Karnataka

Chitradurga

CC/99/2015

C.Suputrappa S/o. Channabasappa - Complainant(s)

Versus

The Branch Manager, Oriental Insurance Co.Ltd., - Opp.Party(s)

Shri.Ningappa C

05 Dec 2016

ORDER

 

 

COMPLAINT FILED ON:03.12.2015

DISPOSED      ON:05.12.2016

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHITRADURGA.

 

CC.NO: 99/2015

 

DATED:  5^th DECEMBER 2016

PRESENT: - SRI. T.N. SREENIVASAIAH  : PRESIDENT                                   B.A., LL.B.,

                   SRI.N. THIPPESWAMY        MEMBER

                                         B.A., LL.B.,                   

……COMPLAINANT	C. Suputrappa, S/o Channabasappa, Age: 55 Years, R/o Near Karuvinakatte Circle, Kabeeranandaswamy Mat Agalu, Chitradurga.   (Rep by Sri. C. Ningappa, Advocate)
V/S
…..OPPOSITE PARTIES	The Branch Manager, Oriental Insurance Co., Sri Sharada Complex, Opp: KSRTC Bus Stand, Chitradurga.   (Rep by Sri. L.Madhusudhan, Advocate)

ORDER

SRI. T.N. SREENIVASAIAH:   PRESIDENT

The above complaint has been filed by the complainant u/Sec.12 of the C.P Act, 1986 for the relief to direct the OP to pay Rs.1,00,000/- with interest at 12% p.a, Rs.1,00,000/- towards compensation, cost and such other reliefs.

2.      The brief facts of the case of the above complainant are that, complainant is doing masonry work for his livelihood, has taken Janata Personal Accident Insurance Policy from OP on 04.02.1999 bearing policy No.42210/47/1999/4966 valid for the period from 04.02.1999 to 03.02.2011 by paying premium of Rs.300/- for Rs.1,00,000/- covering the risk of irrecoverable loss of use of two hands or two feet or one hand etc.  It is further submitted that, he sustained compression fracture of L-5 vertebra on 08.08.2010 due to collapse of wall of his house due to rain.  After the said injury, complainant admitted to Government Hospital, Chitradurga for treatment on 08.08.2010 and discharged on 22.08.2010 and he was suffering from paraplegia in respect of Limbs and he is having 75% total permanent disability and not able to perform his routine works and also masonry work.  Complainant personally issued notice on 11.01.2011 and on 17.01.2012 to the OP requesting to pay the amount under the policy.  Later on 25.10.2012 issued legal notice through Advocate, for which OP replied to the notice stating that, the policy issued to the complainant already cancelled as per the instructions of Regional Office.  Later OP issued intimation to the complainant through RPAD on 06.11.2012 to apply afresh along with claim intimation.  Complainant approached OP several times up to February 2015 but, OP drag on the matter on one or the other reason and at last refused to receive any claim from the complainant.  It is further submitted that, when once the policy is issued under the terms and conditions, no option is opened to the OP to cancel the policy unilaterally, the same amounts to deficiency of service on the part of OP, therefore, prayed for allowing the complaint. 

3.      On service of notice OP appeared through                    Sri.L. Madhusudhan, Advocate and filed version stating that, the complainant has obtained Janatha Personal Accident Insurance Policy from OP for the period from 04.02.1999 to 03.02.2011 subject to terms and conditions and the sum assured under the policy is Rs.1,00,000/-.  But, it is false to state that, the complainant has sustained compression fracture of L-5 vertebrae on 08.04.2010 due to collapse of wall of his house due to rain and he was admitted to Government Hospital, Chitradurga on 08.08.2010 to 22.08.2010 and he was suffering from paraplegia with 75% of total permanent disability and not able to perform any of his routine work and also his masonry work.  It is false to state that, complainant approached OP several times up to February 2015 and OP has drag on the matter and also false to state that, once the policy is issued there is no option to the OP to cancel the policy unilaterally.  It is further submitted that, after receipt of legal notice, on 06.11.2012 OP issued a letter to the Advocate for complainant by sending claim form to fill and submit the claim form along with required documents like Claim Intimation, Copy of Policy, Explanation letter for delay in intimation, Fully completed claim form duly signed, Original Hospital Bills, Original Discharge Summary, Indoor Hospital Case Papers and Original Disability Certificate but, the complainant did not turn up to furnish the same.  It is further submitted that, OP came to know that, the policy issued to the complainant was cancelled long back for the reason that, all the long term policies were cancelled by R.O with an intimation to the concerned Policy Holders, the same is known to the complainant.  The OP being an insurer has a right and discretion to cancel the policy with an intimation to the policy holder and therefore, there is no deficiency of service on their part and prayed for dismissal of the complaint.                

