O   R   D   E   R

 This is the complainant filed under Section 12 of Consumer Protection Act seeking the relief to direct the O.Ps. to pay a sum of Rs.1,00,000/- towards risk covered under the Group Insurance Policy and to pay Rs.20,000/- as compensation for mental agony suffered and expenses incurred by the complainant on the following averments.  The complainant has taken Insurance Policy bearing No.100300/42/04/0200012 from the respondents and the same covers the risk from 8-10-2004 to 7-10-2014 and the assured sum is Rs.1,00,000/-.  On 24-2-2008 the complainant sustained electric shock and was admitted to network hospital and has taken treatment for a period of one month.  Due to the electrical shock sustained by him his legs and hands became defunct and he is confined to bed and is taking assistance from his family members to attend calls of nature and to do other duties.  The complainant is a landless poor and is totally depending upon the mercy of his relatives and villagers.  Since the complainant became totally disabled he is entitled to get the policy amount from the O.Ps.  He got issued a notice on      31-2-2009 to the O.Ps. informing them about the accident and requested them to settle the claim but of no avail.  On 8^th January, 2010 the O.P. gave reply and requested the complainant to send the necessary documents and accordingly he sent the same, but to no effect.  On 20-4-2010 the complainant caused a notice on the O.Ps. and the same was received by them but they did not respond to the same.  Hence, the complaint.

          The O.Ps. filed their respective counters traversing the material allegations made in the complaint.  In the counter of 1^st O.P. it is averred that the risk of alleged disability on account of electrocution is not covered under the policy and there is no direct nexus between the complainant and the Insurance Company and the Certificate of Insurance is issued only in favour of M/s Golden Multi Service Club, Calcutta and the premium as well as the claim settlement is to be made at their instance only.  It is further averred that the risk provided under the terms and conditions of the policy is subject to exception and exclusion and that operating clauses under the terms clearly discloses that only in the event of death / permanent total disablement of insured person resulting solely and directly from the accident caused by           feasibly and violent means the risk is covered.  It is averred that the complainant did not submit any Certificate regarding amputation of leg or about the injuries sustained and as he did not process the claim through proper channel, he is not entitled to attribute deficiency of service on the part of Insurance Company and as the claim is barred by limitation and as there are no merits in the complaint the same is liable to be dismissed.

          In the counter of 2^nd respondent it is averred that they have no role to play in the claim made by the complainant as there is no Consumer and service provider relationship in between them.   It is averred that they are regarded as insured facilitator and as not authorized agent or corporate    agent of the 1^st O.P. and as such they are not liable to pay any amount to the complainant.  It is averred that 1^st O.P. is having legal liability to pay the amount if any payable to the complainant and as the 2^nd O.P. is not an agent of the 1^st O.P. they are not jointly or severally liable to settle the claim and as the petition merits no consideration, the same is liable to be dismissed.

          On behalf of complainant Ex.A.1 to Ex.A.8 are marked.  No documents is marked on behalf of respondents.  Perused the written arguments and heard the counsel for petitioner.  Now the point for consideration is whether the complainant is entitled for relief prayed for.  As per complainant he has taken a policy from the respondents and the same covers the risk from 8-10-2004 to  7-10-2014 for an assured sum of Rs.1 lakh and on 24-2-2008 he sustained electrical shock and has taken treatment for a period of one month and due to the said shock his legs and hands became defunct and is confined to bed and is not able to do any work.

