Complaint is filed on 22-1-2009
Compliant disposed on 20-1-2011
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM::AT:: KARIMNAGAR
PRESENT: HON’BLE SRI K. DEVI PRASAD, B.Sc., LL.B., PRESIDENT
SMT. E. LAXMI, M.A.,LL.M.,PGDCA (CONSUMER AWARENESS), MEMBER
SRI. K. CHANDRA MOHAN RAO, B.Com., LL.B., MEMBER
THURSDAY, THE TWENTY DAY OF JANUARY, TWO THOUSAND ELEVEN
CONSUMER COMPLAINT NO. 10 OF 2009
Between:
D.Venkateshwarlu, S/o. Komraiah, Age 42 years, Occ: Former-Electrician (Surface), Area workshop, RG-I area, (E.C. No.0809763), The S.C.Co. Ltd, Godavarikhani, R/o. H.No.D/1242, Jawahar Nagar, Godavarikhani, District Karimnagar – 505 209.
…Complainant
AND
- The Singareni Colleries company limited, Rep. by its General Manager, Ramagundam Area-I, Post Godavarikhani, district Karimnagar – 505 209.
- New India Assurance Co. Limited Rep. by its Branch Manager, 9-3-143, 1st Floor, Old Clud Road, Near Vinod Mahal, Khammam-507 001.
- New India Assurance Co. Limited Rep. by its Branch Manager, 3-5-83, 1st Floor, Osmanpura, Karimnagar city-505 001.
…Opposite Parties
This complaint is coming up before us for final hearing on 4-1-2011, in the presence of Sri G. Ramulu and R. Venkataiah, Advocates for complainant and Sri G. Narayana Reddy, Advocate for opposite party no.1 and Sri K. Madhava Rao, Advocate for opposite party no.2 & 3, and on perusing the material papers on record, and having stood over for consideration till this day, the Forum passed the following
::ORDER::
1. This complaint is filed under Section 12 of C.P.Act, 1986 seeking direction to the opposite parties to pay an amount of Rs.1,00,000/- towards the sum assured under JPA Policy with interest and costs of the complaint.
2. The brief averments of the complaint are that the complainant was working as electrician in Area Workshop of opposite party no.1. For the purpose of benefit of it’s employees the opposite party no.1 obtained Janata Group Personal Accident benefit policy from the opposite party no.2 and no.3 by paying the Insurance Premium by way of salary deduction. The opposite parties no.2 and no.3 issued said policy undertaking to pay an amount of Rs.1,00,000/- in case of accidental death of the policy holder or sustaining permanent disability. On 7.9.2003 the complainant sustained fracture injuries on his back while he was on duty. Immediately he was referred to NIMS, Hyderabad for treatment where he underwent surgery on 10.9.2003 for the fracture sustained on his T8 to T12. On account of the said injuries he is developed with Paralysis and became disabled. The medical board of opposite party no.1 declared him permanently disabled by assessing his disability at 100% and declared unfit to continue in service. Accordingly his services are terminated by opposite party no.1 from 10.10.2004. As there is Insurance Coverage under group Janata Policy issued by opposite party no.2 and no.3 the complainant requested opposite party no.1 to settle the claim and the same was forwarded to opposite party no.2 and no.3 for settlement of the claim. But the opposite parties did not settle the claim, therefore the complainant got issued a Legal Notice on 22.9.2008 calling upon the opposite parties to settle the insurance claim by paying Rs.1,00,000/- towards the sum assured under the policy. Inspite of service of the Notice the opposite parties failed to pay the sum assured, therefore the complainant sought direction for payment of the said amount with interest and costs.
