This Complaint coming up before us for hearing on                     02-06-11 in the presence of Sri E. Rama Rao, advocate for complainant and of Sri P.S.R. Prasad, advocate for 1^st opposite party and of Sri S.A. Khadar, advocate for 2^nd opposite party, upon perusing the material on record, after hearing both sides and having stood over till this day for consideration this Forum made the following:-

O R D E R

Per Sri A. Hazarath Rao, President:-

        The complainant filed this complaint U/S 12 of Consumer Protection Act seeking Rs.1,00,000/- being insured amount under Janatha accident policy, Rs.10,000/- towards damages and mental agony and Rs.2,000/- for costs.

2.   In brief the averments of the complaint are these:

        The complainant opened an account with the 1^st opposite party on 28-05-08 bearing No.NGSB50611 and has been maintaining the account.  The said account was covered under Janatha Accident policy for Rs.1,00,000/- provided by the 2^nd opposite party.   The complainant on the intervening night of 13/14/-08-06 met with an accident near Sattenapalli while traveling in a jeep.   The SHO, Sattenapalli PS registered the said accident under crime No.106/06 under section 338 IPC. During the course of medical treatment the doctors amputated his right leg below the knee. The complainant incurred huge amount towards medical expenses.   The complainant approached both the opposite parties and submitted all relevant papers and requested them to sanction the eligible amount.  But the opposite parties protracted the matter on some pretext or other.   The opposite parties though received notice dated 01-12-09 got issued by the complainant kept quite.   Not settling the amount by the opposite parties amounted to deficiency of service.  The complaint therefore be dismissed.

3.    The contention of the 1^st opposite party in brief is hereunder:

        Subsequent to opening the account the complainant did not transact regularly.   The 1^st opposite party informed about the complainant receiving injuries in an accident to the 2^nd opposite party on 07-09-06 seeking claim forms.  Subsequently the 1^st opposite party on 17-11-06 issued reminder.   The complainant sent the claim forms to the 2^nd opposite party by registered post on 16-12-06.  The                     1^st opposite party reminded the 2^nd opposite party on 23-01-07 also.   The 1^st opposite party did not commit any deficiency of service.  It is the 2^nd opposite party who has to settle the claim.  

4.      The contention of the 2^nd opposite party in brief is thus:

        The complainant has not given any information under which policy he was covered.  Neither the 1st opposite party nor the complainant furnished the policy number covering the risk.   Without policy number and policy copy it is not possible for 2^nd opposite party to search.   In the types of JPA/GPA policies the 2^nd opposite party will give policy to the institutions with unnamed persons.   The 2^nd opposite party is even now ready to process the claim if the policy number was submitted.   The complainant has not furnished any documentary proof that his leg was amputated.   Rest of the allegations contra mentioned in the complaint are false and are invented.  The complaint therefore be dismissed.

5.     Exs.A-1 to A-9 on behalf of the complainant and Exs.B-1 to B-3 on behalf of 1^st opposite party were marked.

6.      Now the points that arose for consideration in this case are:

1.Whether the opposite parties committed deficiency of service?

2.Whether the complainant is entitled to compensation and if so to what amount?

3.To what relief?

7.  POINTS 1&2:-    The complainant was having Nirbhaya Gold account bearing No.50611 with the 1^st opposite party is not in dispute.   The 1^st opposite party taking a group Janatha Personal Accident policy with the 2^nd opposite party is not in dispute (Ex.B2).  It can therefore be said that the complainant has no direct nexus with the 2^nd opposite party.    

8.     Ex.A-1 is copy of charge sheet in CC 67 of 2007 on the file of the Addl. Munsiff Magistrate, Sattenapalli against One Chirala Koteswara Rao driver of the lorry bearing No.AP27-U1617 wherein the complainant herein was shown as LW2.  Ex.A-2 is copy of wound certificate issued by the Civil Assistant Surgeon, Government General Hospital, Guntur.   Ex.A-3 is copy of medical certificate in respect of orthopaedically handicapped candidate issued by Medical Board, GGH, Guntur.    Ex.A-3 revealed that there was amputation of right leg and the disability was 55%.   Exs.A-1 to A-3 revealed that the complainant sustained the injury resulting in disability as mentioned in Ex.A-3 due to accident.  

