Orissa

Rayagada

CC/304/2015

B. Sinivas - Complainant(s)

Versus

The Branch Manager, HDFC, Bank Rayagada - Opp.Party(s)

Self

18 Aug 2016

ORDER

DISTRICT   CONSUMER  DISPUTES REDRESSAL    FORUM, RAYAGADA

  C.C. Case  No.304/ 2015.

                                                                       

 P R E S E N T .

Sri Pradeep Kumar Dash, LL.B,                             President.

Sri Gadadhara Sahu,B.Sc.                                     Member.

            B.Srinivas,S/o Late Tabitinaidu Barji, of Eddu Street near Congress             Bhaban, Po/Ps/Dist. Rayagada.                                                                                                                                                                                           …….Complainant

                                                            Vrs.

1.         The Branch  Manager, HDFC ERGO General Insurance Company Ltd.,Rayagada,Po/Ps/Dist. Rayagada.

2.         Duly constituted Attorney,HDFC Ergo General Insurance Company Ltd.,6^th Floor,Leela Business Park,Andheri Kurla Road, Andheri(East),Mumbai-400059.

3.         Bancassurance Claims teama,HDFC ERGO General Insurance aCo. Ltd.,Mumbai-   400059.                                                                                   …..…..Opp.Parties

Counsel for the parties:

For the complainant: In Person

For the O.Ps: Sri K.Ch.G.S.Kumandan, Advocate ,Rayagada.

                                                                JUDGMENT

The  gist of the complainant is that  the complainant is a policy holder  of OKP Insurance Company vide Policy No.2950200664102500000 and the policy is valid from 21.01.14 to 20.01.14 and the complainant met with an accident on 19.12.14 for which  case was registered at Gunupur P.S vide FIR No.144/2014 and to  the accident the petitioner was partially disabled . Specialist  of the Dist.Head quarters hospital has granted the disability certificate and for his partial disability, the petitioner is entitled to get Rs.1,50,000/-  as per the policy coverage. After the accident the complainant rushed to the OP 1 and put forth  his grievances for getting the insurance amount but  in spite of his repeated request  the OP 1 turned deaf ear to his request and till date the  OP 1 has not given the said amount  for which the complainant mentally depressed  and suffered mental agony. Hence, prayed to direct the Ops to pay the insurance amount of aRs.1,50,000/-  with interest and award monetary compensation of aRs.1,00,000/-  for mental agony and financial los and litigation and such other relief as the forum deems fit and proper.  Hence, this complaint.

The O.Ps appeared through their learned counsel and  file counter inter alia denying the petition allegations on all its material particulars. It is submitted by the Ops that the complainant has suppressed material information  and has attempted to mislead  this Hon’ble Forum. The relief claimed by the complainant is not available to be granted  since the same is opposed to the terms and conditions of the policy. The repudiation  of the claim by the Ops  is in accordance with the terms and conditions of the policy which can  never be termed as deficiency in service and unfair trade practice. The disability certificate issued by the treating doctor is 80% temporary disability of limb and the disability being a temporary one is not covered under the policy conditions as the policy  only covers permanent total disability and permanent partial disability. The instant case of the petitioner for treatment related to the injury of upper limb and facture of right tibia which does not false under permanent disablement benefit. In the circumstances, there is no deficiency in service  and hence  the complaint  is liable to be dismissed.

It is the cardinal principle of insurance law that the insurer is in the position of a trustee as it is managing the common fund for and on behalf of the community of policy holders. It has to ensure that nobody is allowed to take undue advantage of the arrangement. That means the management of the insurance business requires care to prevent entry(into group) of people  whose risks are not of the same kind as well as paying claims on losses that are not accidental. The Management of insurance companies are required to keep this aspect in mind and make all its decisions in  ways that benefit  the community. This applies also to its investments.  . The life insurance policy is a contract, in terms of the Indian Contract Act.  A contract is an agreement between two or more parties to do, or not do, so as to create a legally binding relationship. Here in this case the complainant was asked  to pay  the  premium   explaining the benefits contained therein and when the  complainant  claims insurance  benefit after his accident, the Ops  taking different plea  to settle the claim which is not acceptable by this forum.

We have gone through the complaint petition and documents available in the record. This forum by relying upon a citation passed by National Commission, New Delhi in the New India Assurance Co. Ltd., Versus M/s Sukhadham India Pvt. Ltd.,2011(1) CPR 191 such as :- “ Insurance Company must settle claim without delay”. In the light of the above decision of law we allow the case.

Hence it is ordered.

                                                                             ORDER

                        In the result the complaint petition is allowed on contest. We ordered  the O.ps to  pay the claim amount  as applicable to the complainant  with    compensation of Rs.2,000/-  for mental agony and cost of litigation.

                        The O.Ps are directed to make the aforesaid payment within 30 days from the date of receipt of this order failing which the OP is liable to pay 9% interest on the above amount  and the  complainant is at liberty to take further proceeding U/s 25 and 27 of the C.P.Act.

            Pronounced in open forum today on this 23^rd of  November,2016 under the seal and signature of this forum.

                         A copy of this order as per the statutory requirements , be forwarded to the parties    free of charge.

 

Member                                                                                               President

Documents relied upon:

 

By the complainant:

1. Copy of letter issued by the O.ps to the complainant.
2. Copy of Policy schedule
3. Copy of certificate  for the purpose of deduction of income tax.
4. Copy of Form II – Disability Certificate
5. Copy of Sarv Suraksha- Claim Document Checklist
6. Copy of FIR
7. Copy of Medical final bills.

By the O.Ps. Nil

 

 

                                                                                                 President