3. The opposite party no.1 SCC Ltd. Filed counter stating that the complainant worked as electrician in the Area Workshop and he met with an accident due to which he sustained grievous injuries. He was referred to NIMS, Hyderabad for treatment where he underwent surgery on 10.9.2003. When he appeared before the medical board of opposite party no.1 to ascertain his fitness to resume duties, he was declared unfit to continue in service as he is developed with permanent disability which is assessed at 100% and he was paid compensation and other emoluments and he was removed from service with effect from 7.10.2004. It is submitted that the opposite party no.1 obtained Group Janata Personal Accident Insurance Policy from opposite party no.2 and no.3 covering all the employees on rolls as on 1.3.2003 for an assured amount of Rs.1,00,000/- by paying premium of Rs.230/- per employee. The said amount is recovered from the salary of the employees. The complainant is also one of the employees who is covered under the said policy. As per the terms and conditions of the policy the nominee would be paid Rs.1,00,000/- for death in an accident or total disability sustained by the employee in an accident. As the complainant was developed total disability the opposite party no.1 informed the opposite party no.2 through a letter Dt:7/8-8-2005 requesting them to settle the claim by paying Rs.1,00,000/- on account of total disability sustained by the complainant. Another remainders were sent by opposite party no.1 on 7.9.2005 and 18.6.2007 requesting opposite party no.2 to settle the claim but even then the claim is not settled. It is stated that the Insurance Company has to settle the claim and the opposite party no.1 is not liable to answer the claim and the opposite party no.1 is not liable to answer the claim of the complainant, therefore opposite party no.1 prayed for dismissal of the complaint.
4. The opposite party no.2 and no.3 filed counter denying all the averments made in the complaint. It is further submitted that the complainant did not sustain 100% disability as claimed by him. It is submitted that the complainant or opposite party no.1 did not inform about the accident and injuries sustained by the complainant within one month as stipulated in the terms and conditions of JPA Policy. The opposite party no.1 sent a letter on 7.9.2005 about the injuries caused to the complainant and therefore it was not made within time. The complainant also did not make any claim until he got issued a Legal Notice Dt: 22.9.2008. Since the claim is time barred the opposite party no.2 and no.3 refused to settle the claim and therefore there was no deficiency of service on their part, hence prayed for dismissal of the complaint.
5. The complainant filed Proof Affidavit reiterating the averments made in the complaint and filed documents which are marked as Ex.A1 to A8. Ex.A1 is the copy of letter from Medical Board declaring complainant unfit for further service Dt: 28.9.2004. Ex.A2 is the copy of opposite party no.1’s letter terminating the service complainant Dt: 07/10.10.2004. Ex.A3 is the letter from Superintendent Engineer, Area Work Shop addressed to opposite party no.2 Dt; 18.6.2007. Ex.A4 is the copy of Legal Notice issued by counsel for complainant addressed to opposite party no.1 & no.2 Dt: 22.9.2008. Ex.A5 is the postal receipt of registered post sent to opposite party no.1 Dt: 22.9.20088. Ex.A6 is another postal receipt of registered post sent to opposite party no.2 Dt: 22.9.2008. Ex.A7 is the acknowledgement from opposite party no.1 Dt: 23.9.2008. Ex.A8 is the acknowledgement from opposite party no.2 Dt: 24.9.2008.
6. The opposite party no.1 filed affidavit of its’ Chief General Manager, Ramagundam Area-I reiterating the averments made in the counter. On behalf of opposite party no.2 and no.3 the Proof Affidavit of it’s Senior Divisional Manager is filed reiterating the averments made in the counter and the documents filed by them are marked as Ex.B1 to B11. Ex.B1 is the office copy of letter issued by Addl. CMO, AH, RG referring the complainant to Corporate Board for assessing the fitness in original Dt: 25.8.2004. Ex.B2 & A1, Ex.B3 & A2 are one and the same documents. Ex.B4 is the office copy of letter addressed by S.E. (E&M) Area Workshop of RG.I to opposite party no.2 informing about the fitness of the complainant Dt: 7/8.8.2005. Ex.B5 is the acknowledgement from opposite party no.2 Dt: 7/8.8.2005. Ex.B6 is the office copy of letter addressed to opposite party no.2 from opposite party no.1 Dt: 7.9.2005. Ex.B7 is the acknowledgement Dt: 7.9.2005. Ex.B8 is another letter from opposite party no.1 addressed to opposite party no.2 Dt: 18.6.2007. Ex.B9 is the acknowledgement Ex.B10 is the certified true copy of Rural Insurance Policy no.610902/47/02/61/00002034. Ex.B11 is the certificate of complainant issued by opposite party no.1.
