DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.
Complaint No. 595
Instituted on: 08.11.2017
Decided on: 08.05.2018
Mukhtiar Singh aged 47 years son of Sohan Singh, resident of Village Ghamur Ghat, Tehsil Lehragaga, District Sangrur.
…Complainant
Versus
1. The Sangrur Central Cooperative Bank Limited, Branch Maniana, Tehsil Moonak, District Sangrur, through its Branch Manager.
2. The Sangrur Central Co-operative Bank, Patiala Gate, Sangrur through its District Manager.
3. The New India Assurance Company Limited, Cinema Road, Branch Nabha, District Patiala, through its Branch Manager.
..Opposite parties
For the complainant : Shri Lovepreet Walia, Adv.
For OPs No.1&2 : Smt. Pooja Bahuguna, Adv.
For OP No.3 : Shri Ashish Garg, Adv.
Quorum: Sukhpal Singh Gill, President
Sarita Garg, Member
Order by : Sarita Garg, Member
1. Shri Mukhtiar Singh, complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the complainant was insured with the OP number 3 through OPs number 1 and 2 under policy number 36150147152300000001 under which the complainant was entitled for accidental death as well as for accidental injuries. The grievance of the complainant is that he met with an accident on 17.3.2016, of which DDR number 36 dated 19.3.2016 was recorded at PS Chhajli and further the complainant was brought to Vinayak Hospital Sunam immediately for treatment from where he was referred to RMC Hospital, Tohana, where he remained admitted from 17.3.2016 to 26.3.2016 and his foot was amputated on 19.3.2016. Thereafter the complainant lodged the claim with the Ops and submitted the documents, but the claim of the complainant was repudiated vide letter dated 30.3.2017, which is said to be wrong and illegal. Thus, alleging deficiency in service on the part of the OPs, the complainant has prayed that the Ops be directed to pay to the complainant the claim amount of Rs.1,00,000/- along with interest @ 9% per annum from the date of repudiation of the claim and further claimed compensation and litigation expenses.
2. In reply filed by Ops number 1 and 2, preliminary objection is taken up on the ground that the complaint is not maintainable. On merits, it has been admitted that the complainant is insured with the OP number 3 under the policy and it is further admitted that after receipt of the application from the complainant, the same was immediately forwarded to the Head Office, Sangrur. The other allegations levelled in the complaint have been denied in toto.
3. In reply filed by OP number 3, it is admitted that the complainant was insured through OP number 1 and 2 under Group Janta Personal Accident Insurance policy from 1.6.2015 to 31.5.2016 for Rs.1,00,000/- subject to the terms and conditions of the policy. It is further stated that after receipt of the intimation dated 5.5.2016, the OP appointed Er. Yashwinder Goyal, Investigator for investigation of the claim, who submitted his report dated 22.12.2016. Later on the Op sought the opinion of Dr. Rajeev Aggarwal in respect of disability, who opined vide letter dated 22.3.2017 that the level of amputation is in the foot and heel had been saved, therefore, the complainant is not entitled to get any claim, as such the claim of the complainant was repudiated vide letter dated 30.3.2017. However, it has been denied that the complainant has suffered 65% of disability as alleged. Any deficiency in service on the part of the Ops has been denied.
4. The learned counsel for the complainant has produced Ex.C-1 to Ex.C-10 copies of documents and affidavit and closed evidence. On the other hand, the learned counsel for OP number 1 and 2 has produced Ex.OP1&2/1 to Ex.OP1&2/3 copies of documents and affidavit and closed evidence. The learned counsel for OP number 3 has produced Ex.OP3/1 to Ex.OP3/3 copies of documents and affidavit and closed evidence.
5. We have carefully perused the complaint, version of the opposite parties, evidence produced on the file and written submissions and also heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits acceptance, for these reasons.
6. In the present case, it is admitted fact between the parties that the complainant was insured with the OP number 3 under the group personal accident policy for Rs.1,00,000/- through OPs number 1 and 2. It is also admitted fact that the complainant suffered accidental injuries on 17.3.2016, of which DDR dated 19.3.2016, Ex.C-6 was recorded at PS Chhajli and it is also not in dispute that the part of the foot of the complainant was amputated. As such, the complainant lodged the claim with the Ops for payment of the insurance amount to the tune of Rs.1,00,000/- under the policy.
7. OPs number 1 and 2 have admitted having issued the said policy and with regard to the other contents, the learned counsel has submitted that the same is the matter of record. OPs number 1 and 2 have further submitted that the complainant moved an application regarding his accident, which was forwarded to OP number 3 for payment of the claim amount, if any. On the other hand, though it is admitted that the claim was lodged with the OP number 3, but the case of the OP number 3 is that the same was repudiated on the ground that the Op sought the opinion of Dr. Rajeev Aggarwal in respect of disability, who opined vide letter dated 22.3.2017 that the level of amputation is in the foot and heel had been saved, therefore, the complainant is not entitled to get any claim, as such the claim of the complainant was repudiated vide letter dated 30.3.2017. But, we are unable to go with this contention of the learned counsel for the OP number 3 that the complainant has produced on record the disability certificate, a copy of which on record is Ex.C-7, which is issued by the office of the Civil Surgeon, Sangrur, wherein it has been clearly mentioned that the complainant has 65% disability. The learned counsel for the OP number 3 has produced on record the opinion of Dr. Rajeev Aggarwal dated 22.3.2017, Ex.OP3/14, wherein he has mentioned that as per the rules the disability to whole body is 30%, but no such rules have been produced on record by the OP number 3 to support such a contention of the Dr. Rajeev Aggarwal. On the other hand, the complainant has produced a disability certificate Ex.C-7, wherein it is clearly mentioned that the disability of the complainant is 65%. It is worth mentioning here that the complainant Mukhtiar Singh was called and he came present on 20.4.2018 and both the members of the Forum also perused the foot of the complainant. Since it is on record that the complainant has suffered 65% of disability due to amputation of half portion of the foot, which is duly issued by the panel doctors of office of Civil Surgeon, Sangrur, as such as per the terms and conditions of the policy, Ex.OP3/2, we feel that the complainant is entitled 50% of the sum insured as the complainant has suffered a loss of a foot. Now, we are of the considered opinion that ends of justice would be met if the complainant is paid an amount of Rs.50,000/- (being 50% of the insured value).
8. In the light of above discussion, we allow the complaint and direct OP number 3 to pay to the complainant an amount of Rs.50,000/- along with interest @ 9% per annum from the date of filing of the present complaint i.e. 08.11.2017 till realisation. OP number 3 is further directed to pay to the complainant an amount of Rs.5,000/- in lieu of consolidated amount of compensation and litigation expenses.
9. This order of ours be complied with within a period of thirty days of its communication. A copy of this order be issued to the parties free of cost. File be consigned to records.
Pronounced.
May 8, 2018.
(Sukhpal Singh Gill)
President
(Sarita Garg)
Member
