Karnataka

Kolar

CC/17/2014

Sri.Byrareddy, - Complainant(s)

Versus

Sri.Nataraj, & Ors. - Opp.Party(s)

Venkataramana Reddy

18 May 2015

ORDER

Date of Filing: 24/04/2014

Date of Order: 18/05/2015

BEFORE THE KOLAR DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, D.C. OFFICE PREMISES, KOLAR.

 

Dated: 18^th DAY OF MAY 2015

PRESENT

Sri. N.B. KULKARNI                                   …….         PRESIDENT

              Sri. R. CHOWDAPPA                                 ……..     MEMBER

CONSUMER COMPLAINT NO: 17 OF 2014

Byra Reddy,

S/o. Late. Munishami,

Aged About 55 Years,

Muddulahalli Village,

Nandiganahalli Post,

Chintamani Taluk,

Chickballapur District.

 

(Rep. by Sriyuth. Venkataramana

Reddy, Advocate)                                                        ….  Complainant.

 

- V/s -

(1) S.B.I. General Insurance

Company Limited,

Nataraj, No.101, 201 & 301,

Junction of Western Express

High-way & Andheri Kurla Road,

Andheri (East),

Mumbai-400 069.

(Rep. by Sriyuth. B. Kumar, Advocate)

 

(2) The Manager,

State Bank Of India,

Pedduru Branch,

Chintamani Taluk,

Chickballapur District.

(Rep. by Sriyuth. A.S.Nagaraju, Advocate)          …. Opposite Parties.

-: ORDER:-

BY Sri. N.B. KULKARNI, PRESIDENT

01.   Earlier the very complainant in-person having submitted the complaint Under Section 12 of the Consumer Protection Act, 1986 has sought relief for recovery of sum of Rs.2,06,594/- for being recovered from the insurance company (thereby to mean the OP-1) together with justified other expenses.

(a) Subsequently on 01.08.2014 the said learned counsel has put in his appearance for the complainant. 

(b) Earlier the OP-1 was incompletely described, whereas subsequently on 13.05.2015 vide order on I.A. No.1 under Order XI Rule XVII Read with 151 of CPC, the full description of the OP-1 came to be shown.

 

02.   The facts in brief:-

The complainant is to contend that, he being an account holder (with OP-2) vide bearing No.86265221021 at Pedduru Branch in Chintamani Taluk of Chickballapur District.  And that the OP-1 insisted that as it was compulsory to have Group Personal accident insurance in as much as, in case of ill-health or accident there would be relief from Insurance Company and hence the same should be complied.  And that sum of Rs.100/- came to be collected and a certificate was issued to him which was to bear No.1571979, dated: 18.07.2012.

 

(a)    Further it is contended that, on 29.04.2013 (as this complaint was submitted in-person by the complainant who has come from rural background having poor literacy from this date is taken read correctly as on 26.04.2013) around 5.30 PM as he fell accidentally from the first floor of his house (at Muddulahalli Village, Nandiganahalli Post, in Chintamani Taluk, Chickballapur District) and that he had sustained grievous injuries and that he was taken to St. John’s Medical College Hospital, Bangalore.  And that as treatment failed, his both legs came to be removed (however again this plea has to be taken read correctly at the strength of other documents available on record that, both these lower limbs are simply in hanging condition, for, this complainant cannot stand on his own which aspect shall be discussed in detail hereafter).  He has also contended that as such he cannot walk and work.  He has incurred the medical expenses which are as below:-

 

Bill No.	Bill Date	MR.D/I.P.No.	Gross Amt	Concession	Medicine Returned	Paid by the patient
1152102	20.07.2013	31412161059923	1,30,273	16,700	1,770	1,11,803/-
1159223	06.09.2013	31412161080326	5,636	200	645	4,791/-

 

(b) Further it is contended that, an approach being made twice with the OP-2, in turn the OP-2 contacted the OP-1 which resulted ultimately in repudiation of his claim.  And that he resorted to take medical treatment with a fond hope that, he would get insurance money.  Thus this complainant has sought the said relief on following grounds:-

