Punjab

Sangrur

CC/642/2014

Shingara Singh - Complainant(s)

Versus

NIC LTD. - Opp.Party(s)

Shri Shingara Singh

15 May 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

                                                               

 

                                                Complaint No.    642

                                                Instituted on:      03.12.2014

                                                Decided on:       15.05.2015

 

Shingara Singh son of Shri Anokh Singh, resident of VPO Dhulkot, Tehsil and District Ludhiana.

                                                        ..Complainant

                                        Versus

1.             The Branch Manager, National Insurance Company Limited, Branch Office, Ahemdgarh, Dhulkot Road, Tehsil Malerkotla, District Sangrur 148 021.

2.             The Manager (Claims) National Insurance Company Ltd. Divisional office, Atam Park, Near Dhuri Railway Crossing, Ludhiana.

3.             Regional Manager, National Insurance Co. Ltd. SCO 337-340, Sector 35-B, Chandgiarh-160 036.

4.             Head Manager, National Insurance Company Limited, Regional Office, 3 Middleton Street, Calcutta 700 071.

                                                        ..Opposite parties

 

 

 

 

For the complainant    :       Shri T.P.S.Dhaliwal, Adv.

For OPs                    :       Shri Ashish Kumar, Adv.

 

 

 

 

Quorum:    Sukhpal Singh Gill, President

                K.C.Sharma, Member

                Sarita Garg, Member

 

 

Order by : Sukhpal Singh Gill, President.

 

1.             Shri Shingara Singh,  complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the complainant purchased a personal accident insurance policy bearing number 401308/42/11/8100000/04 from the OPs, which was valid for the period from 18.11.2011 to 17.11.2012.  The case of the complainant is that on 17.11.2012 while he was going to his village at about 2.30/3.00 PM along with one Mohinder Singh on his motorcycle, one person riding a cycle turned his cycle towards his right side without any indication, as a result of which the motorcycle of the complainant struck behind the cycle and both the complainant and pillion rider fell on the road and received injuries on his left arm, left leg and many other parts of the body.  The complainant was immediately taken to Channa Hospital, Village Jodhan, who got x-rays of the complainant done and provided treatment. It is further stated that thereafter the complainant went to Khan Hospital Mandi Ahemdgarh and thereafter the complainant went to Civil Hospital Malerkotla for further treatment on 21.11.2012, where the doctor got done x-rays and plastered his left leg and left arm and discharged on the same day. It is further stated that the complainant again visited the doctor, who opened the plaster on 8.12.2012. It is further stated that on 14.12.2012, the complainant submitted the written intimation to the OP about the accident and injuries sustained by him, but the Ops rejected the claim of the complainant.  It is further stated that the complainant has spent an amount of Rs.2,00,000/- on the treatment as he also failed to join his job for four months.  Thus, alleging deficiency in service on the part of the OPs, the complainant has prayed that the Ops be directed to pay to the complainant an amount of Rs.2,00,000/- on account of amount spent by him on the treatment along with interest @ 24% per annum  and also claimed compensation for mental tension and litigation expenses.

 

2.             In reply filed by OPs, it is admitted that the complainant obtained the personal accident policy in question for the period from 18.11.2011 to 17.11.2012 for Rs.1,00,000/- under table I and Rs.1,00,000/- under table 3. It is stated that table-1 pertains to death, loss of two limbs, two eyes, one limb and one eye 100% and loss of one limb or one eye 50%.  As regards table-3, the same pertains to temporary total disablement as 1% of capital sum insured upto 104 weeks. As regards, medical expenses arises out of an accident, the same is upto 10% of capital sum insured or 40% of the admissible claim which ever is lower.  It is admitted that the complainant informed the OP on 14.12.2012 regarding the alleged accident.  In the present case, the alleged accident took place on 17.11.2012 and the complainant informed the company on 14.12.2012 after expiry of the policy as well as after 26 days from the date of accident.  Due to late intimation, the OPs could not investigate the claim, as such, it is stated that the OPs have rightly and legally repudiated the claim of the complainant.  However, any deficiency in service on the part of the OPs has been denied.

