BEFORE THE DISTRICT CONSUMER’S FORUM: KURNOOL
Present: Smt. S.Nazeerunnisa, B.A., B.L., Lady Member, President (FAC),
And
Sri.M.V.R.Sharma, B.A., Member
Friday the 19th day of June, 2015
C.C.No.94/2013
Between:
A.Purushotham Reddy, S/o A.Subba Reddy,
Hindu, Aged 45 Years, R/o Komarolu Village,
Orvakal Mandal, Kurnool District …Complainant
-Vs-
The Divisional Manager,
The Oriental Insurance Company Limited,
Above State Bank of Hyderabad,
Santhapeta, Ongole-523 001. …OPPOSITE PARTY
This complaint is coming on this day for orders in the presence of Sri.A.V.Subramanyam, Advocate for complainant and Sri.L.Hari Hara Natha Reddy, Advocate for opposite party and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Sri.M.V.R.Sharma, Member)
C.C. No.94/2013
1. This complaint is filed under section 11 and 12 of Consumer Protection Act, 1986 requesting this Forum to direct the opposite parties:-
(a)To pay the insured amount of Rs.2,00,000/- covered under policy with interest at 18% per annum from the date of accident till the date of realization.
(b)To pay a sum of Rs.50,000/- towards compensation for mental agony.
(c)To pay a sum of Rs.10 ,000/- towards cost of the complaint.
2. The complainant filed complaint and stated that:- The complainant was member of Maithri Services, which is insured its members lives with the opposite party (for short herein called as OP) under Nagarik Suraksha Accidental Policy bearing No.48/2008/241 and he paid the premium for above said policy. The opposite party issued Individual Certificate of Insurance No.88 dated 14.06.2007 covering the personal accident risk for Rs.2,00,000/- which included personal accidental risk of Rs.1,60,000/- and for Hospitalization for a sum of Rs.40,000/- for a period from 14.06.2007 to 13.06.2011.
It is further stated that on 04.03.2011 he met with road accident near Sitaramapuram Metta, Bethamcherla Police Station Limits and the above said police registered a case in Crime No.19/2011 in relation with said accident. Immediately after the accident, he informed the same to the opposite party and he availed treatment at C.N.Hospital, Kurnool. In result he lost his right leg he was completely amputated and thus he had become permanently disabled. The District Medical Board, Kurnool issued Disability Certificate with 70% disability and it is permanent. After discharge from hospital he made a claim under above said policy by enclosing all required documents i.e., F.I.R., Charge Sheet, Disability Certificate and Medical Bills etc., and also stated that he requested personally several times but the opposite party failed to settle the claim and he got issued Legal Notice on 18.01.2013 to the opposite party and his Head Office New Delhi. The opposite party received the said notice but neither settled the claim nor choose to give any reply. Hence the complaint.
3. The opposite party filed written version denying the allegation but admitted that the complainant was covered under Nagarik Suraksha Accidental Policy bearing No.48/2008/241 issued by this opposite party subject to the terms and condition, the above said policy period from 14.06.2007 to 13.06.2011. On 04.03.2011 the complainant met with road accident in the Bethamcherla P.S., and his right leg was completely amputated but he not informed this opposite party above said accident immediately after the accident and taken treatment in C.N.Hospital, Kurnool and did not submitted claim form along with required documents.
It is also stated that with regard to the complainant as per the terms of the policy in case of actual loss of one foot i.e., physical separation entire one leg the complainant is entitled only for 50% of sum assured as specified in the schedule of the policy. Even if the complainant is entitled for any amount the liability of the company is only Rs.80,000/- with regard to medical expenses the liability of the company is maximum up to 20% of the total sum insured for every 12 months of the policy period.
It is further stated that as per the terms of the policy all claims arising out of the policy issued by the company are subject to territorial jurisdiction of the issuing office only in this case the policy issued by Ongole Divisional Officer and the controlling office of the company is the Head Office situated at New Delhi hence this Honourable Forum has no jurisdiction to entertain the case and enquiry into the case and also stated that the Master Policy Holder i.e., Maithri Services is the necessary party to the proceedings. The Maithri Services has to conform that the complainant is the member of the said services. The complaint filed the above case without adding master policy holder to proceedings hence the complaint is bad for non joinder of necessary party. Hence this complaint is liable to be dismissed.
4. On behalf of the complainant Ex.A1 to Ex.A8 are marked and sworn affidavit of the complainant is filed. On behalf of the opposite party Ex.B1 is marked by consent and sworn affidavit of opposite party is filed. No oral evidence let in.
5. Both sides filed Written Argument.
6. Now the points that arise for consideration are:
- Whether there is deficiency of service on the part of opposite party?
