BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri K.V.H. Prasad, B.A., LL.B., President
Smt C.Preethi, M.A., LL.B., Member
Sri R.Ramachandra Reddy, B. Com., LL.B., Member
Wednesday the 8th day of February, 2006.
C.C.No.124/2005
Gujjar Venkata Ramana Rao, S/o Late G.Hanumantha Rao, Aged about 43 years,
H.No.41-340-F4, Kotha Peta, KURNOOL, Kurnool Dist.
. . . Complainant
-Vs-
The Divisional Manager,Oriental Insurance Company Limited,
Bhupal Complex, Kurnool.
. . . Opposite party
This complaint coming on 7.2.2006 for arguments in the presence of Sri. P.Sivasudarshan, Advocate, Kurnool for complainant and Sri.Y.Jayaraju, Advocate, Kurnool for opposite party, and stood over for consideration, till this day, the Forum made the following.
O R D E R
(As per Smt. C.Preethi, Hon’ble Member)
1. This Consumer Complaint of the complainant is filed under Section 11 and 12 of C.P. Act, seeking a direction on the opposite parties to pay policy amount of Rs.1,00,000/- with 24% interest per annum from the date of accident till realisation, Rs.10,000/- towards compensation for mental agony, Rs.3,000/- as costs of the complaint and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The gist of the complaint of the complainant is that the complainant has obtained an individual Janata Policy bearing No.302/2000 dated 3-1-2000 for Rs.1,00,000/- and the policy was commenced from 3-1-2000 to 2-1-2005. On 18-6-2003 at about 9 am the complainant met with accident near Ballery Chowrasta, Kurnool while going on foot, an auto bearing No.AP1-2893 hit the complainant and sustained grievous injuries and was admitted in Govt. General Hospital, Kurnool and his left leg was amputed up to knee level and the complainant obtained a 60% disability certificate from Medical Board. The complainant while hospitalised addressed a letter to opposite party on 18-7-2003 intimating about the accident and amputation of his leg and there was no reply for the said letter and on 13-12-2004 addressed another letter requesting the opposite party to send claim form even to this letter there was no response, finally on 5-1-2005 the complainant got issued a legal notice. The opposite parties after receipt of legal notice replied vaguely for not sending claim form to the complainant. Hence, the complainant was constrained to file this complaint seeking redressal in this Forum.
3. The complainant in support of his case relied on the following documents viz. (1) Policy bearing No.47/2000/302 issued by opposite party to the complainant along with terms and conditions (2) Certified copy of F.I.R (3) C.C of wound certificate (4) Docket order of II SJSCM (5) Legal notice dated 5-1-2005 of complainants counsel to opposite party (6) Reply notice to Ex.A5 (7) Xerox copy of letter dated 18-7-2003 of complainant addressed to opposite party (8) Medical certificate issued by Medical Board to the complainant and (9) Case sheet of complainant, besides to the sworn affidavit of the complainant in reiteration of his complaint averments and the above documents are marked as Ex.A1 to A9 for its appreciation in this case. The complainant caused interrogatories to opposite party and suitabely replied to the interrogatories caused by the opposite party. The complainant also relied on the deposition of PW-1 Dr.H.Umanatha Rao.
4. In pursuance to the notice of this Forum as to this case of the complainant the opposite party appeared through their standing counsel and contested the case by filing written version.
5. The written version of opposite parties denies the complaint as not maintainable either in law or on facts. But admits the complainant has taken a policy bearing No.302/2000 and the same was valid up to 2-1-2005 for insured sum of Rs.1,00,000/-, but denies the complainant sustained injuries in an auto accident and his left leg was amputed up to knee level. It further alleges that it did not receive letters dated 18-7-2003 and 13-12-2004 nor received any intimation or notice from the complainant before to the legal notice. Therefore, the question of sending claim form does not arise and the claim is time barred. The claims will be entertained only when it is made within the time prescribed and fulfils the conditions of the policy. As a claim notice of the complainant was not made within the stipulated time the claim was not entertained and there is no deficiency of service on part of opposite parties and seeks for the dismissal of complaint with costs.
6. In substantiation of its case the opposite parties relied on its sworn affidavit and did not file any documents. The opposite party caused interrogatories to the complainant and replied suitabely to the interrogatories caused by the complainant.
7. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties:?