7. The points for consideration are:
- Whether there is any deficiency of service on the part of opposite parties?
- If so, what relief the complainant is entitled to?
8. Heard both sides.
9. The admitted facts by the opposite party 1 are that the complainant is working as an electrician in Area Workshop Ramagundam-I Area and that he sustained fracture dislocation of T10 to T12 due to which he was referred to NIMS Hospital, Hyderabad for treatment where he underwent surgery for implanting Pedicle Screw. The said accident occurred during course of his employment. On account of the said fracture injuries the complainant is developed with 100% disability due to Paraplegia. When he appeared before the medical board of opposite party no.1 to assess his fitness to continue in service it was declared by the Medical Board that he is totally disabled and he cannot continue his service. To that effect the medical board issued certificate under Ex.A1. Basing on the said certificate the opposite party no.1 terminated the service of complainant and issued a letter under Ex.A2 informing about termination of his services and asked him to vacate the quarter and receive terminal benefits. Accordingly the complainant became unfit and lost his employment.
10. Admittedly the opposite party no.1 obtained a group Janata Personal Accident Policy from opposite party no.2 and no.3 under Ex.b10 giving Insurance Coverage to its employees including the complainant. The Insurance Premium was deducted from the salary of the complainant. In the counter and Proof Affidavit filed by opposite party no.2 and no.3 it is admitted that the said Insurance policy was in force at the time of accident in which the complainant sustained injuries. As per the terms and conditions of the group JPA Policy under Ex.B10 the Insurance Company undertook to pay a sum of Rs.1,00,000/- to the members of the policy in case of death or 100% disability. Since the complainant sustained 100% disability, a claim is made for payment of sum assured under the policy, but the opposite party no.2 and no.3 refused to pay the amount on the ground that the claim is not made within time.
11. A perusal of letter under Ex.A3 issued by opposite party no.1 sent to opposite party no.2 it is disclosed that the intimation of injuries sustained by the complainant was given on 7.8.2005 and 7.9.2005 and thereafter several letters were addressed by opposite party no.1 to settle the claim. A perusal of certificate issued by the medical officers of opposite party no.1 under Ex.B1 and Ex.B2 discloses that the complainant is totally disabled and unfit to continue his service. Inspite of number of letters addressed by the opposite party no.1 the opposite party no.2 and no.3 did not pay the sum assured under the policy.
12. The opposite party no.2 and no.3 denied the claim of the complainant on the ground that the claim is not made within one month as stipulated in the policy. Regarding the delay in filing the claim the counsel for the complainant relied on the judgment of Hon’ble National Commission reported in 2009 (2) CPR 231 in which it is held that “in a Janata Personal Insurance Scheme where premium was to be deducted by employer from salary of employee, the employer would be agent of Insurance Company and it would be liable for the act and omissions of agent”.
The said judgment is applicable to the facts of this case as the premium was paid by opposite party no.1 to opposite party no.2 and no.3 from the salary of the complainant, as such the opposite party no.1 becomes agent of opposite party no.2 and no.3. The complainant also relied on the judgments rendered by Hon’ble National Commission and Supreme Court in
- 2009 (2) CPR (NC) Para no.6
- 2008 (4) CPR 332 NC, Para no.5.2
- 2010 (1) CPR 58 NC, Para no.6
- AIR 1979 Supreme Court 1144, Para no.2
- AIR 1990 Supreme Court 313, Para no.20
All the said judgments relied on by the counsel for the complainant are applicable to the facts of the case.
