Date of filing : 19-08-2005<br /> Date of Order :22-07-2008<br /> <br /> IN THE CONSUMER DISPUTES REDRESSAL FORUM, KASARAGOD<br /> CC.No.133/05<br /> Dated this, the 22nd day of July 2008<br /> PRESENT<br /> SRI.K.T.SIDHIQ : PRESIDENT<br /> SMT.P.RAMADEVI : MEMBER<br /> SMT.P.P.SHYMALADEVI : MEMBER<br /> <br /> Samikutty,<br /> S/o.Raman, } Complainant<br /> Adkathbail Beach,<br /> Po.Kasaragod Taluk & Dist.<br /> <br /> 1. The Commissioner,<br /> Kerala Fishermen’s Welfare Fund Board, } Opposite parties<br /> Head Office, Trichur.1<br /> 2. The Managing Director,<br /> Matsyafed, Karuvankonam,<br /> Thiruvananthapuram.<br /> 3. The Divisional Manager,<br /> National Insurance Co, Ltd,<br /> Trissur Branch, Trissur.<br /> 4. The General Manager,<br /> National Insurance Co.Ltd,<br /> P.B.No.89, Soundarya Building,<br /> M.G.Road, Trivandrum.<br /> <br /> O R D E R<br /> SRI.K.T.SIDHIQ, PRESIDENT<br /> <br /> <br /> The short question arises for consideration in this complaint is whether the injuries sustained to the complainant entitled him to get the insurance benefits covered under the Janata personal accident policy.<br /> 2. Admittedly Samikutty, the complainant here in was a fisherman who sustained grievous injuries while fishing in the high seas. He being a beneficiary of the Janata Personal Accident Insurance policy, submitted his claim for benefits before the Kerala Fishermen’s Welfare Fund Board, Opposite party No.1 herein. It is also the case of Samikutty that he is also a member of Janata Personal Accident Insurance scheme facilitated by Matsyafed the Opposite party No.2. But according to Samikutty his claim for insurance benefits were not honoured by the opposite parties 1 & 2.<br /> 3. In respose to the notice issued, the Commissioner, Kerala Fisherman Welfare Fund Board (for short KFWFB) and Managing Director, Matsyafed entered appearance and filed their versions. According to KFWFB the complaint is bad for non-joinder of insurance company and Samikutty has not produced the Disability Certificate from Medical Board as demanded by the Insurance Company.<br /> 4. The Matsyafed filed their version. According to them even though Samikutty was a member of the JPA scheme facilitated by Matsyafed, he doesnot filed any claim application through the concerned Fisherman Development Welfare Co-op Society.<br /> 5. The Supplemental Opposite parties the Divisional Manager, National Insurance Company Ltd, Trissur and General Manager, National Insurance Company, Trivandrum who were impleaded on the application of Samikutty entered appearance and according to them Samikutty has not produced the disability certificate inspite of their intimations to KFWF Board. The further contentions of National Insurance Company Ltd is that the Samikutty has not sustained any permanent total disability which absolutely disabling him from engaging or giving attention to any employment or occupation of any description. Since Samikutty has not performed his part the claim is not allowed.<br /> 6. Samikutty filed affidavit in support of his claim, Exts A1 to A15 marked in his side. He called for the claim file relating to his claim submitted before Life Insurance Corporation of India. The copy of the said claim file is produced and marked as X1. KFMWF Board produced Exts B1 to B5, for Matsyafed. Ext.B6 is marked. National Insurance Company Ltd produced Ext.B7.<br /> 7. According to Samikutty, the injuries sustained were grievous in nature and he had permanent disability of 50%. He is relying on the claim file submitted before Life Insurance Corporation of India to prove his case. Some of the certificates of doctors in X1 shows that Samikutty is having 50%(permanent disability) and 60% permanent disability.