BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri.K.V.H.Prasad,B.A.,LL.B., President
And
Smt. C.Preethi, M.A.LL.B., Lady Member
Friday the 30th day of May, 2008
C.C.No. 116/07
Between:
Vadde Ramudu, S/o. V. Bheemanna Alies Busanna,
R/o. 51-15-11 A, Rajiv Nagar, Kurnool. … Complainant
Versus
- The National Insurance Company Limited, Represented by its Divisional Manager,
Kolkata.
- The National Insurance company Limited, Represented by its Branch Manager,
Kurnool.
- Golden Multi Services Club Limited, of G.T.F.S.Represented by its Director,
Kolkata.
- Golden Multi Services Club Limited, of G.T.F.S Represented by its Branch-in-charge,
Kurnool. … Opposite parties
This complaint is coming on this day for orders in the presence of Sri.P.V.Ramana Reddy, Advocate, for the complainant, and Sri.L.Hari Hara Natha Reddy, Advocate for opposite party No.1 and 2 and Sri.M.Azmathulla, Advocate, for opposite party No.4 and opposite party No.3 set exparte and upon perusing the material papers on record, the Forum made the following:-
ORDER
(As per Smt. C.Preethi, Lady Member)
C.C.No.116/07
1. This consumer complaint of the complainant is filed U/s 11 and 12 of C.P.Act 1986, seeking a direction on opposite parties to pay Rs.3,00,000/- towards policy amount with 18% interest p.a, Rs.10,000/- towards compensation for mental agony, cost of the complaint and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complaint’s case is that the complainant joined as a member with OP.No.3 through OP.No4 and obtained a Group Janata Personal Accident Insurance Policy bearing No.100300/47/ 01/96000ZZ/04/96/300ZZ from OP.No.1 for Rs.3,00,000/- and the said policy commenced from 15-4-2004 to 14-4-2009. The complainant nominated his wife V. Santhamma as his nominee. While the policy was in force, on 18-7-2005 the complainant met with an accident and sustained grievous injuries which led to the amputation of his right hand. As per the terms and conditions of the policy, risk is covered for permanent total disablement. After taking treatment the complainant approached OP.No.4 and submitted claim form on 23-1-2006 along with original Insurance Policy, F.I.R, charge sheet, would certificate issued by Dhone Hospital, as there was no response, on 14-12-2006 the complainant got issued legal notice to OP.No.3 and 4 inturn OP.No.3 addressed a letter dated 29-12-2006 to the complainants Advocate stating that claim form was sent to OP.No.1. Thereafter, there was no response from opposite parties, hence the complainant resorted to the forum for reliefs.
3. In support of his case the complainant relied on the following documents viz., (1) Xerox copy of policy No.100300/ 47/ 01/ 96000ZZ/04 /96/300ZZ, (2) letter dated 18-5-2006 of complainant addressed to opposite party No.4, (3) Xerox copy of claim form, (4) office copy of letter dated 23-1-2006 of complainant addressed to OP.No.4, (5) certificate copy of FIR in crime No.147/05, (6) certified copy of charge sheet in crime No.147/2005 , (7) certified copy of wound certificate, (8) certified copy of disability certificate, (9) office copy of legal notice dated 14-12-2006 addressed to opposite parties 1 to 4 and (10) copy of letter dated 29-12-2006 of Golden Trust Financial Manger to Senior Divisional Manager, Kolkata, besides to the sworn affidavit of complainant in reiteration of his complaint averments and the above documents are marked as Ex.A1 to Ex.A10 for its appreciation in this case. The complainant caused interrogatories to opposite parties and replied to the interrogatories of opposite parties.
4. In pursuance to the notice of this forum as to this case of the complainant, the opposite parties 1,2 and 4 appeared through their standing counsel and contested the case. The OP.No.3 remained absent throughout the case proceedings.
5. The written version of OP.No.1 submits that the complainant has obtained a Group Personal Accident Policy bearing No.100300/47/01 96000ZZ/04 /96/300ZZ for Rs.3,00,000/- and the said policy was issued by OP.No.1 in association with OP.No.3. The OP.NO.1 denies that the complainant has sustained injuries in road accident and further submits that upon the happening of any event which may give rise to a claim under the policy issued by OP.No.1, written notice with all particulars must be given to the company immediately and in case of death/accident notice must be given within one month after the date of accident through OP.No.3. But in this case the complainant did not intimate about the accident and did not submit the claim form within stipulated time mentioned in the policy. Hence, it is clear violation of terms and conditions of the policy. Hence, opposite party is not able to entertain the claim of the complainant and treated it as no claim. But lastly submits that as per the terms of the policy all claims arising out of the policy issued by this OP.No.1 are subject to Kolkata Territorial Jurisdiction only. Hence, the Hon’ble District Forum has no jurisdiction to entertain this case. As there was no deficiency of service on part of OP.No.1, seeks for the dismissal of complaint.
