BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FEROZEPUR.
C.C. No.306 of 2014 Date of Institution: 22.8.2014
Date of Decision: 23.12.2014
Jaswant Kumar Madaan, aged about 58 years, son of Kharaiti Lal, resident of House No.167, Old Post Office Street, Near Hira Mandi, Ferozepur City.
....... Complainant
Versus
1. The Oriental Insurance Company Limited, Mall Road, Opposite Central Jail, Near Raja Talkies, Ferozepur City, through Branch Manager.
2. The Oriental Insurance Company Limited, The Mall, Opposite Municipal Council, Ferozepur City, through Divisional Manager.
........ Opposite parties
Complaint under Section 12 of the Consumer Protection Act, 1986.
* * * * *
PRESENT:
For the complainant : Sh. O.P. Gabba, Advocate
For the opposite parties : Sh. Ashwani Sharma, Advocate
QUORUM
S. Gurpartap Singh Brar, President
S. Gyan Singh, Member
ORDER
GURPARTAP SINGH BRAR, PRESIDENT:-
Brief facts of the complaint are that the complainant has been getting Personal Accident Insurance Policy from the opposite parties for
C.C. No.306 of 2014 \\2//
the last more than five years continuously. The complainant got the policy during the year 2013-2014 bearing No.48/2013/01931, which was for the period from 22.3.2013 to 22.3.2014. Even at present the complainant is holding the policy for the year 2014-2015. The complainant met with an accident on 21.4.2013, when he struck with some animal near Grain Market, Ferozepur Cantt, while he was coming on his Activa bearing Registration No.PB-05-U-9905. The complainant got multiple injuries as a result of accident. The complainant intimated the opposite parties regarding accident on 22.4.2013. Earlier the complainant did not contact the Doctor and when he felt uneasy due to accident, the complainant contacted Dr. Manmohan Singh Dhillon and was hospitalized in his clinic situated at Ferozepur City. Dr. Manmohan Singh got the X-Ray conducted pertaining to the injuries of the complainant and also gave medicines. The following expenses were incurred by the complainant in the clinic of Dr. Manmohan Singh:-
(a) X-Ray expenses : Rs.100.00
(b) OPD Expenses : Rs.300.00
(Rs.150/- each twice)
(c) Medicines on 22.4.2013 Rs.852.00
(d) Medicines on 27.4.2013 Rs.1612.00
(Rs.1556+56)
The complainant was advised rest for one week and thereafter for another
C.C. No.306 of 2014 \\3//
week. The complainant had to abstain from his work place as he is running canteen in Shaheed Bhagat Singh College of Engineering & Technology. For that Rs.10,000/- have been claimed. The complainant has claimed total amount i.e. Rs.12,764/-. The complainant submitted the above bills to the opposite parties in May, 2013, but till date nothing has been done and no payment has been made to the complainant. Pleading deficiency in service and unfair trade practice on the part of the opposite parties, the complainant has prayed that the opposite parties be directed to pay a sum of Rs.12,764/- regarding which bills have since been given with interest @ 18% per annum from the date of submission of bills till actual payment. Further a sum of Rs.75,000/- has been claimed as compensation for harassment and Rs.10,000/- as litigation expenses.
2. Upon notice, the opposite parties appeared and filed their written reply to the complaint, wherein it has been pleaded that on scrutiny of the papers submitted by the complainant and the investigation report of the investigator of the company, it has been observed that the claim was not tenable. As per the OPD card, there has been no fracture as per noting dated 27.4.2013. As per medical report filed and signed by Dr. Manmohan Singh Dhillon, the symptoms are due to injury as well as due to old age, which does not fall under preview of the Personal Accident Policy. As such the claim has been repudiated on valid grounds. Other allegations of the
C.C. No.306 of 2014 \\4//
complainant have been denied and dismissal of the complaint has been prayed for.
3. Learned counsel for complainant tendered into evidence Ex.C-1 to Ex. C-12 and closed evidence on behalf of the complainant. On the other hand, learned counsel for the opposite parties tendered into evidence Ex.OP-1/1 to Ex.OP-1/4 and closed evidence on behalf of the opposite parties.
4. We have heard the learned counsel for the parties and have also gone through the file.
5. It is the admitted case of the parties that the complainant was insured with the opposite parties vide Personal Accident Insurance Policy bearing No.48/2013/01931 for the period from 23.3.2013 to 22.3.2014. However, claim of the complainant on account of his treatment for accidental injuries suffered by the complainant during the subsistence of the policy has been repudiated by the opposite parties vide letter dated 13.1.2014 Ex.OP-1 & 2/1 on the ground that as per the OPD Card submitted, there has been no fracture as per noting dated 27.4.2013; further as per medical report filled and signed by Dr. Manmohan Singh Dhillon, the symptoms were due to injury as well as due to old age, which does not fall under the preview of the Personal Accident Policy. But no terms and conditions of the Personal Accident Insurance Policy have been placed on
C.C. No.306 of 2014 \\5//
the file by the opposite parties to prove that the insurance claim for accidental injuries is to be paid to the insured only in case the insured suffers fracture due to accident and not for the other injuries suffered by the insured due to accident. It is also not the case of the opposite parties that the complainant did not met with the said accident and he has lodged false claim with the opposite parties. Even otherwise nobody is supposed to suffer injuries on his person just to raise claim under the insurance policy. Treatment of the complainant for accidental injuries from Dhillon Hospital, Ferozepur has also not been disputed by the opposite parties. Therefore, the opposite parties were not justified in repudiating the claim of the complainant on account of his treatment for accidental injuries. The opposite parties are guilty of rendering deficient services to the complainant. The complainant is entitled to the amount spent by him on his treatment for accidental injuries. Photo copy of Receipts and Cash Memos placed on the file by the complainant as Ex.C-7 to Ex.C-8 reveals that the complainant has spent an amount of Rs.2764/- on account of OPD Fee as well as for purchase of medicines. Therefore, the complainant is entitled to a sum of Rs.2764/-, which was spent by him on his treatment. However, the complainant is not entitled to another amount of Rs.10,000/- claimed by him as loss on account of his alleged abstaining from work due to accident, being not admissible under the policy. The complainant has to file the
C.C. No.306 of 2014 \\6//
present complaint by engaging a counsel to seek redressal of his grievance. Therefore, the opposite parties are also liable to pay suitable compensation for harassment and litigation expenses to the complainant.
6. In view of what has been discussed above, this complaint is accepted and the opposite parties are directed to pay to the complainant a sum of Rs.2764/- as insurance claim, which was spent by him for treatment of his accidental injuries, alongwith interest at the rate of 9% per annum from the date of repudiation of the claim i.e. 13.1.2014 till realization. Further the opposite parties are directed to pay a sum of Rs.2000/- as compensation for harassment and Rs.2000/- as litigation expenses to the complainant. This order is directed to be complied with within a period of 30 days from the date of receipt of a copy of this order. File be consigned to record room.
Announced 23.12.2014
(Gurpartap Singh Brar)
President
(Gyan Singh )
Member
