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
Wednesday the 22nd day of October , 2008
C.C.No. 59/08
Between:
K. Subramanyam, S/o. K. Dharmaiah,
H.No.1-51, Kothur Village, Mahaboobnagar, Now residing at H.No.62/236, Fort, Kurnool.
… Complainant
Versus
1. National Insurance Company Limited, Represented by its Divisional Manager,
Division - III Shakesphere Sarani, 6th Floor, Kolkta.
2. National Insurance Company Limited, Represented by its Branch Manager,
3. Tula Complex, Gandhi Nagar, Kurnool.
4. Golden Multi Services Club Limited, Represented by its Director,
S.B. Monsoon, 16, R.No. Mukharjee Road, Kolkta - 700 001.
4. Golden Multi Services Club Limited, Represented by its Branch In - charge,
U-con Plaza, III - Floor, Kurnool.
… Opposite parties
This complaint is coming on this day for orders in the presence of Sri. P.Siva Sudharshan, Advocate, for the complainant, and Sri. L. Hari Hara Nath Reddy, Advocate for opposite party No.1 and 2 and Sri. M. Azmathulla, Advocate for opposite party No.3 and upon perusing the material papers on record, the Forum made the following .
ORDER
(As per Smt. C. Preethi, Lady Member)
C.C.No.59/08
1. This consumer complaint of the complainant is filed U/S 12 of C.P.Act seeking direction on opposite parties to pay Rs.1,50,000/- with 18% interest, p.a. Rs.50,000/- towards compensation for mental agony cost of the complaint and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainant’s case is that the complainant joined as a member with opposite party No.3 through opposite party No.4 and obtained Group Janata Personal Accident Policy bearing No.100300/42/04/8200012 issued by opposite party No.1 for Rs.3 lakhs and the policy commenced from 08-08-2004 to 07-08-2014 . On 6-10-2005 while the policy was inforced the complainant met with accident and was grievously hurt and his right leg up to thigh and right hand were badly injured. Due to the said injuries the complainant lost his livelihood with permanent total disablement. As per the policy terms and conditions the complainant is covered under permanent total disablement . The complainant was under treatment and approached opposite party No.4 on 24-11-2005 and submitted claim form along with required documents. Thereafter, the opposite parties issued a cheque for Rs.1,50,000/- even though the policy is for Rs. 3 lakhs and same was received by complainant under protest on 30-8-2007 . Even though the complainant sustained 80% disability the opposite parties did not settled the claim as per terms and conditions of policy. Hence , the complainant resorted to the forum for reliefs.
3. In support of his case the complainant relied on the following documents viz., (1) Xerox claim form and (2) Xerox copy of medical certificate as to Orthopedically handicapped, besides to the sworn affidavit of the complainant in reiteration of his complaint averments and the above documents are marked as Ex.A1 and A2 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 to 4 appeared through their standing counsel and filed separate written versions.
5. The written version of opposite party No.1 submits that upon happening of any event which may give raise to claim under the policy. A written notice with all particulars must be given to the company immediately and further the claim intimation should be given within 30 days by the claimant to opposite party No.1 through opposite party No.3 and the claim form should be submitted with relevant documents within 90 days from the date of happening of event. And any claims submitted after 90 days shall not be entertained by the opposite party No.1 . The same facts are clearly mentioned in the policy . In this case the complainant did not intimate about the accident within a stipulated time and intimated after four months eight days which is clear violation of terms and conditions of the policy and the opposite party No.1 treated the claim as no claim. Thereafter, the complainant approached Insurance Ombudsman, Hyderabad and the said Ombudsman passed an award dated 23-3-2007 directing opposite party No.1 to condone the delay and settle the claim of the complainant and the opposite party No.1 settle the claim to Rs.1,50,000/- and paid the said amount to the complainant as full and final settlement of the claim and same was accepted by the complainant. This opposite party No.1 settle the claim up to the liability of only 50% of sum insured in case of actual loss by physical separation of one entire hand i.,e amputation of one entire hand . In this case the complainant sustained injuries to his right hand and right leg, therefore, the complainant is entitled to a sum of Rs.1,50,000/- i.e., 50% of sum insured only . Hence , there is no deficiency of service on part of opposite party No.1 and seeks for the dismissal of complaint .
6. The written version of opposite party No.2 submits that this branch did not issue any policy to the complainant and the said policy was issued by opposite party No.1 through opposite party No.3 and 4 and no legal notice was served on this opposite party and the complainant without any proper cause of action filed this complaint against opposite party No.2 and seeks for the dismissal of complaint.
