DATE OF FILING : 23.4.2013
BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM, IDUKKI
Dated this the 31st day of October, 2013
Present :
SRI. LAIJU RAMAKRISHNAN PRESIDENT
SMT. LIZAMMA ABRAHAM. K. MEMBER
CC NO.131/2013
Between
Complainant : Benny Mathew,
Nellikkunnel House,
Murickassery P.O.,
Idukki District – 685 604.
(By Adv: Shiji Joseph)
And
Opposite Parties : 1. The Max New York Life
Insurance Co. Ltd.,
Head Office,
P.O. Bag No.4371, Kaikaji,
New Delhi – 110 019.
2. The Manager,
Amsure Amway India Enterprises,
Byepass Road, Vytila,
Kochi, Ernakulam District.
O R D E R
SMT. LIZAMMA ABRAHAM. K. (MEMBER)
Complainant who was a Higher Secondary school teacher is now suffering from Cerebellar Palsy i.e. due to the shrinking of the cerebellum; the complainant cannot walk or stand by himself. He is bedridden and 100% paralysed. He had lost his job also. Complainant had taken a money back policy with No.550161830, launched in the year 2006 and the complainant had paid the premium till 2012 December. In January 2013 he claimed the policy benefits including the double accident benefit on 25/3/2013. The opposite party issued a cheque for Rs.47,561/- as claim to the complainant. Since the claim amount was too meagre and as against the policy conditions, complainant rejected the amount as full and final settlement and the cheque is not encashed till date. In LIC vs. Hiralal (2010 NCJ 34) Honourable National Commission has laid down that an accident can be sudden or slowly evolving process like percolation of harmful substances affecting human body. In the complainant’s
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case due to shrinkage of cerebellum, the complainant is totally immobile and incapable of doing anything by himself. As per the decision of the National Commission in LIC vs. Hiralal, the complainant is entitled to get the policy amount with double accident benefit. It is a gross deficiency in service from the part of the opposite party to deny the claim as per policy conditions. Complainant is entitled to get compensation for the deficiency in service from the opposite party.
2. Inspite of the notices from the Forum, the opposite party never appeared or represented. Hence they were made exparte.
3. The point for consideration is whether there was any deficiency in service from the part of the Opposite Parties, and if so, for what relief the complainant is entitled to.
4. No oral evidence adduced by the complainant. Exts.P1 to P3 marked from the side of the complainant.
5. The POINT: The complainant had taken a money back policy with No.550161830 in the year 2006. The policy document dated 15/1/2006 is marked as Ext.P1. The complainant, who was a Higher Secondary School teacher, was affected with cerebellar palsy. The disability certificate of the same is marked as Ext.P2. Opposite Party disbursed Rs.47,561/- as insurance claim. Receipt for the same is marked as Ext.P3. Complainant who was a Higher Secondary school teacher is 100% paralysed due to cerebellar palsy and he has lost his job. Complainant had taken money back policy in 2006 and he had stated that the premium was paid till December 2012. Complainant stated that since he is 100% paralysed and is bedridden he is eligible for double accident benefit under the policy. Opposite party has disbursed Rs.47,561/- which the complainant refused to accept. Complainant filed a memo before the Forum to encash the cheque issued by the opposite party for he was in urgent need of money for treatment and encashed the same with protest. On perusing the document produced by the counsel for the complainant it is found that the amount disbursed to the complainant was not the claim amount, but the excess amount he had paid as premium after the occurrence of disability to the complainant. Exts.P2 and P3 prove the same. Ext.P1 is a clear proof that complainant had taken the said policy with opposite party. It is evident from
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Ext.P2 that complainant is disabled due to cerebellar palsy. We think it is totally unjust and unfair on the part of the opposite party to state that the complainant is eligible for the sum insured only after maturity. It is evident from the Exhibits that the complainant is totally paralysed and that he has lost his job. Complainant is not in a curable condition and opposite party has appropriated a substantial amount from the complainant. People opt for insurance schemes such as these to ensure protection and cover the expenses of such unforeseen risks in life and for future financial security. In this case it is evident that the complainant is in a very pathetic and helpless condition. The act of the opposite party by denying the accident claim which is due to the complainant is a gross deficiency in service. Complainant has lost his job and has incurred huge expense for his treatment and needs a considerable amount for his future treatment. But opposite party has no contentions against the allegations of the complainant. The opposite party never appeared before the forum nor was represented.
The disease of the complainant has impeded him from any kinds of movement and work. We think it is a gross deficiency is service from the part of the opposite party to deny the accident claim to the complainant who has taken the policy to insulate himself against such mishaps. We think that the complainant is entitled to get double accident claim for the disease which is of a rare kind.
It is clear from Ext.P3 that opposite party had issued a cheque of Rs.47,561.79/-. Eventhough the complainant was not satisfied with the amount, since he was in dire need of money, the complainant encashed the cheque. But this amount was in fact, not any policy amount. It was the additional amount the complainant had paid after he was diagnosed with the disease. The insurance company has made an attempt to deceive the complainant and deny him of the double accident benefit, he is rightfully entitled to, by giving him a cheque of a very meagre amount. The act of the opposite party is neither ethically nor legally justifiable. There is gross deficiency in service from the part of the opposite party.
Hence the petition allowed. The opposite parties are directed to pay the double accident benefit with 9% interest from the date of this petition, to the
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complainant and the opposite parties are also directed to pay Rs.5,000/- as compensation and Rs.5000/- as cost of this petition within 30 days of the receipt of a copy of this order failing which the amount shall carry 12% interest per annum from the date of default.
Pronounced in the Open Forum on this the 31st day of October, 2013
Sd/-
SMT. LIZAMMA ABRAHAM. K. (MEMBER)
Sd/-
I agree SRI. LAIJU RAMAKRISHNAN (PRESIDENT)
APPENDIX
Depositions :
Nil.
Exhibits :
On the side of the Complainant :
Ext.P1 - The policy document dated 15/1/2006.
Ext.P2 - Copy of the disability certificate issued to the complainant
by the District Medical Board, Idukki.
Ext.P3 - The receipt issued by the opposite party for Rs.47,561.79/-
dated 25.3.2013
On the side of the Opposite Party :
Nil.