- Whether the complainant is entitled for the reliefs as prayed for?
- To what relief?
7. POINTS i and ii:- The learned counsel appearing for the complainant contended that the complainant was a member of Maithri Services which insured its member lives with the opposite party under Nagarik Suraksha Accident Policy for sum of Rs.2,00,000/- for the period of 14.06.2007 to 13.06.2011 and also contended that he met with road accident and he had lost his right leg and it was completely amputated immediately after accident he informed the same to the opposite party so he entitled for the same with interest and costs.
Per contra learned counsel for opposite party contended that the complainant not informed immediately about the accident to this opposite party and as per terms and conditions of the policy in case of actual loss of one foot is entitled for 50% of the sum assured with regard to medical expenses is maximum up to 20% of the total sum assured for every 12 months.
8. In the present case on hand there is no dispute that the complainant is the member of Maithri Services which insured its member lives with the opposite party under Nagarik Suraksha Accident Policy. As seen from Ex.A1 the opposite party issued Individual Certificate of the Insurance No.88 dated 04.06.2007 for period from 14.06.2007 to 13.06.2011 to the complainant, covering the accident risk of complainant for Rs.2,00,000/- which includes personal accident risk of Rs.1,60,000/- and for Hospitalization a sum of Rs.40,000/-. On 04.03.2011 the complainant met with road accident near Sitaramapuram Metta, Bethamcherla P.S., Limits as seen from Ex.A2 it reveals that the Bethamcherla Police registered a case in Crime No.19/2011 in the relation in the said accident the complainant availed treatment at C.N.Hospital, Kurnool. As seen from Ex.A7 he lost his right leg and it was completely amputated and he incurred expenditure for treatment as per Ex.A6 Rs.39,359.50Ps., as seen from Ex.A3 it reveals that the Disability Certificate issued by the District Medical Board, Kurnool he suffered with 70% Disability and its permanent. After discharge from the Hospital the complainant submitted claim along with all required documents i.e., F.I.R., Charge Sheet, Disability Certificate and Medical Bills.
Though the opposite party contended that as per terms and condition of the policy physical separation entire one leg of the complainant is entitled for only 50% as sum assured with regard to medical expenditure up to 20% of the total sum assured for every 12 months.
9. As seen from Ex.B1 Nagarik Suraksha Policy terms and conditions, it is clearly shows that the loss of one hand/one foot/one eye the complainant eligible for 50% sum insured amount which amounts Rs.80,000/- for hospitalization on account of accident (on production of Bills) maximum up 20% of total sum insured for every 12 months of the policy period which amounts Rs.32,000/-.
Hence we opinied that the complainant is lost his right leg and he was completely amputated, the District Medical Board, Kurnool declared that the complainant suffering with 70% disability and its permanent. Hence the complainant is entitled for 50% of sum assured amount along with 20% of Medical Expenditure of every 12 months.
10. Point No.iii:-In the result, the complaint is partly allowed directing the opposite party liable to pay sum assured amount of Rs.80,000/- and to pay Rs.32,000/- towards medical expenditure, and also pay interest 9% per annum from the date of filing the complaint till the date of realization for above amounts and to pay Rs.2,000/- towards costs of the complaint to the complainant. Time for compliance is one month from the date of receipt of this order. Lest it will carry interest @ 12% per annum.
Dictated to the stenographer, typed by her, corrected and pronounced by us in the open bench on this the 19th day of June, 2015.
Sd/- Sd/-
MEMBER PRESIDENT (FAC)
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: Nil For the opposite party: Nil
List of exhibits marked for the complainant:-
Ex.A1 Photo copy of Individual Certificate of Insurance issued by opposite party in favour of complainant dated 14.06.2007.
Ex.A2 Photo copy of FIR in Crime No.19/2011 of Betamcherla P.S.
Ex.A3 Photo copy of Disability Certificate issued by District Medical Board, Kurnool in favour of complainant.
Ex.A4 Photo copy of Legal Notice dated 18.01.2013.
Ex.A5 Postal Receipt and Acknowledgement
Ex.A6 Photo copy of Discharge Card.
Ex.A7 Photograph.
Ex.A8 Photo copy of Secondary School Certificate
List of exhibits marked for the opposite party:-
Ex.B1 Photo copy of Individual Certificate of Insurance issued by opposite party in favour of complainant dated 14.06.2007 along with terms and conditions.
Sd/- Sd/-
MEMBER PRESIDENT (FAC)
// Certified free copy communicated under Rule 4 (10) of the A.P.S.C.D.R.C. Rules, 1987//
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