Date 01/03/2013

Per Mr.B.A.Shaikh, Hon`ble Presiding Judicial Member.

1.       This appeal is preferred against the order dated 31/12/2007 passed by the Dist. Forum, Latur in CC.No. 206/2006, whereby the said complaint has been  allowed.

2.       In brief facts as stated in the complaint are that, the complainant ( respondent No. 1 herein ) is a member of opposite party  No. 2 which had taken insurance policy from the opposite party No. 1 insurance company to cover the risk of bodily injury and death of the complainant. The sum assured was Rs 1,00,000/-.  The complainant sustained grievous serious injury on 20/04/2005 while working in the shop of opposite party No. 3 as a coolie at  the time of carrying gunny bag. He thereby sustained 100 % permanent disablement. Therefore he claimed aforesaid amount of Rs 1,00,000/- from the opposite party No. 1. It  did not pay the same. Hence he filed complaint  and submitted that direction be given to all the opponents to pay him Rs 1,00,000/- with interest with effect from 20/04/2005 and also to pay him Rs 20,000/- towards mental harassment and Rs 5,000/- towards cost of the complaint. 

3.       The opposite party No. 1 filed written version and denied the claim. It is submitted that the complainant  had sustained injury on 20/04/2005 and he mentioned the date of accident as 01/04/2005. It also submitted that complainant was admitted in hospital on 26/11/2005 and  therefore the complainant is not entitled to claim the sum assured. It also denied that the complainant sustained 100 % permanent disablement.

4.       The opposite party No. 2 filed written version and submitted that the doctor had written wrong date as 01/04/2005 and therefore said date was corrected by the same doctor as 20/04/2005. It also submitted that there is no deficiency in service provided by it to the complainant and hence it is not liable to pay compensation.

5.       The opposite party No. 3 despite of service of notice failed to appear before the Dist. Forum below and hence complaint was proceeded ex-parte against him.

6.       The Dist. Forum below after considering the evidence brought on record and hearing the respective advocates of contesting parties came to the conclusion that the complainant sustained 100 % permanent disability due to accident  that took place on 01/04/2005  and that therefore he is entitled to  the compensation of Rs 1,00,000/- from the insurance company. It also directed that the said amount shall  be paid with interest 9 % p.a. from 05/10/2006. It also directed the insurance company to pay to the complainant Rs 2000/- towards mental harassment and Rs 1,000/- towards cost of the complaint.

7.       The opposite party No. 1 insurance company preferred this appeal  against that order. It is submitted by Adv.D.S.Kulkarni learned advocate appearing for the appellant that in the claim application complainant had given date of incident as 20/04/2005 and that  injury certificate issued by Dr. Sudhakar Gulawe, Medical Officer, Latur shows  date of accident as 01/04/2005 and as per the case papers submitted by the complainant he had taken treatment in Government Hospital on 01/04/2005 and that as the accident did not take place during the period of policy i.e. from 16/04/2005 to 15/04/2006, the claim has been rightly repudiated by the appellant. He further submitted that corrected medical certificate was not tendered to the appellant but it was directly produced before  the Dist. Forum below and hence it can not be considered. He also submitted that the claim was submitted to the appellant after five months of accident  and that 100 % permanent disablement is also not proved by the appellant and at  the most  it can be said that he sustained  50 % permanent disablement only. He therefore submitted that appeal may be allowed and impugned judgment and order may be set aside.

8.       On the other hand Shri.A.K.Jawalkar, learned advocate appearing for the respondent (original complainant) supported the impugned judgment and order. He submitted that there were statements of two eye witnesses recorded by police showing that accident took place on 20/04/2005. He also submitted that the certificate of shop owner ( respondent No. 3 ) is also filed. He also submitted that medical certificate shows permanent disablement to the extent  of 100 %   and hence he submitted that appeal may be dismissed.

9.       No doubt initially  complainant/respondent herein had given the date of accident as 01/04/2005 while submitting claim proposal to the appellant. But he committed said mistake inadvertently. He obtained medical certificate from the said doctor who certified that the complainant was admitted for treatment in hospital of Dr. Sudhakar Gulawe  on 20/04/2005. He also obtained the relevant document   from Government hospital and they were also produced  showing that complainant was admitted in Government hospital for treatment on 20/04/2005.  Moreover in a statement of two witnesses namely Shri. Balasaheb Niwruti Kamble and Shri. Rajkumar Birajdar they stated before police that  the accident took place on 20/04/2005  in their presence and in that accident complainant sustained injury to his right leg. The respondent No. 3 Shri.Sharad Shinde who is the owner of the shop  also issued the certificate stating that on 20/04/2005 accident took place in his shop. Moreover, complainant also produced permanent disablement certificate issued by Dr. Sudhakar Gulawe  in which it is stated that the complainant sustained 100 %  permanent disablement due to the aforesaid injury sustained by him. We find no reason to disbelieve said  documents produced by the complainant before the Dist. Forum below. The date of the accident and the treatment taken by the complainant was inadvertently given wrong by the complainant in his claim form and by Dr. Sudhakar Gulawe in his certificate issued  initially. But lateron they were corrected by them. Hence, on the said ground the repudiation of the claim is not justified.

10.     Thus it is proved from the aforesaid documents that the complainant sustained 100 % permanent disablement in an accident on 20/04/2005 and the said date is covered under the period of policy which was from 16/04/2005 to 15/04/2006. In view of the terms of the said policy the complainant has been rightly granted compensation of Rs 1,00,000/- which was the sum assured under that insurance policy. We find no merits in this appeal and thus it deserves to be dismissed.

O   R    D    E    R

1.       Appeal is dismissed.

2.       No order as to costs.

3.       Copies of the judgment and order be sent to both the parties.