BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, GURDASPUR.
Complaint No: 251 of 2019.
Date of Institution: 01.08.2019.
Date of order: 22.08.2023.
Kirpal Singh S/o Sulakhan Singh R/o Village Khokhar, P.O Dorangla, Tehsil and District Gurdaspur. Pincode- 143526
....Complainant.
VERSUS
- The Gurdaspur Central Co-operative Bank Ltd, Branch Dorangla, District Gurdaspur, through its Branch Manager. Pincode- 143526.
- Liberty Videocon General Insurance Company Ltd, 10th Floor, Tower A, Peninsula Business Park, Ganpatrao Kadam Marg, Lower Parel, Mumbai-400013. Phone No. +91-2267001367. ….Opposite Parties.
Complaint Under section 12 of the Consumer Protection Act.
Present: For the complainant: Sh.Kewal Singh Saini, Advocate.
For the opposite party No.1: Sh.B.S.Thakur, Advocate.
For the opposite party No.2: Sh.Sandeep Ohri, Advocate.
Quorum: Sh.Lalit Mohan Dogra President, Sh.Bhagwan Singh
Matharu, Member.
ORDER
Lalit Mohan Dogra, President.
Kirpal Singh, Complainant (here-in-after referred to as complainant) has filed this complaint under section 12 of the Consumer Protection Act, (here-in-after referred to as 'Act') against The Gurdaspur Central Co-operative Bank Ltd. and others (here-in-after referred to as 'opposite parties).
2. Briefly stated, the case of the complainant is that the complainant is an account holder of opposite party No.1 Branch Dorangla, vide his Account No.60 New Account No.070834028000197 and complainant took Sehkari Bank Beema Yojna of Videocon Group Personal Accident Policy vide Policy No.4113-200501-16-7000012-00-000 of opposite party No.2 through the opposite party No.1 and the complainant had been depositing the premium regularly to the opposite party No.2 through opposite party No.1/Bank vide his account statement of the said Bank. It is alleged that on 17.01.2017, one hand i.e. right hand of the complainant was cut into pieces upto wrist i.e. near the elbow while working on electric fodder cutter for preparing fodder for his domestic cattle. After that the complainant was taken to Simran Hospital, Gurdaspur on 17.01.2017 where he was medically treated and diagnosed. It is further pleaded that the complainant was Discharged on 20.01.2017 from the said Hospital vide Discharged Card showing details of admission, discharge and injuries. It is further pleaded that the doctor at civil hospital assessed the disability of the complainant as 60%. It is further alleged that the complainant sent his claim for benefit under insurance scheme to the opposite party No. 2 through opposite party No.1, but the opposite party No.2 had rejected his claim vide rejection letter dated 11.06.2018 of the opposite party No.2 stating therein that as per submitted documents by the complainant, “ Insured Kirpal Singh sustained injuries right hand arm cut while working in field, it does not come under Permanent Total Disability and that as per policy coverage, the complainant covered for part-1 accidental death, permanent total disability and permanent partial disability and that the company therefore regret to convey their inability to consider the above mention loss under the policy and thus claim stands repudiated”. It is further alleged that then the complainant approached the opposite party No.2 through opposite party No.1 and also wrote a letter to opposite party No.2 to consider his case sympathetically in any category, as one hand of the complainant has been amputated due to the accident while working at a fodder cutter for preparing fodder for his domestic cattle which are necessary for an Agriculturist, but the opposite party No.2 has not replied nor paid any claim to the complainant. It is further alleged that the complainant has become handicapped of one hand i.e. right hand and agriculture work is not possible with single hand. It is further pleaded that even cattle cannot be tied with "Kills" with single hand and also even one hand cannot be washed without the other and it is permanent disability infact. It is further pleaded that however, if this is not permanent total disability technically, then it is certainly a case of permanent partial disability, but rejection of the claim of the complainant and non-responding to the request of the complainant to consider his case under any category is a deficiency in service and malpractice on the part of opposite party No.2. It is further pleaded that due to this illegal act and conduct of the opposite parties the complainant has suffered great loss and also suffered mental agony and physical harassment and inconvenience and as such there is a clear cut deficiency in service on the part of the opposite parties.
On this backdrop of facts, the complainant has alleged deficiency in service and unfair trade practice on the part of the opposite parties and prayed that the necessary directions may kindly be issued to the opposite parties to pay the claim of the complainant under the policy i.e. Rs.60,000/- under permanent partial disability to the extent of 60% vide table or benefits under the heading permanent partial disability in the interest of justice. The complainant may also be awarded compensation for harassment meted out to the complainant by the opposite parties for not making him the payment as per the policy.
3. Upon notice, opposite party No.1 appeared through counsel and filed their written reply by taking preliminary objections that the present complaint against the opposite party No.1 is not maintainable as they are not liable to pay any compensation as claimed in this complaint. It is pleaded that the OP No.1 forwarded the claim application of the complainant to the Opp. Party No.2 and the Opp. Party No.2 is responsible to pay the compensation amount, if the same falls under the spirit of the clauses of the insurance policy. It is further pleaded that the Opp. Party No.2 being insurance company and premium of the insurance has been deducted from the complainant through OP No.1. It is further pleaded that the role of the OP No.1 is only to the extent that he is holding the account of the complainant and sending the premium to the insurance with the consent of the complainant and beyond that the OP No.1 is not liable and responsible for any cause and the OP No.1 sent the letters of complainant to the Opp. Party No. 2. It is further pleaded that the OP No.1 only came to know by the present complaint that the claim application of the complainant has been repudiated by the insurance company and the reason for repudiation, must be disclosed in the letter of repudiation.