9.     The contention of the 1^st opposite party is that it forwarded claim forms and other relevant papers to the 2^nd opposite party for processing the claim.   The contention of the 2^nd opposite party is that no information was given either by the complainant or by the 1^st opposite party and if any information was given it was silent regarding policy number.   The policy number was known to the 1^st opposite party only.   In the notice issued by the complainant on 01-12-09 though registered post to both the opposite parties (Ex.A-6) did not contain the policy number under which he was covered.  The version as well as the affidavit filed by the 1^st opposite party was silent regarding the policy number covering the complainant.  Under those circumstances, the contention of the 2^nd opposite party about the 1^st opposite party not mentioning the policy number is corroborated.    The 2^nd opposite party cannot process the claim further in the absence of policy number as rightly contended by it.  The 2^nd opposite party received the notice issued by the complainant on 01-12-09 itself as seen from Ex.A-7 postal acknowledgment.  A duty is cast on the           2^nd opposite party to bring it to the notice of the 1^st opposite party seeking the policy number in the least after the receipt of Ex.A-6 notice.    The 2^nd opposite party failed to do such exercise.  Under those circumstances, we opine that both the opposite parties committed deficiency of service.  

10.   The complainant claimed Rs.1,00,000/- as compensation under the policy.   In Ex.B-2 agreement between the opposite parties 1 and 2 the liability of the 2^nd opposite party was fixed as mentioned below:

NATURE OF DISABILITY DUE TO ACCIDENT                     INSURANCE COVER Rs.

          Death                                                                    50,000

          Permanent total disability                                       50,000

          Loss of two eyes/feet/hands                                  50,000              

        Loss of two limbs out of eyes/hands/feet               50,000

        Loss of one eye/foot/hand                            25,000

11.   Ex.B-2 binds all the parties to the complaint.   Ex.A-3 revealed that right leg of the complainant was amputated below knee.   It can therefore be said that the complainant had lost right foot.   In view of Ex.B-2 the complainant is entitled to Rs.25,000/- only under Ex.B-2.

12.   The decisions relied on by the 2^nd opposite party reported in National Insurance Company Limited vs. Smt Lakshmibai Apparas Shindey (2004 (2) CPR 417) and National Insurance Company Limited, Vijayawada vs. Rangu Anjamma and others (2004 (5) ALD 233) has no application to the facts of the case as the 2^nd opposite party never addressed letter either to the complainant or the 1^st opposite party seeking relevant documents.

13.   The accident under which the complainant sustained grievous injury took place on 14-08-06.   The complainant did not place any material before this Forum to show that he issued similar notice that of Ex.A-6 to the opposite parties earlier.   Under those circumstances, awarding interest from 01-12-09 will meet ends of justice.

14.  Both the opposite parties failed to perform their obligations in attending to the grievance of the injured in reasonable time.   This conduct on behalf of the opposite parties caused much agony and discomfort to the complainant as rightly contended.   The complainant incurred Rs.19,800/- towards his treatment in Sri Rama Seetha Hospital, Guntur.   Awarding a sum of Rs.2,500/- each as compensation towards mental agony of the complainant will meet ends of justice.   In view of the afore-mentioned discussion, these points are answered in favour of the complainant accordingly. 

15.  POINT No.3:-   In view of above findings, in the result the complaint is partly allowed as indicated below:

1. The 2^nd opposite party is directed to pay Rs.25,000/- together with interest at 9% p.a., on it from 01-12-09 till payment.
2. Both the opposite parties are directed to pay a sum of Rs.2,500/- each as compensation to the complainant.
3. Both the opposite parties are directed to pay a sum of Rs.500/- each towards costs.
4. The above amounts ordered shall be paid within a period of six weeks from the date of receipt of the copy of the order.

Typed to my dictation by Junior Steno, corrected by me and pronounced in the open Forum this the 9th day of June, 2011.

Sd/-XXX                                   Sd/-XXX                                 Sd/-XXX

MEMBER                                             MEMBER                                        PRESIDENT

APPENDIX OF EVIDENCE

  DOCUMENTS MARKED

For Complainant:

For 1st opposite party:        

                                                                                                                 Sd/-XXX

                                                                                PRESIDENT