THE KARNATAKA STATE CONSUMER DISPUTES

REDRESSAL COMMISSION, BANGALORE. (ADDL. BENCH)

DATED THIS THE 1^st DAY OF JULY 2021

PRESENT

SRI RAVI SHANKAR – JUDICIAL MEMBER

SMT. SUNITA C.BAGEWADI - MEMBER

APPEAL NO. 405/2014

The Oriental Insurance Co., Ltd.,

Rep. by its authorized Signatory,

Regional Office, 2^nd Floor,

Sumangala Complex, (Opp. HDMC),

2^nd Floor, Lamington Road,

Hubli-580 020.

….Appellant/s.

(By Shri/Smt. Manoj Kumar M.R., Adv.,)

                                          -Versus-

Puttappa S/o Bhyrappa

Aged about 49 years,

R/o Dyamalamba Nilaya,

K.B.Extension, 2^nd Cross,

Chitradurga Town-577 501.

……….. Respondent/s

(By Sri/Smt B.M.Siddappa, Adv.,)

:ORDERS:

BY SRI.RAVI SHANKAR  -  JUDICIAL MEMBER

         The Opposite Party in complaint No.33/2013 on the file of Chitradurga District Commission preferred this appeal before this Commission being aggrieved by the order dated:28/11/2013, wherein the District Commission directed the Opposite Party to pay Rs.1,20,000/- to the complainant together with 9% interest p.a. along with Rs.10,000/- towards mental agony and Rs.5,000/- towards cost.

2.      The appellant/Opposite Party submits that they have issued one Nagriksuraksha individual policy vide policy No.472108/48/2011/970 which is valid from 14.11.2010 to 13.11.2011.  Such being the case, the complainant met with an accident on 22.04.2011 at 6.40 hours and suffered grievous injuries.  He was hospitalized and treated form 26.04.2011 to 15.05.2011 and spent nearly Rs.2,27,712/- towards treatment.  After the treatment, the complainant applied for claim under the said Nagriksuraksha individual policy, but the complainant had not furnished the required documents within the stipulated period of 14 days.  Hence, they have repudiated the claim.  Being aggrieved by the said rejection, the complainant preferred a complaint before the Chitradurga District Commission.  After trial, the District Commission allowed the complaint and directed the Opposite Party to pay Rs.1,20,000/- along with interest as stated above.  The District Commission made an error in awarding 80% of the assured amount of the policy without considering the terms and conditions of the policy.  Hence, prays to set-aside the order passed by the District Commission.

3.      We have heard the arguments from both sides.

4.       On going through the memorandum of appeal, certified copy of the order and documents produced before the District Commission, we noticed that the complainant had obtained Nagriksuraksha individual policy vide policy bearing No.472108/48/2011/970 which is valid from 14.11.2010 to 13.11.2011.  When the policy is in force, he met with an accident on 22/04/2011, for which he suffered grievous injuries and took treatment at SSIMS Hospital, Davangere and also obtained disability certificates from Doctors who treated him.  The complainant claimed for Rs.2,27,712/- towards medical expenses.  But the Opposite Party has not considered the claim stating that the complainant had not filed the claim along with required documents within 14 days from the date of discharge and in spite of request, the complainant had not submitted the original documents.  Hence, they have closed the claim.

5.       The District Commission after considering the arguments submitted by both the parties has come to the conclusion that the Opposite Party is liable to pay Rs.1,20,000/- together with @ 9% p.a. along with cost and compensation.  Whereas the learned counsel for appellant vehemently argued that the complainant in-fact had taken two policies one is two wheeler policy bearing No.472108/31/2011/4478 which is valid from 22/11/2010 to 21/11/2011 and he paid a premium of Rs.50/- towards personal accident coverage and complainant also filed a separate complaint No.32/2013 before Chitradurga District Commission claiming under the said policy for personal accident benefit.  Apart from that the complainant also made a claim under Nagriksuraksha policy, but the complainant had not produced original documents in order to settle the claim under Nagriksuraksha policy.  Hence, they have repudiated the claim and submit to set-aside the order.  But the appellant has not produced any materials to show what the result in complaint No.32/2013.    If at all, he claimed under personal accident benefit it is a separate claim by virtue of the two wheeler package policy as he paid Rs.50/- towards personal accident coverage.  Whereas, in this complaint, the complainant had claimed for hospitalization charges and treatment reimbursement by virtue of the Nagriksuraksha policy, which covers up-to Rs.1,60,000/-.

6.       We noticed that Dr. Ambrish S., Orthopedic Surgeon,  had given his opinion that the complainant has suffered permanent disability      up-to 30% with respect to the spine and further one Dr.K.H.Chithanya has given his opinion that the complainant suffered 50% of the disability on facial injuries and fractures.  The District Commission after considering both opinions of the Doctors have arrived to the conclusion that the complainant had suffered 50% of the disability and as per the terms and conditions have awarded 80% of the assured amount.  The order passed by the District Commission has no irregularity.  We found there are no any valid grounds in the memorandum of appeal to set-aside the order.  Hence, the appeal fails.  Accordingly, we proceed to pass the following:-    

:ORDER:

The appeal is dismissed.  No costs.

The impugned order dated:28/11/2013 passed by Chitradurga District Consumer Commission in C.C.No.33/2013 is hereby confirmed.

The amount in deposit shall be transmitted to the concerned District Commission to pay the same to the Respondents/complainant.

Send a copy of this order to both parties as well as Concerned District Commission.

Sd/-                                                                                                      Sd/-

Member.                                                               Judicial Member.

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