6. The written version of OP.NO.2 submits that this OP.No.2 has no knowledge of the complainant joining as a member with OP.No.3 through OP.No.4 and has taken Group Personal Accident policy from OP.No.1 for Rs.3,00,000/-. This OP.No.2 branch did not issue any policy to the complainant, and the said policy has been issued by OP.No.1 through Op.No.3 and 4. There was no contract between OP.No.2 and the complainant, and the complainant unnecessarily added OP.No.2 as party to the proceedings. The OP.No.2 further submits that the policy issued as a specialized policy and as per terms and conditions of the policy all claims arising out of the said policy are subject to Kolkata Territorial Jurisdiction only and the Hon’ble Kurnool Forum has no jurisdiction to entertain this case. As there is no deficiency of service on part of OP.No.2 the complaint may be dismissed against OP.No.2 with cost.
7. The written version of OP.No.4 submits that Golden Multi Service Club Limited is a registered service club formed under Indian Companies Act, 1986. The Janata Personal Accident Insurance Policy was issued by OP.No.1 covering the risk of members of Golden Multi Services Club of Golden Trust Financial Services. The memorandum of understanding dated 1-1-2007 between Op.no.1 and Golden Multi Service Club of Golden Trust Financial Services agreed to cover insurance to the members of Golden Multi service Club under Group Personal Accident Insurance Policy. The Golden Trust Financial Services collected premium and remitted to OP.No.1 and OP.No.1 issued a certificate to that effect. As per terms and conditions of the policy it is the Op.no.1 which has to settle the claim and OP.no.3 and 4 has nothing to do, as to the settlement of claims. But further submits that after receiving claim form along with documents from the complainant, the OP.No4 forwarded the same to OP.No.3 and in turn it was forwarded to OP.No.1 vide letter dated 10-6-2006 and the same was received by OP.no.1 on 12-6-2006. Hence, this opposite party has no role as to the settlement of the claim and there is no deficiency of service and seeks for the dismissal of complaint against OP.No.4 with costs.
8. In support of their case the opposite parties relied on the following documents viz, (1) Xerox copy of terms and conditions of Group Janata Personal Accident policy, (2) attested copy of M.O.U dated 1-1-2001 between Ops 1, 3 and (3) letter dated 17-7-2001 issued by OP. No.1 and (4) letter dated 10-6-2006 of OP.No.3 to OP.No.1 marking its copy to the complainant , besides to the sworn affidavit of opposite parties 1, 2 and 4 in reiteration of their written version averments and the above documents are marked as Ex.B1 to B4 for its appreciation in this case. The opposite parties 1, 2 and 4 caused interrogatories to the complainant and replied to the interrogatories to complainant.
9. Hence, the point for consideration is to what relief the complainant is entitled to:
10. It is the case of the complainant that he has taken a Group Janata Personal Accident Policy bearing NO.100300/47/0/ 96000ZZ/04 /96/300ZZ for a period from 15-4-2004 to 14-4-2009 form Op.NO.1 through OP.No.3 & 4 vide Ex.A1. On 18-7-2005 the complainant met with accident and received grievous injuries and taken treatment in a Hospital at Dhone which led to the amputation of his right hand. The Ex.A5 certified copy FIR and Ex.A6 certified copy of charge sheet clearly shows that the complainant met with accident and Ex.A7 certified copy of wound certificate an Ex.A8 certified copy of disability certificate indicates that the complainants right hand has been amputed. After taking treatment, the complainant approached OP.No.4 on 23-1-2006 vide Ex.A4 and submitted claim form vide Ex.A3 and other required relevant documents i.e., Ex.A1, Ex.A4, Ex.A5, Ex.A6, Ex.A7, vide Ex.A2 dated 18-5-2006. The said claim form in Ex.A3 and other documents were forwarded to OP.No.1 vide Ex.B4 by OP.No.4 for settlement of the claim. As per Ex.B3 the complainant has to submit claim form to OP.No.3 and 4 and inturn OP.NO.3 has to process the claim and submit to OP.no.1 . In this case the OP.NO.3 forwarded the claim to OP.no.1 vide Ex.B4, but there after the OP.No.1 did neither settled the claim nor repudiated it.