(1) The sum spent for medical expenses -        Rs.1,16,594/-

(2) Travelling expenses                           -         Rs.   20,000/-

(3) Court expenses                               -   Rs.   70,000/-

                                        TOTAL           -   Rs.2,06,594/-

 

03.   Along with the complaint the complainant has submitted

(i) Xerox copies of Case Summery and Discharge Record as issued by the St’ John’s Medical College Hospital, Bangalore,

(ii) Insurance Policy,

(iii) Receipt dated: 18.12.2013 as issued by the said hospital,

(iv) I.D. Card,

(v) Letter dated: 25.03.2014 as issued by the OP-1,

(vi) Radiology Report as issued by the said Hospital,

(vii) C.T. Brain Plain as issued by the said Hospital.

 

04.   The OP-1 has put in written version resisting the claim of the complainant in toto though did admit of issuance of the said insurance policy.  It is contended that strictly going by insurance policy terms there should be permanent total disability or death in which he went 100% of the sum insured would be released and not otherwise.  And that even that loss on account of accident/injury should result in this 365 days from the date of accident. 

(a) Further it is contended that the fact of sustaining accidental injury should have been brought to its notice immediately.  And as the complainant is guilty of in reporting the matter immediately there could be no deficiency in service on its part.  So contending dismissal of the complaint has been sought.

 

05.   The OP-2 has also put in written version specifically contending that, as the matter is exclusively triable by Civil Court the provisions of the act cannot be pressed in to service and that hence the complaint is liable to be dismissed.  Further it is contended that as the complaint is frivolous it is liable to be dismissed Under Section 26 of the Act.  And that there could be no shortcoming in the matter of rendering services, hence it is not accountable.

(a) Further it is contended that, when the complainant had approached on 16.01.2014, the documents furnished by him were sent to the OP-1 and that the complainant was even directed to keep approaching the OP-1.  Further it is contended that it was not a necessary party.  And that since no relief is claimed against it the complaint is liable to be dismissed with exemplary costs. 

 

06.   The complainant and the OP-1 have put in their affidavit evidence. 

(a) On 13.05.2015 the learned counsel appeared for the opponent No.1 with list has submitted specimen copy of the insurance policy.

(b) The learned counsel appearing for the complainant and opponent No.1 have put in their written arguments.

(c) On 15.05.2015 the learned counsel appearing for the complainant has submitted the general information with regard to physical condition and treatment of the complainant as issued by the said hospital on 25.07.2014, notary attested disability certificate issued by the Directorate for the empowerment for disabled and senior citizens, Bangalore, photo, the letter dated: 10.03.2014 as issued by the OP-1 to the complainant have been submitted.

(d) On 15.05.2015 the learned counsel appearing for the OP-1 has submitted copy of the citation in Revision Petition No.1077/2012 of the Hon’ble NCDRC, New Delhi, dated: 14.08.2012.

(e) On 15.05.2015 itself heard the arguments as advanced by the learned counsel for the complainant and the OP-1.  On this day this District Forum also made suomotu observation with regard to the present physical condition of the complainant.  It was noticed in the order sheet that, this complainant was physically lifted by his younger brother and made to be seated on the chair.  There was a sack to collect the urine in as much as cathedra was inserted.  Though the complainant could occupy the chair comfortably hardly he could make a raising thus the effort to stand on his own was totally impossible.

07.   Therefore the points that do arise for our consideration in this case are:-

(A) Whether the opponents are guilty of deficiency in service as contended by the complainant?

(B) If so, to what relief the complainant is entitled to?

(C) What order?

 

08.   Findings of this District Forum on the above stated points for the following reasons are:-

POINT (A): In the Affirmative

 

POINT (B): The complainant is entitled to recover the sum as covered by the policy to the extent of 100% i.e., Rs.4,00,000/- from the OP-1 & 2 jointly and severally within a period of one month from the date of communication of this order, failing which these Op Nos.1 & 2 are further liable to pay interest @ 9% pa from 26.03.2014 till realization.