 

3.             The learned counsel for the complainant has produced Ex.C-1 copy of treatment slip dated 17.11.2012, Ex.C-2 copy of treatment slip Khan Hospital, Ex.C-3 copy of notice, Ex.C-4 reply to notice, Ex.C-5 copy of treatment slip Civil Hospital, Malerkotla, Ex.C-6 copy of x-ray and payment slip, Ex.C-7 to Ex.C-12 original x rays, Ex.C-13 to Ex.C-15 affidavits, Ex.C-16 copy of postal receipt, Ex.C-17 payment receipt number 8956, Ex.C-18 attested copy of admission card, Ex.C-19 attested copy of OPD slip (Civil Hospital Malerkotla), Ex.C-20 attested copy of payment receipt, Ex.C-21 attested copy of General cash sheet, Ex.C-22 attested copy of general physical examination and closed evidence. On the other hand, the learned counsel for the OPs has produced Ex.Ops/1 copy of policy, Ex.Ops/2 copy of terms and conditions, Ex.OPs/3 copy of processor PA insurance, Ex.OPs/4 to Ex.Ops/6 copies of letters, Ex.OPs/7 affidavit and closed evidence.

 

4.             We have very carefully perused the pleadings of the parties and heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits part acceptance, for these reasons.

 

5.             It is an admitted fact that the complainant is insured with the OPs under the policy number 401308/42/11/8100000/04 under personal accident policy for the period from 18.11.2012 to 17.11.2012 for Rs.2,00,000/-, a copy of which on record is Ex.OP-1.

 

6.             In the present case, the complainant has claimed an amount of Rs.2,00,000/- on account of expenses incurred by him as his left leg and left arm were fractured and as such, he took treatment from Channa Hospital, Jodhan, Khan Hospital, Mandi Ahemdgarh and Civil Hospital, Malerkotla. To support such a contention, he has placed reliance on the prescription slip Ex.C-1 issued by Channa Hospital, Jodhan,  prescription slip issued by Khan Hospital Ex.C-2, Ex.C-7 to Ex.C-12 x-rays etc. Further the complainant has also produced on record his own sworn affidavit Ex.C-13,  affidavit of Shri Harbans Singh Sandhu, Advocate Ex.C-14, affidavit of pillion rider Shri Mohidner Ex.C-15.

 

 

7.             The stand of the Ops in this case is that the complainant did not intimate the Ops about the accident, rather he intimated the OPs only on 14.12.2012, which is a clear cut violation of the terms and conditions of the policy.  Since it is an admitted fact of the complainant that he has suffered injuries in the accident and his left arm and left leg were plastered, he was unable to intimate the OPs about the accident immediately.  As such, we feel that the complainant intimated the OPs about the accident after recovering from the injuries and it cannot be said that he intentionally did not intimate the OPs about the accident immediately.

 

8.             We have very carefully perused the terms and conditions of the insurance policy, which is on record as Ex.OPs/2 and Ex.Ops/3.  In the present case, it is admitted fact on record that the complainant suffered injuries in the accident and also took treatment from Channa Hospital, Khan Hospital and Civil Hospital, Malerkotla and in the Civil Hospital, Malerkotla he remained admitted as is evident from the copy of admission record, which is Ex.C-18.  Since the complainant took treatment from three doctors, including the Civil Hospital, Malerkotla, it cannot be said that the complainant spent nothing on the treatment and no claim is payable, more so when his left arm and leg were plastered and he further deprived from attending his duty/work.  In the circumstances of the case, we feel that ends of justice would be met if the OPs are directed to make a payment of Rs.10,000/- for the medical expenses incurred by him.

 

9.             Accordingly, we allow the complaint and direct the Ops to pay to the complainant an amount of Rs.10,000/- on account of compensation for medical expenses and an amount of Rs.5000/- on account of litigation expenses.

 

 

10.            This order of ours be complied with within a period of thirty days of its communication. A copy of this order be supplied to the parties free of cost. File be consigned to records.

                Pronounced.

                May 15, 2015.

                                                        (Sukhpal Singh Gill)

                                                                President

 

 

                                                                (K.C.Sharma)

                                                                     Member

 

 

                                                                (Sarita Garg)

                                                                   Member