8. It is a case of the complainant that he has obtained an Individual Janata Personal Accident Policy vide Ex.A1 from opposite party covering the period 3-1-2000 to 2-1-2005 and the said policy covered the risk to the extent of Rs.1,00,000/- against accidental death or disablement. On 18-6-2003 the complainant met with accident which resulted in fractures to his left leg F.I.R. was lodged and the left leg of the complainant was amputed upto knee level. The complainant wrote two letters dated 18-7-2003 vide Ex.A7 and 13-12-2004 to opposite party, as he did not receive any reply legal notice dated 5-1-2005 vide Ex.A5 was served on opposite party and opposite party replied dated 7-2-2005 vide Ex.A6 stating that as per condition No.1 of the policy claim notice shall be given in writing and within one month if reasonable cause is shown, as no notice was received by opposite party within one month sending of claim form does not arise.
9. It is settled law that conditions of insurance policy are to be constituted so as to serve the main purpose of the very contract of insurance and not to defeat the same. It is not in dispute that the complainant suffered 60% permanent disability to his left leg as per the Medical Certificate issued by Medical Board vide Ex.A8 and deposition of RW-1, as such it would deprive him from doing his occupation throughout his life. It is in this sense disability to be viewed as having resulted in total and irrecoverable loss of left leg. Clause –(d) in Ex.A1 indicates that if such injury within one year of its occurrence be sole or direct causes permanently and total disability to the insured from engaging in being occupied with or giving attention to any employment whatsoever, the capital sum insured would be awarded. The policy of the complainant stood intact for 5 years and the complainant alone is entitle to the assured amount, but the opposite party rejected his request for assured amount on ground that intimation of accident was delayed and the complainant relied on the decision of Uttar Pradesh State Commission between L.I.C of India v/s Rajendra Singh Gaur reported in IV (2004) CPJ page 53, wherein, death it was held that intimation was delayed but the nominee completed all formalities therefore repudiation was held unjustifiable. After perusal of conditions 1 to 8 of said policy it is seen that there is no stipulation mentioned in the said conditions as to the time limit prescribed for giving intimation of accident by those insured persons who sustained permanent or total disability within a year of its occurrence and there is nothing in the conditions as to the consequences if intimation is delayed in cases of accident, if subsequently resulted in deaths/disablement (both permanent or total) hence, what appears is that such cases can be considered by the insurance company irrespective of time limit basing on the medical report and documents submitted by the insured. The Ex.A8 Medical Certificate dated 24-9-2003 issued by Medial Board to the complainant, it indicates that the complainant suffered 60% disability to his left leg, from the above exhibit it is clear that the complainant sustained disability, subsequent to the accident and there appears no such grave violation of policy condition that the complainant in all events be denied of insured amount.
10. In this case the complainant was hospitalised for three months and has to obtain disability certificate as disability occurred subsequent to accident and the opposite party could have condoned the delay and accepted the requests of the complainant for payment of assured amount with out insisting for one month period limitation and more so there is no period limit prescribed for disabilities occurred subsequent to the accidents in the conditions of said policy. The learned counsel for the complainant strongly relied on the unreported decision of our State Commission in F.A.No.590/2005 of C.D.No.305/2002, wherein, it was held that if accidents subsequently resulted in death/disablement such cases shall be consider irrespective of time limit basing on medical report. Hence, from the above there appears every deficiency of service from the opposite party’s side towards the complainant.
11. To conclude following the above mentioned decisions and from the discussions made above the complainant is certainly entitled to receive insured amount under the above mentioned policy as the complainant subsequent to the accident resulted in permanent disability up to 60% of his left leg as per Ex.A8.
12. In the result, the complaint is allowed directing the opposite party to pay insured amount of Rs.1,00,000/- to the complainant with 12% interest from the date of complaint till realisation along with Rs.5,000/- as costs within a month of receipt of this order.
Dictated to the Stenographer, transcribed by him corrected and pronounced by us in the Open Forum this the 8th day of February, 2006.
PRESIDENT
MEMBER MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: For the opposite party: Nil
Deposition of PW-1 (Dr.H.Umanatha Rao)
Exhibits Marked for the complainant:
Ex.A1 Policy bearing No.47/2000/302 issued by opposite party to the
complainant along with terms and conditions
Ex.A2 Certified copy of F.I.R
Ex.A3 C.C of wound certificate
Ex.A4 Docket order of II SJSCM
Ex.A5 Legal notice dated 5-1-2005 of complainants counsel to opposite party
Ex.A6 Reply notice to Ex.A5
Ex.A7 Xerox copy of letter dated 18-7-2003 of complainant addressed to opposite
party
Ex.A8 Medical certificate issued by Medical Board to the complainant
Ex.A9 Case sheet of complainant
Exhibits Marked for the opposite party: Nil
PRESIDENT
MEMBER MEMBER
Copy to:-
1. Sri. P.Sivasudarshan, Advocate, Kurnool
2. Sri. Y.Jayaraju, Advocate, Kurnool
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties on:
