Date of filing : 06-06-2012
Date of order : 26-05-2014
IN THE CONSUMER DISPUTES REDRESSAL FORUM, KASARAGOD
CC.194/2012
Dated this, the 26th day of May 2014
PRESENT:
SMT.P.RAMADEVI : PRESIDENT
SMT.K.G.BEENA : MEMBER
SMT.SHIBA.M.SAMUEL : MEMBER
1 T.Ganesh Bhat, S/o.Late Shankara Bhat, : Complainants
Mithala House, Kuloor village, Po.Charla,
Manjeshwar.671323
2 Bhuvaneshwari, W/o.T.Ganesh Bhat
Mithala House, Kuloor village, Po.Charla,
Manjeshwar.671323
(Adv.M.Vittala, Kasaragod)
The Divisional Manager, : Opposite party
United India Insurance Co.Ltd, MG Road,
Kasaragod. Po. 671121.
(Adv.C.Damodaran, Kasaragod)
O R D E R
SMT.K.G.BEENA, MEMBER
The grievance of the complainant No.1 is that he has availed a group insurance policy in 2009 from opposite party to cover the risk occurred in the course of agricultural operation. Complainant No.1 fell down from a tree on 11-01-2010 during the course of agricultural activity. Due to said accident he had serious injury on the spinal cord and was confined to bed. Complainant No.1 lodged a claim dated 16-03-2010 with all medical reports before opposite party but opposite party has not settled the claim. Complainant sent a lawyer notice dated 7-4-2012 calling upon opposite party to settle the claim for which they sent reply stating that the claim cannot be honoured with the disability certificate produced by her. Hence the complaint for necessary redressal.
2. Advocate Sri.C.Damodarn filed vakalth and version on behalf of opposite party. According to opposite party the complaint is not sustainable policy coverage for Rs.50,000/- incase of death and Rs.25000/- incase of loss of limb or eye is admitted by the opposite party in their version. Another contention raised by opposite party is that there is more than 2 months delay in lodging the claim. As per policy condition claim should have been preferred immediately and documents are to be produced by the complainant. As per disability certificate produced by the complainant 75% in relation to spine and there is no loss of limb or permanent disability. Production of original documents are highly necessary to settle the claim.
3. Complainant filed IA 365/12 to implead the Manager, North Malabar Gramin Bank Miyapadavu branch as supplemental opposite party No.2 IA dismissed on the ground that the opposite party No.2 is not a necessary party.
4. Complainant produced documents. Exts A1 to A15 marked. Exts B1 to B3 on the side opposite party. For Complainant Adv.M.Vittala filed argument notes. Opposite party heard.
5. The question raised for consideration are:
1 Whether there is deficiency in service in repudiating the claim?
2 If so what is the relief?
6. Issue No.1: Opposite party in their version admitted the issuance of policy to the complainant in 2009. The policy was issued to the complainant as an agriculturist to cover the risk occurred in the course of agricultural operation. Unfortunately the complainant fell down from a tree on 11-02-2010 after one year from the issuance of policy and was seriously injured to the spinal cord and confined to bed.
7. The documents submitted by the complainant Exts A5 to A15 proves that the complainant was undergoing treatment from 11-01-2010 to 22-02-2010 complainant submitted the claim before opposite party on 16-03-2010 considering the gravity of the injury and the circumstances of the complaint, there is no delay in submitting the claim. In Ext.A2 reply notice opposite party admits insurance coverage for a sum of Rs.50,000/- incase of death or 100% permanent total disability. As per Ext.A12 the disability of the complainant is 75% in relation to spine. Eventhough the doctors recommended for a compensation of Rs.1,00,000/- as per the terms of the risk coverage policy under Kisan Credit Card Scheme is only Rs.50,000/- is available. The policy will cover the Kisan Credit Card holders up to the age of 70 years and whose names are declared by the banks and in respect of whom the premium is paid by the banks to the insurance company. In Ext.B3 also (List prepared and passed by the insurance company) complainant’s name is included. But opposite party failed to pay the amount in time or inform the reason for the delay. The act of opposite party amounts to deficiency in service. Complainant was constrained to wait last 4 years for the refund of the insurance amount.
8. When an injury is related to spine and if it is 75% then it should be considered as 100% permanent disability 100% disability to whole body is nothing but a stable corpus and it is a case of death. When spine is not functioning and injury is caused to it insurance company is liable to honour the claim.
In Ruabiky V George D Cruz 1961 Kerala 108 it was held that injury to spine to be considered as total disablement.
Therefore the complaint is allowed and opposite party is directed to pay Rs.50,000/- with10% interest per annum from 16-03-2010 till payment with Rs.25,000/- as damages and Rs.2000/- as cost. Time for compliance is 30 days from the date of receipt of copy of this order.
Sd/- Sd/- Sd/-
MEMB ER MEMBER PRESIDENT
Exts.
A1.7-4-12 Copy of lawyer notice.
A2.17-4-2012 reply notice.
A3.23-1-10 Medical Certificate for availing financial assistance for treatment issued by Thejaswini
Hospital, Mangalore to T.Ganesh Bhat.
A4.17-02-10 Recommendation with report issued by Dr.Mahesha.K.
A5. Photo copy of Discharge summary of Ganesh Bhat.
A6. Photocopy of Discharge Bill
A7. 22-1-2010 Photocopy of Receipt issued by Dr.Mahesha.K. to Ganesh Bhat towards professional
Charges for an amount of Rs.8000/-
A8.21-1-2010 Photocopy of Receipt for Instrument charges for Rs.4000/-
A9.22-01-10 Photocopy of Receipt for Physician Charges for Rs.500/-
A10.21-01-2010 photocopy of Receipt for Anaesthetist charges for Rs.4000/-
A11.16-1-10 receipt issued by Lions Centre for the physically handicapped Mangalore.
A12. 05-09-2011 Photocopy of Certificate for the persons with disabilities.
A13. Photocopy of pass book of Ganesh Bhat
A14. Photo copy of Bill issued by Medico Dynamics, Palakkad Monolock Polyscrew and Connection Road
For an amount of Rs.35,200/-
A15.Photocopy of bill issued by Deepa Jyothi Enterprises for an amount of Rs.8160/-
B1.Copy of claim form
B2.copy of certificate for the persons with disability.
B3.copy of policy.
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
Pj/ Forwarded by Order
SENIOR SUPERINTENDENT