<br /> 8. As per Janata Personal Accident Policy the Insurance Company will indemnify the insured if the insured shall sustain any bodily injury resulting solely and directly from accident caused by outward violent and visible means that is to say<br /> a) If such injury shall within six calender months of its occurrence be the sole and direct cause of the death of the insured the Capital Sum Insured the Capital Sum insured Stated in the Schedule. The amount payable under this clause shall be paid to the Nominee shown in the Schedule.<br /> b) If such injury shall within six calender months of occurrence be the sole and direct cause of the total and irrecoverable loss of sight of both eyes or of the actual loss by physical separation of two entire hands or two entire feet or of one entire has and one entire foot or of such loss of sight of one eye and such loss of one entire hand or one entire foot the Capital Sum insured stated in the Schedule.<br /> c) If such injury shall within six calender months of its occurrence be the sole and direct cause of the total and irrecoverable loss of sight one eye or of the actual loss by physical separation of one entire hand or one entire foot fifty percent (50 percent) of the Capital Sum insured stated in the Schedule)<br /> d) If such injury shall within six calendar months of its occurrence be the sole and direct cause of permanently totally and absolutely disabling the insured from engaging in being occupied with or giving attention to any employment or occupation of any description whatsoever the Sum insured stated in the Schedule. <br /> 9. As per the clause (d) above it is vivid that the insured is entitled for benefits if he is incapacitated to do any work. But in X1 series the doctor has stated that Samikutty is doing some other job which do not need hard work.<br /> 10. So it is clear that the injury sustained to Samikutty will not come within the scope of clause(a) to (d) of the JPA policy which entitles him to get the benefits.<br /> 11. Moreover the non-production of Medical Certificate as required by the insurer also casts a serious doubt about the degree of disability caused to Samikutty. Had there been such a disability which make him eligible for the claim then Samikutty should have been produced the Medical Certificate as required.<br /> 12. For the foregoing reasons we do not find any deficiency in service on the part of opposite parties in not honouring the claim of Samikutty. Hence the complaint fails and accordingly we hereby dismiss the complaint. No cost.<br /> Sd/- Sd/- Sd/-<br /> MEMBER MEMBER PRESIDENT<br /> Exts.<br /> A1. 20-11-2001. Copy of Lawyer notice.<br /> A2.14-12-2001 Reply notice.<br /> A3. Pass book.<br /> A4. Identity Card<br /> A5.Photo copy of Discharge Summary<br /> A6. Photocopy of Discharge Summary<br /> A7. Photo copy of disability certificate<br /> A8. Treatment Certificate<br /> A9.3-6-02 letter sent by OP to complainant<br /> A10. Post card issued by OP to complainant <br /> A11 (a to a.Q) series photo copies of Medical Bills.<br /> A12.26-4-01. Photo copy of Receipt issued by Adkathbail Fishermen <br /> Development WelfareCo.op Society.<br /> A13. 21-1-02. Photo copy letter sent by complainant to OP No.1.<br /> A14. 5-1-02. Application for Disability Compensation.<br /> A14(a)Application again submitted for disability benefit<br /> A15. X-ray of the complainant.<br /> <br /> B1.Copy of Claim Form.<br /> B2. Copy of Disability certificate<br /> B3. 9-7-03 Letter sent by National Insurance Co.Ltd to Commissioner,Kerala<br /> Fishermen’s Welfare Fund Board, Thrissur.<br /> B4.Copy of Investigation Report.<br /> B5. 24-10-03 Letter sent by Matsya Board, Kozhikkode to complainant.<br /> B6. Extract or resolution dtd.24-06-08 Adkathbail Fishermen Development <br /> Welfare Co-op.Society.<br /> B7.Attested true copy of the Policy.<br /> <br /> X-1. Documents in respect of EPDB Claim of Samikutty.<br /> <br /> Sd/- Sd/- Sd/-<br /> MEMBER MEMBER PRESIDENT<br /> <br /> Pj/ Forwarded by Order<br /> <br /> <br /> SENIOR SUPERINTENDENT<br />