Bihar

Gaya

CC/60/2016

Mr. Anand Prakash - Complainant(s)

Versus

The National Insurance Co. Ltd. Divisional Manager, Division III - Opp.Party(s)

Sanjay Kumar

30 Aug 2017

ORDER

In the court of District Consumer Forum, Gaya

Consumer Complainant Case No. - 60 of 2016

Anand Prakash son of Siri  Deolal Prasad, Resident of village- Rati Bigha, Post Office -Bakraur, Police Station-Bodhgaya, District-Gaya..Complainant

                                                   V/s
1. The National Insurance Company Limited through its Divisional Manager, Division  III, National Insurance Building, ground floor, 8 India exchange place, Kolkata -

Present:
 1. Shri Ramesh Chandra Singh..... President

 2. Syed Mohtashim Akhtar....Male Member

 3. Smt. Sunita Kumari ....Female Member

            Dated:- 06^th Sep of

                                                ORDER

                                          Case No. - 60 of 2016

                         1.   The instant case has been filed by the complainant Anand Prakash against the National Insurance Company Limited and another for deficiency in service and to get direction to pay the insured amount of ₹ / 47 / 01 / /02 / 96 /rd October

                                                  Case No. - 60 of 2016

₹

                              3. After due notice the opposite party number 1 appeared and filed his written statement but the opposite party number 2 did not appear and so ex party hearing was preceded against him.

                                              Case No. - 60 of 2016

                           4. In written statement the opposite party number one has submitted that the complaint petition is not maintainable as on Fact and in law also. There is no cause of action for the present case. The complaint case is barred by limitation and principle of waiver, estoppels and acquiescence. There is no claim filed before the Opposite Party within 30 days from the date of resident. This Court has no jurisdiction to hear the case. There is no any allegation regarding negligence of deficiency in service on the part of the opposite party. Hence, the allegation made in column number 3 of the complaint is matter of record and the complaint is bound to prove especially. Neither the complainant nor the O.P number 2 forwarded the claim form within time Point The date of accident is 30 December

                                                  Case No. - 60 of 2016

complainant may be ascertained. As per policy conditions permanent total disability / actual loss by physical separation of one entire hand which does not covered under the policy. The opposite party is not liable for payment of any amount or interest or any for harassment to the complainant.

                           5. The main point of determination before his court is whether the complainant has been able to prove his case for deficiency in service and weather he is liable to get relief as sought for.

                              6. Both parties have filed evidences on affidavit and documents in order to prove their case. The complainant has filed copy of Bodhgaya CD case number

                                                  Case No. - 60 of 2016

letter of company,[

                             7. It is admitted fact that the Complainant has purchased a policy under Janta Personal Accident Insurance bearing number Since the resolution of the dispute depends on interpretation of the terms of the policy it is relevant to examine the terms of the said policy.

                                                  Case No. - 60 of 2016

A copy of Janata personal accident insurance has been submitted by the opposite party with profits. Under the scope of cover on the happening of which benefit payable States as under:

1). Death -

2). Total and irrecoverable loss of:

                                                  Case No. - 60 of 2016

It appears from peristaltic of description of Dr. Manoj Kumar of Orthocenter dated 7 January

                                                  Case No. - 60 of 2016

insured. In purview of terms and conditions of Janata personal accident insurance policy total and unrecoverable loss of actual physical separation of on entire hand should be interpreted in sense as to whether the complainant is able to do his any physical work with this hand. It appears from the application given to officer-in-charge Bodhgaya on which SDE case was registered on 7 January

                                                  Case No. - 60 of 2016

to get 50% of sum assured. The insurance certificate shows that the sum assured is ₹

           Dictated and corrected

Female Member        Male Member                          President

Sunita Kumari               Syed Mohtashim Akhtar       Ramesh Chandra Singh