 

POINT (C):   As per the final order.

 

REASONS

POINT (A) & (B):-

07.   To avoid repetition in reasonings and as these points do warrant common course of discussion, the same are taken up for consideration at a time. 

 

1. It is a fact that this complainant was issued Group Personal accident insurance policy vide certificate No.1571979 to cover the period from 18.07.2012 to 17.12.2013.  And the same was assured for Rs.4,00,000/-.  The notary attested copy of this insurance policy which is annexed with the affidavit by way of examination of the complainant, is also to discloses that premium amount of Rs.100/- has been collected on the part of the OP-2 and hence for the purpose of OP-1.
2. That on 26.04.2013 during validity of this insurance policy the complainant due to accidental fall from the first floor of his house at Muddulahalli Village, Nandiganahalli Post, Chintamani Taluk, Chickballapur District, is also not in dispute.  Further the factum of this complainant having been admitted in the said hospital and was in-patient from 26.04.2013 to 20.07.2013 is also not in dispute.
3. What is tried to be disputed by the Ops in general and the OP-1 in particular is with regard to non-intimation of sustaining injury due to accidental fall immediately soon after 26.04.2013 and about permanent total disablement with regard to both legs.
4. The said documents issued by the said hospital would indicate that the complainant as on the date of discharge could perform ADL with minimal assistance.  Whereas the disability certificate and ID Card issued by the Directorate for the Empowerment of Disabled and Senior Citizens, Bangalore, is to disclose that, there is locomotor disability of permanent basis.  Further the general intimation issued on 25.07.2014 at the said hospital is to disclose that this complainant was so in-patient from 26.04.2013 to 20.07.2013 for traumatic paraplegia and he was even further re-admitted on 05.03.2014 till 10.03.2014 (within one year of the said injury due to accidental fall) for continuation of re-habilitation.  It is certainly mean that, this complainant continued to suffer locomotor disability being a permanent physical impairment which even stood confirmed by this Forum by making a suomoto entry in the order-sheet as noted above.  Thus permanent total disablement as agreed in the said policy stood true.  Consequently the OP-1 in particular and the OP-2 in general are accountable to pay 100% of the sum assured as agreed, which would mean the sum of Rs.4,00,000/- being the insured amount.
5. The resistance is that, the complainant did not report immediately.  It cannot be forgotten that saving of the life of this complainant was a paramount duty.  And while under treatment on 26.11.2013 i.e., within seven months i.e., on 26.11.2013 the complainant submitted for claim with the claim No.1 which came to be repudiated on 10.03.2014.  Therefore it is not open for the OP-1 to contend that, the complainant was guilty of contended delay in preferring his claim.  This stand on the part of the OP-1 is designed only to avoid ensuing the legal liability.
6.  The principle enunciated in the said citation is to the effect that, if there could be no permanent total disablement the insurer is not accountable.  As noted above with regard to both legs of this complainant there is permanent total disablement, therefore, the OP-1 in particular and the OP-2 in general are accountable to pay 100% of the insured sum of Rs.4,00,000/-.  Therefore the said principle in the said citation is inapplicable to the case on hand.
7. We are aware that, the complainant has made the claim in a sum of Rs.2,06,594/- on the said ground as noted above.  It cannot be forgotten that the ignorant complainant has resorted to that claim by presenting the complaint in-person.  He would be punished for such plea contra.  We are of the definite opinion that for the reasons noted above the complainant is entitled to 100% of the insured sum.  So the OP-1 in particular and the OP-2 in general are accountable for 100% of the insured sum being Rs.4,00,000/-.  Hence the findings.

 

POINT (C):-

08.   We proceed to pass the following:-

ORDER

01.   For the foregoing reasons, the complaint stands allowed with costs of Rs.1,000/- as hereunder:-

(a) The complainant is entitled to the insured sum of Rs.4,00,000/- for being recovered from the OP-1 & 2 jointly and severally within a month from the date of communication of this order to them, failing which, they are further liable to pay interest @ 9% pa from 26.03.2014 till realization.

(b)