BEFORE THE DISTRICT FORUM (UNDER CONSUMER PROTECTION ACT,1986) SANGAREDDY, MEDAK DISTRICT (A.P)-502 001
PRESENT: SMT.U.SUNITA, M.A., SENIOR MEMBER/LADY MEMBER
SRI MEKALA NARSIMHA REDDY, MALE MEMBER
P.G.D.C.P.L.
THURSDAY THE 13TH DAY OF DECEMBER, 2007
C.D.NO.12/2007
Between:
Mohammed Nayeem S/o Mohd. Pasha Miyan,
Aged 35 years, Occ: Nil, R/o Lakdaram,
Mandal Patancheru, Medak District.
…Complainant…
And
1. The Branch manager, A.P.Vikas Grameena Bank,
(Former Manjeera Grameena Bank) Branch
Isnapur, Mandal Patancheru, Medak District.
2. The Branch Manager, United India Insurance Co.,
Branch Sangareddy, Medak District.
…Opposite parties…
This complaint is coming on before us for final hearing on 30.11.2007 in the presence of Sri M.Siddaiah, Advocate for the complainant and of Sri Joshi Narayana Rao, Advocate for the opposite party No.1, and of Sri P.Rama Rao, Advocate for the opposite party No.2 and the matter having stood over for consideration till this date this forum made the following :
O R D E R
Per Smt. U. Sunita, Senior Member/Lady Member
This is a complaint filed under section 12 of Consumer Protection Act, 1986 by the complainant with a prayer to direct the opposite parties jointly and severally to pay the assured amount of Rs.50,000/- with interest at 18% p.a. from the date of accident i.e., 3.3.2006 till realization, Rs.20,000/- towards compensation and also pay costs.
The brief facts of the case of the complainant are that the complainant was an auto driver by profession and driving the auto he is earning Rs.5,000/- per month nearly and by that amount the complainant eke out his livelihood and maintaining his family. On 3.3.2006 while he was proceedings from Sangareddy to Patancheru side by driving the auto bearing No. AP 23 V 4082 along with one
Satyanarayana at about 3.00 P.m. when the complainant reached near Kowlampet bus stage and when he was trying to overtook the lorry tanker bearing No. MH 06 K 958 dashed to the said lorry, due to which the auto was completely damaged and the complainant also received severe injuries. The police Sangareddy ® registered a case in Cr.No. 8/2006 U/sec. 337 IPC and the same is pending before the Addl.J.F.C.M., Sangareddy. The complainant was shifted to Gandhi Hospital, Secunderabad. Due to the accident the left eye of the complainant was completely damaged and lost his vision. He also received injury to the right eye and his vision of right eye also affected. The complainant was admitted in Gandhi hospital, Secunderabad on 3.3.2006 to 20.3.2006 and again admitted on 3.4.2006 and discharged on 24.4.2006. Thereafter, the complainant approached the District Medical Board, Medak at Sangareddy and the said Medical board issued a Physically handicapped certificate on 9.5.2006.
It is further submitted that the complainant has opened an account in A.P.Vikas Grameena Bank, Branch Isnapur i.e., opposite party No.1 on 24.11.1998 vide account No.3108. As per clause (5) of the terms and conditions of the account the account holder is entitled for benefit of Rs.50,000/-if he lost one eye and as per clause (6) the account holder has to made an application within 90 days. After discharging from the hospital i.e. on 24.4.2006 the complainant made an application to the opposite party No.1 for payment of assured amount on 19.5.2005 and the Medical Officer, Gandhi hospital, Secunderabad also endorsed on the application that the complainant has lost his left eye and also injury to right eye. The opposite party No.1 sent the claim of the complainant to the opposite party No.2 and inturn the opposite party No.2 erroneously closed the file and intimated the same to the complainant on 17.1.2007. Thereafter, the complainant approached the opposite parties and requested to pay the assured amount, but the opposite parties with a malafide intention evaded the payment. As such there is deficiency of service on the part of the parties. Thus the case of the complainant.
The opposite party No.1 filed counter stating that he is not aware that whether the complainant was an auto driver by profession and driving the auto to eke out his livelihood. It is further stated that the complainant is an account holder of the opposite party No.1 under Manjira Suraksha Scheme bearing Account No.3108. This opposite party sent the intimation about the accident to the opposite party No.2 on17.5.2006/19.5.2006 requesting for arranging the claim form. Accordingly the opposite party No.2 sent the claim form and the same was filled in and sent to the opposite party No.2 along with medical certificates, FIR and the certificate issued by the Medical Board through its letter No.Insurance/
06-07/1,dt.22.5.2006. It is further stated that the opposite party No.2 repudiated the claim of the complainant and sent a letter vide No.051403/Misc/07/3123/07, dt.17.1.2007 informing the loss of sight of one eye is only 30% not total loss, hence they are not liable to pay any amount and closed the file. It is further stated that again the complainant gave a representation to the opposite party No.1 on 19.1.2007 to arrange claim amount and the same was sent to the opposite party No.2 requesting them to settle the claim. It is stated that the opposite party No.2 has to settle the claim. The opposite party No.2 is alone responsible for payment of compensation to the complainant for repudiation of the claim. Hence to dismiss the complaint against this opposite party.