4.      Complainant has examined as PW-1 by filing affidavit evidence and the documents Ex.A-1 to A-14 were got marked. On behalf of OPs, one Sri.H.N. Govindaraj, Divisional Manager has examined as DW-1 by filing the affidavit evidence and no documents have been got marked.   

5.      Arguments of both sides heard.

6.      Now the points that arise for our consideration for decision of above complaints are that;

(1)  Whether the complainant proves that the OPs have committed deficiency of service in settling the claim made by him and entitled for the reliefs as prayed for in the above complaint?

              (2) What order?

          7.      Our findings on the above points are as follows:-

          Point No.1:- Partly in Affirmative.

          Point No.2:- As per final order.

REASONS

8.      It is not in dispute that, complainant is a mason by profession has taken Janata Personal Accident Insurance Policy bearing No.42210/47/1999/4966  from OP on 04.02.1999 valid for the period from 04.02.1999 to 03.02.2011 by paying premium of Rs.300/- and the sum assured was Rs.1,00,000/- covering the risk of irrecoverable loss of use of two hands or two feet or one hand etc.  He sustained compression fracture of L-5 vertebra on 08.08.2010 due to collapse of wall of his house due to rain.  Therefore, he admitted to Government Hospital, Chitradurga for treatment on 08.08.2010 and discharged on 22.08.2010 and due to the same, he was suffering from paraplegia in respect of Limbs and he is having 75% total permanent disability and not able to perform his routine work.   On 25.10.2012 he issued legal notice through Advocate, for which OP replied to the notice stating that, the policy issued to the complainant already cancelled as per the instructions of Regional Office.  Bit, later OP issued intimation to the complainant through RPAD on 06.11.2012 to apply afresh along with claim intimation.  Complainant approached OP several times up to February 2015 but, OP refused to receive any claim from the complainant.  It is argued by the complainant that, when once the policy is issued, no option is opened to the OP to cancel the policy unilaterally, the same amounts to deficiency of service on the part of OP.

9.      In support of his contention, the complainant has filed his affidavit evidence and reiterated the contents of complaint and relied on the documents like Original Policy marked as Ex.A-1, letter dated 11.01.2011 by the complainant to Oriental Insurance Company, Chitradurga marked as Ex.A-2, Postal acknowledgement marked as Ex.A-3, Letter dated 28.03.2012 to the complainant marked as Ex.A-4, Legal notice dated 25.10.2012 with postal receipt marked as Ex.A-5, Ex.A-6 is the Postak acknowledgement, Reply to the notice marked as Ex.A-7, Accident Claim Form marked as Ex.A-8, letter dated 17.01.2012 by the complainant to OP marked as Ex.A-9, letter dated 02.01.2013 by the District Surgeon, Chitradurga to one S.A. Narayanamurthi marked as Ex.A-10, Referral Card marked as Ex.A-11, Voter ID of complainant marked as Ex.A-12, Medical Certificate marked as Ex.A-13 and Certificate of Disability marked as Ex.A-14.

10.    On the other hand, it is argued by the OP that, the complainant has obtained Janatha Personal Accident Insurance Policy from OP for the period from 04.02.1999 to 03.02.2011 subject to terms and conditions and the sum assured under the policy for a sum of Rs.1,00,000/- but, denied the fact that, the complainant has sustained compression fracture of L-5 vertebrae on 08.04.2010 due to collapse of wall of his house due to rain and about complainant admitted to Government Hospital, Chitradurga on 08.08.2010 to 22.08.2010 and he was suffering from paraplegia with 75% of total permanent disability and not able to perform any of his routine work and also his masonry work and also denied that,  once the policy is issued there is no option to the OP to cancel the policy unilaterally.  After receipt of legal notice, on 06.11.2012, OP issued a letter to the Advocate for complainant by sending claim form to fill and submit the claim form along with required documents but, the complainant did not turn up to furnish the same.  Thereafter, OP came to know that, the policy issued to the complainant was cancelled long back for the reason that, all the long term policies were cancelled by R.O with an intimation to the concerned Policy Holders, the same is known to the complainant.  The OP being an insurer has a right and discretion to cancel the policy with an intimation to the policy holder.  Therefore, there is no deficiency of service on its part.

