss of two limbs, loss of one limb and one eye) 50% of the capital sum insured. Moreover, in case of loss of sight of one eye or loss of one limb, 25% of the capital sum insured and further permanent total and absolute disablement resulting solely due to an accident, 50% of the capital sum insured. Further it has been pleaded that as per Clause-C (5) of the general conditions of the policy, an event, which might become a claim under the policy, must be reported to the opposite party immediately and in case within one month of the happening of such event. However, in the case of death, written notice must also be given before internment/cremation unless reasonable cause is shown for not doing so. For claim purpose in case of
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injury, Claim Form, Purchase Bill in original, Copy of FIR, if any, Photograph and Medical Certificate from Government Hospital doctor confirming extent of disability are to be submitted. All the terms and conditions were duly supplied to the insured and he is very well aware about the same. The complainant did not give any information regarding the alleged accidental injury to the opposite party. Other allegations of the complaint have been denied and dismissal of the complaint has been prayed for.
3. Learned counsel for the complainant tendered into evidence Ex.C-1 to Ex.C-37 and closed evidence on behalf of the complainant. On the other hand, learned counsel for the opposite party tendered into evidence Ex.OP-1/1 to Ex.OP-1/2 and closed evidence on behalf of the opposite party.
4. We have heard the learned counsel for the parties, considered the written arguments filed by the complainant and have also gone through the file.
5. The grievance of the complainant is that he had purchased bags of fertilizer from the IFFCO Center, Abohar in the year 2008 and as per the scheme, he was covered for an accidental claim benefit of
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Rs.1,00,000/-; he met with a major accident on 4.2.2008 and remained under treatment for a long period in various hospitals and became physically handicapped to the extent of 95%, but the opposite party has not made the payment of insurance claim despite submission of all the required documents to the opposite party. The factum regarding purchase of the bags of fertilizer by the complainant from IFFCO Center has not been specifically denied by the opposite party. The opposite party has also pleaded in its written reply that all the terms and conditions of the policy were duly supplied to the insured. The pleadings of the opposite party itself reveal that the complainant was insured with the opposite party for purchase of bags of fertilizer. The opposite party has pleaded that the complainant did not give any information regarding the accidental injury as required under Clause-C (5) of the terms and conditions of the policy. The opposite party has placed on the file copy of terms and conditions of Sankat Haran (Kisan Gramin Bima Yojana) as Ex.OP-1/2 and a perusal of its Clause-C (5) (b) reveals that in case of injury claim, Claim Form, Purchase Bill in original, Copy of FIR, if any, and Photograph and Medical Certificate from Government hospital doctors confirming extent of disability are to be furnished to the opposite party and claim must be reported to the opposite party immediately and in any case within one month of the happening of such event. The complainant has specifically
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pleaded in para No.4 of the complaint that the Company got signatures of the complainant on blank printed proformas for disbursement of the amount of accidental claim and also he also collected purchase bill, policy and other documents on the pretext that he will forward the accident claim to the Head Office. The complainant has also placed on the file copy of FIR No.12 dated 5.2.2009 as Ex.C-5, copy of Certificate For The Physically Handicapped issued by Chief Medical Officer, Civil Hospital, Abohar as Ex.C-6. So far as delay in giving intimation and submission of claim is concerned, a perusal of copy of FIR Ex.C-5 and report of Additional Deputy Commissioner dated 9.11.2012 Ex.C-12 reveals that the complainant remained under treatment for accidental injuries for a long period in various hospitals and he has become physically handicapped to the extent of 95% as per the disability certificate issued by Chief Medical Officer, Civil Hospital, Abohar Ex.C-6. This fact is also very much clear from the medical record of various hospitals regarding admission and treatment of the complainant for accidental injuries placed on the file by the complainant as Ex.C-3, Ex.C-4 and Ex.C-14 to Ex.C-37. Therefore, the complainant has sufficient cause for not submitting the claim to the opposite party in time. Having sufficient cause with the complainant, the delay in filing the present complaint was also condoned by this Forum vide order dated 18.7.2014. Moreover, as per the instructions issued by the
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IRDA vide Circular NO.IRDA/HLTH/MISC/CIR/216/09/2011 dated 20.9.2011, the insurers must not repudiate such claims unless and until the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time. In “Reliance General Insurance Company Limited Versus Sri Avvn Ganesh”, 2012 (1) CPC 681 (NC), on the death of the insured claim was repudiated only on the ground that intimation of death was given after four months against period of one month and the Hon’ble National Commission, New Delhi has held that delay cannot be a cause of repudiation of a valid claim. Therefore, the claim of the complainant on account of his accidental injuries is liable to be considered by the opposite party, which has not been settled/paid so far by the opposite party to the complainant. As per Clause ‘A.5.’ of the terms and conditions of the Sankat Haran (Kisan Gramin Bima Yojana) Ex.OP-1/2, under heading Capital Sum Insured, it has been provided that one SANKAT HARAN Bima cover for Capital Sum Insured of Rs.4000/- for each and every purchase of IFFCO Fertilizer bag by any farmer subject to Total Maximum Capital Sum Insured of Rs.1,00,000/- to any one farmer under this Policy and Policies to be issued in future under the same scheme during the period of insurance. Clause ‘A.5.B.’ of these terms and conditions provides table of benefits to be paid to the insured persons of different percentage/categories of disability. As per Certificate for the
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Physically Handicapped issued by Chief Medical Officer, Civil Hospital, Abohar Ex.C-6, complainant Varinder Kumar has become permanent disable to the extent of 95%. However, the complainant has neither alleged nor produced any evidence that as to how much bags of fertilizer were purchased by him from IFFCO Center, Abohar. Therefore, in the absence of exact quantity of bags of fertilizer purchased by the complainant, net amount payable to the complainant under the policy cannot be assessed. Therefore, it would be appropriate to direct the opposite party to pay the insurance claim to the complainant admissible under the “Sankat Haran” policy taking into consideration the number of bags of fertilizer purchased by the complainant from IFFCO Centre, Abohar as per their record as well as taking into consideration percentage disablement suffered by the complainant as per Certificate dated 9.6.2010 Ex.C-6 issued by the Chief Medical Officer, Civil Hospital, Abohar.
6. In view of what has been discussed above, this complaint is accepted and the opposite party is directed to pay the amount of insurance claim to the complainant admissible under the “SANKAT HARAN” (Kisan Gramin Bima Yojana) policy taking into consideration the number of bags of fertilizer purchased by the complainant from IFFCO Centre, Abohar as per their record as well as taking into consideration percentage of disablement suffered by the complainant as per Certificate dated
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9.6.2010 Ex.C-6 issued by the Chief Medical Officer, Civil Hospital, Abohar, with interest at the rate of 9% per annum from the date of filing the present complaint i.e. 4.7.2014 till realization. Since Shri Vishal Arora, Advocate was appointed as counsel for pursuing the present complaint on behalf of the complainant and his fee of Rs.3300/- was paid from Legal Aid account of this Forum, the opposite party is also directed to deposit a sum of Rs.3300/- as litigation expenses in the Legal Aid Account of this Forum. This order is directed to be complied within a period of 30 days from the date of receipt of copy of this order. File be consigned to record room.
Announced
24.12.2014
(Gurpartap Singh Brar) President
(Gyan Singh) Member