13. When the opposite party no.2 and no.3 issued group Janata Policy for the benefit of employees of opposite party no.1, it is the duty of Insurance Company to honour the terms and conditions of the policy. By filing documents the complainant proved his claim that he sustained 100% disability while on duty and after his Medical Examination he was declared unfit and his services are terminated. As per the terms and conditions of Group Janata Policy the opposite party no.2 and no.3 undertook to pay a sum of Rs.1,00,000/- in case of death or bodily injury causing 100% disability. Therefore, the opposite parties no.2 and no.3 cannot escape from the liability to pay the sum assured. It is admitted fact that the complainant sustained injuries while on duty and it is incumbent upon the opposite party no.1 to inform the accident to the Insurance Company. As per the principles laid down in the above said judgments the Hon’ble National Commission held that the lapses on the part of employer who is an agent of the Insurance Company there is liability to pay the amount. Inspite of service of Legal Notice under Ex.A4 the opposite parties failed to pay the sum assured to the complainant. In view of the foregoing reasons, we hold, that there is deficiency in service on the part of opposite parties in paying the sum assured under the Group Janata Policy. Therefore, we direct the opposite party no.1 to no.3 to pay a sum of Rs.1,00,000/- to the complainant together with interest @ 9% P.A. from the date of complaint along with Rs.1,000/- towards costs of the complaint.
14. In the result the complaint is allowed directing the opposite party no.1 to no.3 to pay a sum of Rs.1,00,000/- towards the sum assured under Group Janata Insurance Policy together with interest @ 9% P.A. from the date of filing the complaint i.e. 22.1.2009 till the date of realization and Rs.1,000/- towards costs of the proceedings within one month from the date of receipt of this order.
Typed to my dictation by Stenographer(DUR) after correction the orders pronounced by us in the open court this the 20th day of January, 2011.
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
NO ORAL EVIDENCE HAS BEEN ADDUCED ON EITHER SIDE FOR COMPLAINANT:
Ex.A1 is the copy of letter from Medical Board declaring complainant unfit for further service Dt: 28.9.2004.
Ex.A2 is the copy of opposite party no.1’s letter terminating the service complainant Dt: 07/10.10.2004.
Ex.A3 is the letter from Superintendent Engineer, Area Work Shop addressed to opposite party no.2 Dt; 18.6.2007.
Ex.A4 is the copy of Legal Notice issued by counsel for complainant addressed to opposite party no.1 & no.2 Dt: 22.9.2008.
Ex.A5 is the postal receipt of registered post sent to opposite party no.1 Dt: 22.9.20088.
Ex.A6 is another postal receipt of registered post sent to opposite party no.2 Dt: 22.9.2008.
Ex.A7 is the acknowledgement from opposite party no.1 Dt: 23.9.2008.
Ex.A8 is the acknowledgement from opposite party no.2 Dt: 24.9.2008.
FOR OPPOSITE PARTIES:
Ex.B1 is the office copy of letter issued by Addl. CMO, AH, RG Dt: 25.8.2004.
Ex.B2 & A1, Ex.B3 & A2 are one and the same documents.
Ex.B4 is the office copy of letter addressed by S.E. (E&M) Area Workshop of RG.I to opposite party no.2, Dt: 7/8.8.2005.
Ex.B5 is the acknowledgement from opposite party no.2 Dt: 7/8.8.2005.
Ex.B6 is the office copy of letter addressed to opposite party no.2 from opposite party no.1 Dt: 7.9.2005.
Ex.B7 is the acknowledgement Dt: 7.9.2005.
Ex.B8 is another letter from opposite party no.1 addressed to opposite party no.2 Dt: 18.6.2007.
Ex.B9 is the acknowledgement
Ex.B10 is the certified true copy of Rural Insurance Policy no.610902/47/02/61/00002034.
Ex.B11 is the certificate of complainant issued by opposite party no.1.
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