The opposite party No.2 filed counter stating that the allegations made in the complaint are neither true nor correct. It is stated that the complainant has created a false and baseless allegation. Infact, the complainant himself has drove the vehicle in rash and negligent manner and dashed to a lorry. The police also registered a case against the complainant and the same is pending inCr.No.38/2006 of P.S., Sangareddy ®. It is further stated that as per the terms if a person lost one eye, one hand or one leg lost fully in the accident the person is entitled for Rs.50,000/- only. The Medical Board issued a disability certificate dt.9.5.2006 showing that the complainant has received only 35% disability, hence the complainant is not entitled for any compensation. As per the terms and conditions of the policy the complainant is not entitled for any compensation. It is further stated that the allegation of receiving the injury to right eye is created for the purpose of the case.
As per the Medical certificate, the complainant has received disability only to left eye that too at 35% only. On 17.1.2007 this opposite party informed to the complainant about the repudiation of his claim and intimated that this opposite party is liable to pay 50% of the Capital sum insured in case of loss of total and irrevocable loss of sight of one eye. The complainant has lost of sight of one eye i.e. left eye is only 35% not total loss. Hence this opposite party is not liable and closed the file as No claim. It is further stated that after filing the complaint, this opposite party addressed a letter to Medical Board on 27.4.2007 and the Medical officer opined that the complainant received only 35% disability of left eye. Hence as there is no deficiency of service on the part of this opposite party, this complaint may be dismissed.
Heard both sides.
Both parties have filed their affidavits. Exs.A-1 toA-6 are marked on behalf of the complainant and Exs.B-1 to B-9 are marked on behalf of the opposite parties. Ex.A-1 is the Xerox copy of F.I.R, Ex.A-2 is the original pass book, Ex.A-3 is the original Physically Handicapped certificate, Ex.A-4 is the Xerox copy of claim form, Ex.A-5 is the copy of letter addressed to the opposite party No.1 by the opposite party No.2., Ex.A-6 is the original Discharge card. Ex.B-1 is the letter addressed to Dr.K.Vishnu Murthy, Ophthalmologist,Sangareddy, Ex.B-2 is the opinion given by the doctor along with physically handicapped certificate, Ex.B-3 is the Janatha Personal Accident Insurance Policy terms and conditions, Ex.B-4 is the copy of letter addressed to the opposite party No.1 by the opposite party No.2, Ex.B-5 is the copy of letter addressed to the opposite party No.2 by the opposite party No.1, Ex.B-6 is the copy of letter addressed to the opposite party No.2 by the opposite party No.1, Ex.B-7 is the copy of letter addressed to the opposite party No.1 by the opposite party No.2, Ex.B-8 is the copy of application given by the complainant, Ex.B-9 is the copy of letter addressed to the opposite party No.1 by the opposite party No.1. The complainant is examined as P.W-1 and Dr.K.Vishnu Murthy is examined as P.W-2.
The point that arises for consideration is, whether the complainant proved the deficiency of service on the part of the opposite parties in settling the claim ?
We have gone through the contents of the complaint, counters, affidavits filed on either side, written arguments filed herein, and the documents filed on either side and the examination of P.W-1 & P.W-2 and the relevant material available on record. The staunch case of the complainant is that he is a auto driver by profession having a auto and he has opened an account with the opposite party No.1vide A/c No.3108 under Manjira Suraksha Scheme and as per terms and conditions of the said account the account holder is entitled for benefit of Rs.50,000/- if he lost one eye. On 3.3.2006 the complainant was proceeding from Sangareddy to Patancheru by driving Auto bearing No.AP 23 V 4082 along with one Satyanarayana and at about 3.00 P.M. when the complainant reached near Kowlampet village bus stage the complainant was trying to over took a lorry bearing No.MH06K958 and dashed to the said lorry, due to which he sustained severe injuries. The police Sangareddy registered a case in Cr.No.38/2006 U/sec.337 IPC and the same was pending before the Addl.JFCM, Sangareddy. The complainant was shifted to Gandhi hospital, Secunderabad. The left eye of the complainant was completely damaged and lost his vision. The complainant also received injury by the right eye and his vision of right eye is also effected. He was admitted in Gandhi hospital 3-3-2006 to 20-3-2006 and again admitted on 3-4-2006 and discharged on 24.4.2006. It is further submitted that the Medical board issued a
physically handicapped certificate on 9.5.2006. As the policy is in existence and as he lost his left eye vision he made an application to the opposite party No.1 for payment of assured amount, the said application was sent to the opposite party No.2, but the opposite party No.2 erroneously repudiated the claim of the complainant. Hence he filed this complaint.