    11.   On hearing the rival contentions of both parties and on perusal of the documents including the affidavit and documentary evidence, it clearly made out that, the complainant took Janata Personal Accident Insurance Policy bearing No.42210/47/1999/4966 from OP on 04.02.1999 for the period from 04.02.1999 to 03.02.2011 by paying premium of Rs.300/- and the sum assured was Rs.1,00,000/- covering the risk of loss of use of two hands or two feet or one hand etc.  It is pertinent to note that, on 08.08.2010 he sustained compression fracture of L-5 vertebra due to collapse of wall of his house due to rain.  At that time the policy was in force.  Therefore, he submitted a claim form but, the OP refused to receive the claim from the complainant.  It is pertinent to note that, Ex.A-1, the insurance policy at serial No.(c) it is mentioned that, if such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of sight one eye or total and irrecoverable loss of use of a hand or a foot, fifty percent (50%) of the capital sum insured stated in the schedule hereto.  So, in this case, the complainant sustained compression fracture of L-5 vertebra.  It is evident from the endorsement given by District Hospital, Chitradurga dated 04.07.2011 i.e, Ex.A-13, wherein it has been mentioned that, the complainant sustained injuries to his waist and the disability is 75%.   It is also evident from Ex.A-14 that, complainant is physically disabled and has 75% permanent physical impairment in relation to his limbs.   So, in our considered view, the complainant has suffered permanent physical disability and he could not do any work during his life.  He sustained injuries to his L-5 Vertebra on 08.08.2010 due to collapse of wall of his house on that date, the policy was in force and the total insured value comes to Rs.1,00,000/-, as per policy terms and conditions, the OP is liable pay 50% of the insured amount but, the OP insurance company has refused pay the amount, which cannot be acceptable.  So, in our considered view, the OP has committed deficiency of service.  Accordingly, this Point No.1 is held as partly affirmative to the complainant.           

            12.     Point No.2:- As discussed on the above point and for the reasons stated therein we pass the following:-

ORDER

The complaint filed by the complainant U/s 12 of CP Act 1986 is partly allowed.

It is ordered that, the OP is hereby directed to pay a sum of Rs.50,000/- along with interest at the rate of 9% p.a from the date of filing of the complaint till realization. 

It is further ordered that, the OP is hereby directed to pay Rs.10,000/- towards compensation towards mental agony to the complainant.  

It is further ordered that, the OP is hereby directed to pay Rs.5,000/- towards costs of this proceeding.  

It is further ordered that, the OP is hereby directed to comply the above order within 30 days from the date of this order.

 

 (This order is made with the consent of Member after the correction of the draft on 05/12/2016 and it is pronounced in the open Court after our signatures)         

 

                                     

 MEMBER                                                   PRESIDENT

-:ANNEXURES:-

Witnesses examined on behalf of Complainant:

PW-1:  Complainant by way of affidavit evidence.

Witnesses examined on behalf of OPs:

DW-1:  Sri. H.N. Govindaraj, Divisional Manager of OP by way of affidavit evidence. 

Documents marked on behalf of Complainant:

01	Ex-A-1:-	Original Policy
02	Ex-A-2:-	Letter dated 11.01.2011 by the complainant to Oriental Insurance Company, Chitradurga
03	Ex-A-3:-	Postal acknowledgement
04	Ex-A-4:-	Letter dated 28.03.2012 to the complainant
05	Ex-A-5:-	Legal notice dated 25.10.2012 with postal receipt
06	Ex-A-6:-	Postal acknowledgement
07	Ex-A-7:-	Reply to the notice
08	Ex.A-8:-	Accident Claim Form
09	Ex.A-9:-	Letter dated 17.01.2012 by the complainant to OP
10	Ex.A-10:-	Letter dated 02.01.2013 by the District Surgeon, Chitradurga to one S.A. Narayanamurthi
11	Ex.A-11:-	Referral Card
12	Ex.A-12:-	Voter ID of complainant
13	Ex.A-13:-	Medical Certificate
14	Ex.A-14:-	Certificate of Disability

Documents marked on behalf of OPs:

-Nil-

MEMBER                                                            PRESIDENT

Rhr**