          In the counters filed by the respondents they did not deny about issuance of policy by the complainant.  They have taken a plea that the complainant did not submit any certificate to show the nature of injuries sustained and as he did not suffer total disability and as he did not furnish the relevant documents for processing the claim there is no deficiency of service on their part and as such the petitioner is not entitled to get any amount as claimed.  Though the 1^st respondent has taken a plea that the claim is barred by law of limitation, the said contention is not proved by placing any cogent evidence on their behalf.  The evidence reveals that the personal policy issued by the 1^st respondent is covering the risk of complainant and was in force when he sustained electrical shock on 28-4-2009.  The complainant filed the complaint on 30-8-2010 that is within 2 years from the date of above said accident.  The 1^st respondent has taken another plea that for not impleading the 2^nd O.P. the petition is bad in law.  The above said contention raised by 1^st respondent was taken into consideration, and the 2^nd OP was brought on record and they too filed counter in this case.  As already stated supra both the respondents have taken a plea that the complainant has not submitted the relevant documents for processing the claim and as such there is no deficiency of service on their part.  The above said stand taken by the O.Ps. is not true and correct.  As per complainant after he sustained electrical shock he was admitted in the hospital and undergone treatment for a period of one month in Network Hospital at Visakhapatnam and as he became totally disabled he made request to the O.Ps. to settle his claim and when the O.Ps. did not pay any heed to his words he got issued a notice on 31-12-2009 to which 1^st O.P. gave a reply dt.8-1-2010.  It is his contention that when he was asked to submit duly filled proforma along with required documents he sent the same to the O.P. on 9-2-2010 and when the O.P. did not settle the claim he got issued another notice dt.20-4-2010 and the O.P. having received the said notice, did not respond to the same.  To prove the above said contention he filed copy of notice dt.31-12-2009, copy of reply dt.8-11-2010 and another notice dt.20-4-2010 and got the same marked as Ex.A.2, Ex.A.4 and Ex.A.6 respectively. 

          The contents of above said notices clearly reveals that when the complainant was asked to submit relevant documents he has submitted the same to the 1^st O.P. but his claim was not settled. 

          In the counter filed by 1^st respondent they have taken a plea that the  reverse side of Ex.A.1 policy certificate contains the terms and conditions but the same are not legible and readable.    As per the complainant he sent the original policy document to the 1^st O.P. for settlement of his claim.  As the 1^st O.P. is in the possession of original document they ought to have filed the same in the Forum but for the reasons best known they did not file the same.  It is well settled that the party having material documents fails to produce the same in court an adverse inference has to be drawn that in case such documents are filed they would go against them.

          Ex.A.1 copy of certificate of Insurance was issued in favour of 2^nd O.P. covering the risk of complainant who is one of the subscribers of the said policy and when the same was in force he sustained electrical shock and as per Ex.A.8 Medical Certificate, the injuries sustained by him caused disability which is assessed at 70%.   Since the complainant became disabled by the injuries sustained due to electrical shock, he is entitled to get the assured amount from the respondents.  The evidence on record reveals that the complainant has submitted the relevant documents for settlement of his claim but for the reasons best known they did not settle his claim.  Therefore, there is deficiency in service on the part of O.Ps. for not settling the claim of complainant. 

          In the result, the complaint is allowed directing the 1^st O.P. to pay to the complainant a sum of Rs.1,00,000/- (Rupees one lakh only) with interest @ 9% p.a., from the date of complaint till the date of payment.  The 1^st O.P. is further directed to pay a sum of Rs.1000/- (Rupees one thousand only) towards costs which includes the Advocate fee of Rs.500/- (Rupees five hundred only).  Comply the order within one month from this date of order.

Dictated to the Typist, transcribed by her, corrected by me and pronounced by us in the open Forum, this the 27^th day of November, 2013.

Member                                                           President

CC. 106 of 2010

APPENDIX OF EVIDENCE

WITNESSES EXAMINED

     For P.W.1                                                                                     For R.W.1

DOCUMENTS MARKED

For complainant:-

1.   Ex.A.1 copy of Policy of National Insurance Co.,

2.   Ex.A.2 Lawyer notice dt.31-12-2009

3.   Ex.A.3 DTDC Courier receipt

4.   Ex.A.4 reply letter dt.8-1-2010

5.   Ex.A.5 Courier receipt

6.   Ex.A.6 Notice dt.20-4-2010

7.   Ex.A.7 Courier receipt

8.   Ex.A.8 Medical Certificate 

For O.P:-

      NIL                                                                                 President