Haryana

StateCommission

A/715/2018

CHOLAMANDALAM MS GEN.INSURANCE CO. - Complainant(s)

Versus

MUKESH KUMAR MUDGIL - Opp.Party(s)

RAJNEESH MALHOTRA

08 Apr 2019

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

 

                                                                                   

First Appeal No :  715 of 2018

Date of Institution: 01.06.2018

Date of Decision : 08.04.2019

 

 

 

Cholamandalam MS General Insurance Company Limited, through its Manager, 2^nd Floor, “Dare House”, NSC Bose Road, Chennai-600001.

                                      Appellant-Opposite Party

Versus

 

 

 

 

Mukesh Kumar Mudgil son of Shri Ram Niwas, resident of House No.270, Village Para, Rishi Nagar, Ladhor Road, Rohtak, Haryana. 

 Respondent-Complainant

 

 

 

 

CORAM:             Hon’ble Mr. Justice T.P.S. Mann, President.

                             Shri Diwan Singh Chauhan, Member                      

 

 

Argued by:          Shri Rajneesh Malhotra, counsel for the appellant-opposite party.

                             Shri Hemen Aggarwal, counsel for the respondent-complainant

                            

                                                   O R D E R

 

T.P.S. MANN J.

 

          The opposite party has filed the instant appeal against the order dated 22.02.2018 passed by learned District Consumer Disputes Redressal Forum, Rohtak whereby complaint filed by the complainant under Section 12 of the Consumer Protection Act, 1986 was allowed and he was awarded Rs.9,00,000/- towards disability, Rs.50,000/- for hospitalization after deducting Rs.1,25,000/- already received by him from the opposite party i.e. Rs.8,25,000/- alongwith interest @ 9% per annum from the date of filing the complaint till its realization besides Rs.10,000/- as compensation and Rs.5,500/- as litigation expenses.

2.      According to the complainant, he had insured himself with the opposite party under Group Personal Accident Master Policy for the period from 24.10.2013 to 23.10.2014.  The assured amount in case of permanent disability was Rs.10,00,000/-, permanent partial disability Rs.2,50,000/-, accidental hospitalization Rs.50,000/- and education benefit Rs.25,000/-.  He met with an accident on 05.06.2014. FIR was lodged at Police Station Sadar, Rohtak as he had sustained serious and grievous injuries.  He had become permanently disabled, which was assessed as 90% by the Medical Board on account of amputation below knee, fracture of right lower limb, bone left side forearm with the implant in SITU with stiffness left side wrist and hand with sensory loss of left hand and in this way, his earning capacity reduced to zero.  The complainant was entitled to receive an amount of Rs.9,50,000/- as compensation.   The opposite party sent a cheque dated 06.02.2015 for an amount of Rs.1,25,000/- as part payment but it was in violation of the terms and conditions of the policy and also provisions of law.  The opposite party was liable to pay the amount of Rs.9,50,000/- to the complainant, who had already submitted the required documents pertaining to medicines and treatment.  He requested the opposite party time and again to pay the balance amount of compensation.  However, the opposite party assured him that the balance amount would be disbursed shortly but it avoided the payment on one pretext or the other. Hence, the complaint.

3.      Upon appearance, the opposite party filed the written version stating therein that the complainant had concealed and suppressed material and relevant facts.  The sum assured for the permanent disability was not Rs.10,00,000/- but was Rs.2,50,000/- only and in the present case, the leg below knee had been amputated and accordingly, the complainant was compensated for 50% of the same i.e. Rs.1,25,000/-.  The complainant was not entitled to get any claim and compensation as prayed from the opposite party and therefore the complaint was liable to be dismissed with costs.

4.      As mentioned above, learned District Forum allowed the complaint and awarded various sums of money to the complainant.

5.      The State Commission has heard learned counsel for the parties and perused the impugned order besides going through the evidence.

6.      The opposite party has taken the stand that it was a case of partial disability and as such, he was entitled to receive Rs.1,25,000/- only.  The disability had been caused by accident as there was amputation of one leg, the disability was put as 90%.  Therefore, it being a case of total/permanent disability, the complainant was rightly awarded Rs.9,00,000/- and Rs.50,000/- for hospitalization.  An amount of Rs.1,25,000/- has been ordered to be deducted as the complainant had already received the same.

7.      In view of the above, no fault can be found with the impugned order passed by the learned District Forum.  The appeal is devoid of any merit and therefore dismissed.

8.      The statutory amount of Rs.25,000/- deposited by the appellant at the time of filing the appeal be released in favour of the complainant against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any. 

 

Announced 08.04.2019

(Diwan Singh Chauhan) Member

(T.P.S. Mann) President

UK