On the other hand the opposite party No.1 in his counter contended that after receiving the application from the complainant for issuance of claim form, the opposite party No.1 sent the same to the opposite party No.2 and again
after filling up of the claim the opposite party No.1 sent the same to the opposite party No.2 along with all the documents furnished by the complainant with a request to settle the claim of the complainant. The opposite party No.1 has contended that he did his job by sending the claim form to the opposite party No.2 within time and making correspondence with them and it is the duty of the opposite party No.2 to settle the claim of the complainant, hence there is no deficiency of service on his part. A perusal of Exs.B-5 to B-9 discloses that the opposite party No.1 has sent the claim form of the complainant to the opposite party No.2 within time and he made correspondence with the opposite party No.2, thus itself shows that the opposite party No.1 has did his part of job.
The opposite party No.2 in his counter stated that the Medical Board issued a certificate mentioning that the complainant has received only 35% disability. Therefore he is not entitled for any compensation. His next contention
is that the allegation of receiving the injury to the right is created for the purpose of this case. His staunch contention is that the complainant has lost his left eye vision 35% only, but not total loss, hence the opposite party No.2 is not liable and closed the claim as No Claim and intimated the same to the opposite party No.1 on 17.1.2007. His next contention is that after filing of the complaint the opposite party No.2 wrote a letter to the Medical Board and the medical officer opined that the complainant received only 35% disability on left eye. Therefore, as per the terms and conditions of the policy if a person lost one eye one hand or one leg lost fully in the accident the person is entitled for receiving Rs.50,000/- only, but in the instant case he lost vision of left eye is only 35%. Therefore he is not entitled for policy benefit.
At this juncture it is relevant to go through the examination of P.W-2 Dr.K.Vishnu Murthy who is working as Civil surgeon Spl.District Govt.Hospital, Sangareddy. P.W-2 in his chief examination deposed that he issued Ex.A-3 certificate and as per Ex.A-3 left eye vision is nil due to Corneal Laceration injury and Lenticular injury. Right eye vision is 6/9. His visual disability is 35% only
and as per the certificate issued by him the complainant has lost his vision in left eye totally and right eye vision is diminished slightly. He also deposed in his cross examination that the Board shall issue the certificate after conducting the tests. It
is true that visual disability of both eyes is 35%. P.W-2 in Re examination stated that he has mentioned that in the left eye vision is reduced to PL+ that amounts to
total loss of vision of blindness. In the left eye there is total loss of vision amounts to 30% disability and in his right eye vision is 6/9 that amounts to 5% disability put together the total visual disability is 35%.
The opposite party further argued that the certificate which was sent to the opposite party (copy of Ex.A-3) the additions made in green ink is not traced. A perusal of Ex.A-3 it is mentioned that RE (N) V.6/9, LE V Pl+, visual disability is 35%. It shows that there is some discrepancies in the evidence of the P.W-2. Any how the P.W-2 the doctor who is competent to decide the percentage of visibility of eye in his Re-examination stated that in the left eye there is total loss of vision amounts to 30% disability and in his right eye vision is 6/9 that amounts to 5% disability put together the total visual disability is 35%. P.W-2 also stated that the left eye vision is reduced to PL+ that amounts to total loss of vision of blindness. As has discussed above and taking into consideration of PW-2 evidence we are of the opinion that the complainant is entitled to receive Rs.50,000/- along with interest under Manjira Suraksha Scheme as his left eye visibility is 35%. As such the point is answered infavour of the complainant.
…contd…9…
In the result, the complaint is allowed directing the opposite party No.2 to pay to the complainant Rs.50,000/- with interest at 9% p.a. from 17.01.2007 till the date of realization. It is further directed to pay Rs.1,000/- towards costs of this complaint. This order shall be complied within one month from the date of receipt of this order. The C.C. against the opposite party No.1 is dismissed.
Typed to my written draft, corrected and pronounced by us in the open forum on this the 13th day of December, 2007.
Sd/- Sd/-
MALE MEMBER SENIOR MEMBER/
LADY MEMBER
Copy to
1) The Complainant
2) The Opp.Parties
3) Spare copy Copy delivered to the Complainant/
Opp.Parties On _____________
Dis.No. /2007, dt.
