This is a complaint U/s 12 of the Consumer Protection Act, 1986 with the prayer for an order directing the O.P. No. 1 & 2 to pay of sum assured of Rs.2,40,000/- as 60% disablement of total sum assured of Rs.4,00,000/-  along with interest @ 10% p.a. , to pay compensation of Rs.25,000/-, litigation cost of Rs.5,000/- and any other reliefs to the complainant.

The complaint case in short is that the complainant purchased a Janata Personal Accident Insurance Policy under the O.P. No. 1 and 2, National Insurance Company through O.P.No.3 vide policy No. 100300/47/01 /9600022/02/96/30406, valid from 01.03.2003 to 28.02.2018, sum assured of Rs.4,00,000/-. On 13.05.2010 during the policy coverage period the complainant faced an accident and received injury of electrocution. He was at first admitted at local hospital and thereafter to another hospital. Due to the above accident his left hand was imputed. He appeared before a Medical Board and the Board observed that the complainant has suffered 60% disablement. So, he claimed insurance amount with submission of necessary documents before the insurance company, but the insurance company made no payment till date rather by sending letter, insurance company repudiated his claim without any valid ground. So, finding no other alternative to get relief from the O.P./ insurance company , the complainant filed this case before this forum.                                          

On the other hand, in spite of receiving notice, the O.P. No.1 has not appeared in this case. So, this case is heard ex-parte against the O.P. No.1 and the O.P. No.2 by filing W.V. has contested this case with formal denial and prays for dismissal of the petition of the complainant with cost.  The O.P. No. 3 has contested this case and cross examined of the P.W.-1.

To establish the case, the complainant has relied upon an affidavit-in-chief sworn by him as P.W.1 along with documents and he also examined and cross examined.

DECISIONS WITH REASONS

Giving due consideration to the contents of the complaint petition, documentary evidence on record, hearing, argument advanced by the lawyers of both sides, the Ld. Forum has come to the findings as follows: -

It is admitted fact that the complainant has a policy holder under the O.P./ insurance company vide policy No. 100300/47/01/9600022/02/96/30406, valid from 01.03.2003 to 28.02.2018, sum assured of Rs.4,00,000/- and he was a victim of an electrocution occurred on 13.05.2010 during the policy coverage. The photocopy of the documents insurance policy and GD also supported the above fact. After accident the complainant by sending letters on 06.08.2013, 15.01.2015, 30.07.2015 etc. informed the matter to the O.P./ insurance company and also submitted claim Form with necessary documents before the O.P. to get payment. It also admitted that after accident the complainant as well as victim suffered 60% permanent disability. From the disability certificate filed by the complainant also proved that the complainant after the accident his left hand was amputed and the Medical Officers, who are on the board had opined that Ashis Kumar Das, the victim suffered 60% permanent disability. But, from the letters dated 29.01.2015 & 04.12.2015 issued by the O.P./ insurance company to the complainant it has been revealed that O.P./ insurance company repudiated his claim.

Now what we get that the accident is admitted, it also admitted that the complainant was a victim of said accident and consequently the victim suffered 60% permanent disability. So, the main question is that whether the complainant is entitled to claim a sum of Rs.2,40,000/- against the O.P./ insurance company out of total sum assured Rs.4,00,000/-. As per the condition of the policy in question the full reimbursement of the sum assured is only made in case of death, but in cases the proportionate reimbursement of the sum assured is made according to the gravity of the injury suffered by the victim. Here in our case we do find that left hand of the complainant was amputed and Medical Officers who are on the board had opined that the complainant, Ashis Kumar Das suffered 60% permanent disability. Ld. lawyer of the complainant referred to the relevant schedule of the Work-men’s Compensation Act, 1923 and it further submits that the case of the complainant comes under Scheduled I, Part II, Serial No.4 which provides that loss of a hand or of the thumb and four fingers of one hand or amputation from (11.43 cms) below tip of olecranon; percentage of loss of earning capacity is 60%. In our case we also find that the complainant suffered such amputation as described in the Disability Certificate that the percentage of disability is calculated is 60% permanent. So, in our view the complainant has suffered 60% permanent disability that is his loss is 60% of his earning capacity as per the Schedule I, Part II, Serial No.4. The sum assured of Rs.4,00,000/- and out of this Rs. 4,00,000/-he is entitled to claim reimbursement of its 60% i.e. Rs.2,40,000/- in our considerate view.

Fees paid are correct.

Hence, it is

ORDERED,

That the consumer complaint being No. CC - 25/16 be and the same is allowed on contest without cost against the O.P. No. 1 and 2 and dismissed on contest against the O.P. No. 3.

The complainant do get an order of 60% of sum assured i.e Rs.2,40,000/-out of total sum assured of Rs.4,00,000/- and also compensation of Rs.3,000/- for harassment and mental pain together with litigation cost of Rs.2,000/- against the O.P. Insurance Company, which is in total of Rs.2,45,000.00/- (Rupees two Lakh forty-five Thousand) only and be paid within one month from the date of passing of this order; failing which the awarded amount will carry interest @ 9% p.a. till full realization; otherwise the complainant will be at liberty to realize his claim in accordance with law.

Let copies of this order be supplied to the parties free of cost.