On merits, the opposite party No.1 have reiterated their stand as taken in legal objections and denied all the averments of the complaint and there is no deficiency in service on the part of the opposite party. In the end, the opposite party prayed that the complaint filed by the complainant against the Opp. Party No. 1, is not maintainable and the same may kindly be dismissed, as the Opp. Party No. 1 is not liable to pay any compensation to the complainant.
4. Upon notice, opposite party No.2 appeared through counsel and filed their written reply by taking preliminary objections that the complainant has no cause of action and locus standi to file the present complaint, that the insurance is a contract between two parties and both the parties are bound with the terms and conditions of the policy. It is further pleaded that the liability if any of the insurance Co. / OP No.2 is only as per terms and condition of the policy, that there is no deficiency in services on the part of the insurance Co. / OP No.2. It is pleaded that the claim has been repudiated as per terms and conditions of the policy and the rejection letter dated 11.6.2018 has been duly sent to the complainant. It is further pleaded that the claim has been lodged by Kirpal Singh for amputation his arm below elbow in an accident, allegedly on 17.1.2018 and as per submitted documents, Kirpal Singh sustained injuries of right hand arm cut while working in field , however, the said injuries do not fall under the purview of permanent total disability as defined by the Policy. It is further pleaded that the injury sustained by the complainant is not one of specified injuries covered by the policy. It is submitted that the Policy affords cover for Accidental Death and Permanent Total Disability only. The opposite party no.2 has denied the claim of the complainant giving cogent reasons.
On merits, the opposite party no.2 have reiterated their stand as taken in legal objections and denied all the averments of the complaint and there is no deficiency in service on the part of the opposite party. In the end, the opposite party prayed for dismissal of complaint with costs.
5. Learned counsel for the complainant has filed affidavit of Kirpal Singh, (Complainant) as Ex.C-1 along with other documents as Ex.C-2 to Ex.C-8.
6. Learned counsel for the opposite party No.1 has filed affidavit of Gurdip Singh (Branch Manager, The Gurdaspur Central Co-op Bank, Branch Dorangla, Gurdaspur as Ex.OP-1/1 along with reply.
7. Learned counsel for the opposite party No.2 has filed affidavit of Ashish Singh Tomar (Legal Manager, Liberty General Ins. Co. Ltd.) as Ex.OP-2/1/A along with other documents as Ex.OP-2/1 to Ex.OP-2/5.
8. Rejoinder filed by the complainant.
9. Written arguments filed by the opposite party no.1 but not filed by the complainant and also not filed by the opposite party no.2.
10. Counsel for the complainant has argued that complainant is account holder of opposite party No.1 and took Sehkari Bank Beema Yojna of Videocon Group Personal Accident Policy from opposite party No.2. It is further argued that during continuation of policy on 17.01.2017 right hand of the complainant got injured and later on was amputated. The disability of the complainant was assessed as 60% by the competent medical authority copy of which is Ex.C-6.
11. On the other hand counsel for the opposite party No.2 has argued that policy of insurance is admitted. However, since the only right hand of the complainant was amputated as such the claim is not admissible. As per schedule given in the policy only 100% of the sum assured is required to be paid if both hands or both feet or one hand and one foot is amputated, only in that case compensation is payable. Accordingly, the claim was rightly repudiated by the opposite party No.2 vide its letter addressed to the complainant.
12. We have heard the Ld. counsels for the parties and gone through the record. It is admitted fact that complainant was member of Sehkari Bank Beema Yojna of Videocon Group Personal Accident Policy. It is further admitted fact that on 17.01.2017 complainant suffered accidental injury and right hand was amputated and disability was assessed by the competent medial authority as 60%. The claim has been denied by the opposite party No.2 by relying upon policy schedule as per which only in case of amputation of both the hands, the compensation is payable. The contention of the Ld. counsel for the opposite party No.2 is that in disability certificate Ex.C-6 word permanent disability has not been mentioned is not acceptable as the right hand of the complainant has been admittedly amputated in the accident and as such as per policy Ex.C-4 column No.3 complainant is entitled to 60% of the sum assured. Since the complainant was insured for Rs.1,00,000/- as per policy of insurance, as such complainant is definitely entitle to receive Rs.60,000/- from the opposite party No.2. As such repudiation of claim by opposite party No.2 amounts to deficiency in service.
13. Accordingly, the present complaint is partly allowed and opposite party No.2 is directed to pay Rs.60,000/- to the complainant alongwith interest @ 9% P.A. w.e.f. 11.06.2018 i.e. the date of repudiation till realization. Since the complainant had become handicapped and disabled and suffered mental tension and harassment for getting his genuine claim from the opposite party No.2, as such opposite party No.2 is directed to pay Rs.10,000/- as compensation and Rs.5,000/- as cost of litigation. Entire exercise shall be completed by opposite party No.2 within 30 days from the receipt of copy of this order.
14. The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.
15. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record room.
(Lalit Mohan Dogra)
President
Announced: (B.S.Matharu)
Aug. 22, 2023 Member
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