7. The written version of opposite party No.3 and 4 submits that the opposite party No.4 collected premium from its members and forwarded to opposite party No.1 and opposite party No.1 issued certificates to the said effect and as per the said certificate the entire liability is on opposite party No.1. The opposite party No.1 received claim form and documents from the complainant and the same was forwarded to opposite party No.1 as per the policy and requested opposite party No.1 to settle the claim and opposite party No.1 settled and issued a cheque dated 30-8-2007 for Rs.1,50,000/- to the complainant and the complainant received the said amount and no protest was mentioned by the complainant . It further submit that as per the memorandum of understanding dated 2-4-2004 the opposite party No.1 is exclusive and sole authority to settle the claim under the policy and this opposite parties are in no way related and concern in settlement of claim . Hence, there is no deficiency of service on part of this opposite parties and seeks for the dismissal of complaint with costs.
8. In support of their case the opposite parties relied on the following documents viz., (1) Attested copy of bearing No. 100300/42/04/8200012 , (2) attested copy of letter dated 6-12-2006 of opposite party No.1 to complainant (3) award of ombudsman dated 23-3-2007 , (4) attested copy of letter dated 30-8-2007 of opposite party No.1 to complainant , (5) attested copy of receipt dated 30-8-2007 issued by complainant to opposite party , (6) letter dated 5-11-2007 as to the receipt of cheque No.232110 dated 30-10-2007 for Rs.1,50,000/- and (7) memorandum of understanding between opposite parties 1 and 3 , besides to the sworn affidavit of the opposite parties 1 to 4 in reiteration of his written version averments and the above documents are marked as Ex.B1 to B7 for its appreciation in this case and replies to the interrogatories exchanged.
7. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service.
8. It is the case of the complainant, that he has obtained a policy bearing No. 100300/42/04/8200012 vide Ex.B1 for Rs.3,00,000/- from opposite party No.1 through opposite party No.4 . While the policy was in force, the complainant met with accident and was Orthopedically handicapped for 80% as per Ex.A2. The Ex.A2 is the Xerox copy of Medical Certificate issued by Nizam Institute of Medical Services to the complainant ,where in the extent of disability to the complainant was mentioned as 80% . The complainant made a claim with opposite parties and the opposite parties settled the claim for 50% disability for Rs.1,50,000/- . As per the policy conditions mentioned in Ex.B1 100% disability policy holder will be paid the total sum assured of Rs.3,00,000/- and 50% disability policy holders will be paid Rs.1,50,000/-.
9. The complainant in this case suffered 80% disability, as per the policy 50% disability and 100% disability are entitled for compensation . If the complainant suffered 100% disability the opposite parties have to pay total sum assured, but the complainant did not suffer from 100% disability in the said accident. The disability to the complainant as per Ex.A2 is 80% only taking into consideration the disability suffered by the complainant the opposite parties settled the claim to 50% of assured sum . Hence there appears no deficiency of service on part of opposite parties for settlement to 50% sum assured.
10. The complainant in this case is claiming the total sum assured, the total sum assured is payable only when there is 100% disability and no material is filed by the complainant to show that he suffered 100% disability for claiming said amount. Therefore , as there is no material on record to support the case of the complainant, hence the complainant is not remaining entitled to the reliefs sought and the complaint is dismissed.
In the result, the complaint is dismissed.
Dictated to the stenographer, transcribed by her , corrected and pronounced by us in he open bench on this the 22nd day of October, 2008.
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. Claim form Xerox.
Ex.A2. Xerox copy of medical certificate as to the orthopedically handicapped.
List of exhibits marked for the opposite parties:
Ex.B1. Attested copy of policy No.100300/42/04/8200012.
Ex.B2. Attested copy of letter dated 06-12-2006 of OP.No.1 to complainant.
Ex.B3. Award if Ombudsman dated 23-03-2007.
Ex.B4. Attested copy letter dated 30-08-2007 of OP.No.1 to complainant.
Ex.B5. Attested copy of receipt dated 30-08-2007 issued by complainant to OP .
Ex.B6. Letter dated 05-11-2007 of cheque No.232110 dated 30-10-2007 for Rs. 1,50,000/-.
Ex.B7. Memorandum between OP 1 & 3 attested along with Notarial
Certificate.
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 :
Copy was dispatched on :
