THE KARNATAKA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, BANGALORE. (ADDL. BENCH)
DATED THIS THE 15th DAY OF MAY, 2023
APPEAL NOs.691/2015 and 694/2015
PRESENT
SRI RAVI SHANKAR, JUDICIAL MEMBER
SMT. SUNITA C.BAGEWADI, MEMBER
1. Appeal No.691/2018
M/s. SBI General Insurance Co. Ltd,
Corporate office,
Nataraj No.101, 201 & 301,
Junction of Western Express
High Way and Andheri, ...Appellant/s
Kurla Road, Andheri (East)
Mumbai-400 069
Represented by Legal Manager,
(By Sri.Prashant T.Pandit, Advocate)
-Versus-
Sri.Byra Reddy,
S/o Late Munishami,
Aged about 56 years, …. Respondent/s
Resident of Muddulahalli
Village, Chintamani Taluk,
Chikkaballapura District
(By Sri.K.M.Venkatesh Mouni, Advocate)
2. Appeal No.694/2018
State Bank of India
Peddur Branch,
Chintamani Taluk,
Chikkaballapur District,
Represented by its ...Appellant/s
Branch Manager,
Mr.Shaikh Jaffervalli,
(By Sri.Brijesh Chander Guru, Advocate)
-Versus-
1. M/s. SBI General Insurance Co. Ltd,
No.101, 201 & 301,
Junction of Western Express
High Way and Andheri, ...Respondent/s
Kurla Road, Andheri (East)
Mumbai-400 069
2. Sri.Byra Reddy,
S/o Late Munishami,
Aged about 55 years,
Resident at Muddulahalli
Village, Nandiganahalli post,
Chintamani Taluk,
Chikkaballapura District
(Respondent No.1- By Sri.Prashant.T.Pandit, Advocate)
(Respondent No.2- By Sri.K.M.Venkatesh Mouni, Advocate)
COMMON ORDER
BY SRI RAVI SHANKAR, JUDICIAL MEMBER
The Appellant/Opposite Party No.1 in appeal No.691/2015 and the Appellant/Opposite Party No.2 in appeal No.694/2015 being aggrieved by the same order dated 18-5-2015 passed by the District Consumer Commission, Kolar in Complaint No.17/2014 preferred these Appeals and the same are clubbed together.
2. The Opposite Party Nos.1 and 2 in complaint No.17/2014 preferred these appeals against the order passed by the District Consumer Commission, Kolar which directed this appellant to pay Rs.4,00,000/- towards 100% disability, failing which 9% interest payable from 26-3-3014 till realization and submits that the complainant had obtained a group insurance policy vide bearing no.86265221021 and in this regard the Opposite Party had issued a certificate bearing no.1571979 dated 18-7-2012. Such being the case on 29-4-2013 he accidently fell down from the first floor of his house and suffered leg injury, immediately he was taken to St.John’s Medical College Hospital for treatment and he was hospitalized as in-patient for a period from 26-4-2013 to 20-7-2013 and he spent nearly Rs.2,06,594/- towards medical treatment. Being the beneficiaries of the group insurance policy, the complainant claimed for reimbursement of the said amount. This appellant had repudiated the claim for the reason that the complainant had not intimated the accident within 7 days from the date of this occurrence. Further the accidental fall is not covered under the policy and the repudiated the claim. Aggrieved by the said, the complainant preferred the complaint before the District Commission and District Commission after trial allowed the complaint and directed to pay the above said amount. In fact as per the terms and conditions of the policy, the complainant has to inform this appellant within 7 days from the date of accidental fall and he has not informed well within time and after lapse of certain months, he has informed and claimed for reimbursement, due to which they could not able to ascertain the cause of accident, hence repudiated the claim and submits there is no deficiency of service. In spite of that the District Commission allowed the complaint and directed this appellant to pay the above said amount. The District Commission has not appreciated the defence taken by this appellant. Hence, prays to set aside the order passed by the District Commission and to dismiss the complaint.
3. Heard.
4. On perusal of the certified copy of the order and memorandum of appeal, it is an admitted fact that, the complainant is one of the member of the group insurance policy issued by the Opposite Parties vide certificate no.1571979 dated 18-7-2012. It is also admitted fact that the complainant in his home has fallen from first floor and suffered severe leg injuries, due to which he taken treatment at St.John’s Hospital as an in-patient from 26-4-2013 to 20-7-2013 and he spent nearly Rs.2,06,594/-. In spite of taking treatment the complainant was not able to use his legs. We observed that during the course of trial the complainant appeared before the District Commission and District Commission observed that he was not able to stand himself and arrived to conclusion that he suffered 100% disability as the legs were hanging without any control. The District Commission arrived to the conclusion that there is no any violation of terms and conditions and directed this appellant to pay Rs.4,00,000/- insured amount as the complainant has suffered permanent disability. The appellants before this Commission as argued that any accident has to be informed within 7 days from the date of accident in order to claim the compensation, whereas the complainant had claimed medical expenses at belated stage and prayed for dismissal of the complaint. The ground taken before this Commission are not justifiable, we noticed that the complainant has hospitalized as a inpatient from 26-4-2013 to 20-7-2013 in the St.John’s Hospital and he has to look after his health at that junction of time, no one can except any information to the insurance company with respect to the accidental fall, the grounds for repudiation taken by the appellant is not justifiable. The District Commission has after considering the disability and other documents had arrived to pay the insured amount as per the policy, according to us the order passed by the District Commission is in accordance with law. No interference is required. It is a clear case of deficiency of service on the part of this appellant in not settling the claim. Anyhow the amount claimed by the complainant was enhanced Rs.4.00 lakhs by considering the disability suffered by the complainant the said award is justifiable.
5. In Appeal No.694/2015 the appellant submits that, they have only provided banking facilities to the complainant and they have not liable to pay any compensation for the accidental fall of the complainant, due to which he suffered disability and he only a account holder of their branch, by virtue of account he opted for insurance with the respondent no.2. But the District Commission after trial arrived to the conclusion that, this appellant including the appellant in Appeal No.691/2015 jointly and severally liable to pay the compensation amount of Rs.4.00 lakhs. In fact, there is no any nexuses between the transaction took place with respect to the policy obtained by complainant and Respondent No.2. As such prays to dismiss the complaint against them.
6. On perusal of the certified copy of the order, the District Commission has directed both this appellant and appellant in appeal no.691/2015 jointly and severally liable to pay an amount of Rs.4.00 lakhs along with litigation expenses of Rs.1,000/-. When these appellants are directed to pay jointly and severally that goes to shows that, the insurance company who have indemnified is liable to pay the said amount. This appellant failed to interpret the order passed by the District Commission. Anyhow the order is hereby modified as follows.
ORDER
Both Appeals are disposed off with the modification that, the Appellant in Appeal No.691/2015 is directed to pay the award amount with 9% interest per annum from 26-3-2014 passed in the Complaint No.17/2014 along with litigation expenses of Rs.1,000/- within 30 days from the date of receipt of this order, failing which further 9% interest will be charged on the award and interest amount from the date of default till realization.
The amount in deposit shall be transmitted to the concerned District Commission to pay the same to the complainant.
Send a copy of this order to both parties as well as Concerned District Commission.
Member Judicial Member