11. The main contention of OP.No.1 is that the intimation of accident should be given to the Insurance company with in one month form the date of accident as per the condition No1 . The condition NO.1 says that unless reasonable cause is shown the intimation should be given in one month, but in this case the complainant met with accident and was grievously hurt which later on led to amputation of his right hand, hence for the said above reason the complainant could not intimate about the accident with in one month. But immediately after treatment approached OP.No.4 on 23-1-2006 and intimated about the accident. Hence, the contention taken by OP.No.1 is untenable and can not be acted upon.
12. The second contention of OP.No.1 is that this forum has no jurisdiction to entertain this case as the policy is a specialized policy and the claims arising out of said policy are subject to Kolkata Jurisdiction only. This contention of OP.No.1 can not be accepted, as per Sec.11 (C) of C.P.Act 1986, which says, cause of action, wholly or in part arises. In this case the complainant paid premium for the said policy to OP.No.4, who is residing within the jurisdiction of this forum. Hence, this forum has jurisdiction to entertain this complaint of the complainant, as part of cause of action aroused within the jurisdiction of this forum.
13. To sum up, the above discussions it is clear from the exhibits marked that the complainant met with accident and his right hand has been amputed. The complainant has been covered under the policy vide Ex.A1 and the policy was in vague at the time of accident, hence the complainant is covered under the policy and he is certainly remaining entitled to the assured amount.
14. Now the question is to what amount the complainant is entitled to:- on the reverse of Ex.A1 under benefit column, in column 2.8 actual loss by physical separation of one entire hand is 50% of sum assured. Hence the complainant is entitled to 50% of the total sum assured only. The total sum assured under the Ex.A1 policy is Rs.3,00,000/- . So, the 50% of total sum assured comes to Rs.1,50,000/- only. Therefore, the complainant is entitled to Rs.1,50,000/- only and not to Rs.3,00,000/- as claimed in the complaint. As per Ex.B3 letter dated 17-7-2001 issued by National Insurance Company (OP.NO.1) stated the duties of Ops 3 and 4 is to submit all required documents/papers to OP.No.1 and for non settlement of any valid claim, what so ever the responsibility and liability is with them and none less. Hence, as no case is made out against OP.No.2,3 and 4 case against them is dismissed. As per Ex.B3 the liability is fixed on OP.No.1 to pay the assured to the complainant.
15. In the result, the complaint is allowed directing the opposite party No.1 to pay to the complainant the assured amount of Rs.1,50,000/-under the policy vide Ex.A1, Rs.5,000/-as compensation and Rs.1,000/- as costs within one month from the date of receipt of this order. In default, the OP.no.1 is liable to pay supra award with 12% interest from the date of default till realization.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open forum on this the 30th day of May 2008.
Sd/- Sd/-
MEMBER PRESIDENT
Appendix of evidence
Witness examined
For Complainant: For Opposite parties:
-Nil- -Nil
Documents marked
For the Complainant:
Ex.A-1. Xerox copy of policy No.100300/47/01/96000ZZ/04
96/300ZZ.
Ex.A-2. Letter, dated 18-5-2006 of complainant addressed
to opposite party No.4. ,
Ex.A-3. Xerox copy of claim form.
Ex.A-4. Office copy of letter, dated 23-1-2006 of
Complainant addressed to opposite party NO.4.
Ex.A-5. Certified copy of First Information Report (FIR)
in crime No.147/2005 (No. in 5 papers)
Ex.A-6. Certified copy of charge sheet in crime No.147/2005
(No. in 6 papers)
Ex.A-7. Certified copy of wound certificate (No. in 2 papers).
Ex.A-8. Certified copy of disability certificate (No. in 2 papers)
Ex.A-9. Office copy of legal notice, dated 14-12-2006 addressed
to opposite party 1 and 4 along with 2 postal receipts
and acknowledgements of opposite party No.1
Ex.A-10. Copy of letter, dated 29-12-2006 by Golden Trust
Financial Manger to Senior Divisional Manager, Kolkata
in response to Ex.A9.
.
For the opposite parties:
Ex.B-1. Xerox copy of terms and conditions of Janata Personal
Accident Policy.
Ex.B-2. A Letter copy of MOU dated 1-1-2001 between opposite party 1 and 3 (No. in 4 papers)
Ex.B-3. Letter, dated 17-7-2001 issued by National Insurance
Company (opposite party No.1)
Ex.B-4 Letter, dated 10-6-2006 of opposite party No.3 to opposite party No.1 marking its copy to the complaint.
Sd/- Sd/-
MEMBER PRESIDENT
Copy to:
- Sri. P. V. Ramana Reddy, Advocate,Kurnool for the complainant.
- Sri. L. Hari Hara Natha Reddy, Advocate, Kurnool for OP.No.1 & 2.
- Sri. M. Azmathulla, Advocate, for OP.NO.4
Copy was made ready on :
Copy was dispatched on:
Copy was delivered to:
