BEFORE THE DISTRICT FORUM: KURNOOL

Present: Sri. T.Sundara Ramaiah, B.Com B.L., President

And

Sri. M.Krishna Reddy, M.Sc., M.Phil., Male Member

And

         Smt. S.Nazeerunnisa, B.A., B.L., Lady Member

Friday the 2^nd day of September, 2011

C.C.No.136/2010

Between:

Shaik Khasimbee, D/o Late Shaik Munir Ahmed,

H.No.22-36-2, Pagidyala Road, Nandikotkur-518 401.                                   

      …Complainant

                                       -Vs-

1. The Senior Divisional Manager,Bajaj Alianz General Insurance Company Limited,

    GE Plaza, Air Port Road, PUNE-411 000.

2. The Managing Director,Golden Multi Services Club Limited,

    S.B.Mansison, 16, R.N.Mukherjee Road, Kolkatta-700 001.

3. The Branch Incharge, Golden Multi Services Club Limited,

    40-384/1, U-con Plaza, 3^rd floor, Park Road, Kurnool-518 001.                

            ...Opposite ParTies

This complaint is coming on this day for orders in the presence of Sri P.Siva Sudarshan, Advocate for complainant and Sri A.V.Subrmanyam, Advocate for opposite party No.1 and opposite party No.2 called absent and Sri M.Azmathulla, Advocate for opposite party No.3 for upon perusing the material papers on record, the Forum made the following.

           ORDER

                  (As per Sri. T.Sundara Ramaiah, President)

   C.C. No.136/2010

1.     This complaint is filed under section 11 and 12 of C. P. Act, 1986 praying:-

1. To direct the opposite parties to pay the policy amount of Rs.1,00,000/- to the complainant with interest at 24% per annum from the date of accident i.e., 04-09-2009 till the date of realization;

1. To grant a sum of Rs.20,000/- towards mental agony;

1. To grant a sum of Rs.2,000/- towards cost of the complaint;
   •  
2. To grant any other relief as the Honourable Forum deems fit and proper in the circumstances of the case.                                  

2.    The case of the complainant in brief is as under:- The complainant took the Janatha Personal Accident Policy from opposite party No.1 though opposite parties 2 and 3 organizations for an assured sum of Rs.1,00,000/-.  The opposite party no.1 issued the policy bearing No.06-09-2401-6401-00445413 in favour of the complainant.  The period of the policy is from 15-10-2008 to 14-10-2013.  The complainant sustained grievous injuries in road accident that took place on 14-09-2009 at about 7-00A.M. near Thatoor Village.  After the accident the complainant was shifted to the Government General Hospital, Kurnool.  The doctors declared that the complainant sustained fracture to his legs.  The police registered a case in Crime No.106/2009 under section 337 I.P.C.  The complainant submitted the claim form to opposite party No.1 through opposite parties 2 and 3 along with relevant documents.  Opposite party No.1not settled the claim of the complainant even after Six months.  There is deficiency of service.  Hence the complaint.

3.     Opposite party No.1 filed written version stating that the complaint is not maintainable.  The complainant took Janatha Personal Accident Policy from opposite party No.1 through opposite parties 2 and 3 for Rs.1,00,000/-.  The period of the policy is from 15-10-2008 to 14-10-2013.  The policy was issued subject to the terms and conditions. The complainant has to prove the accident. The complainant submitted the claim form where in it is mentioned that there was loss of both legs.  The complainant is not entitled to any amount unless there is death/permanent disablement.  There is no disablement to the complainant.  The complainant did not furnish required documents to settle the claim in spite of repeated demands.   As there was no response from the complainant the opposite party No.1 was forced to close the claim on 27-01-2009 and the same was communicated to the complainant.  In the present case there is no death or disablement. The complaint is liable to be dismissed.   

        Opposite party No.2 is set exparte.

        Opposite party No.3 filed written version stating that the complaint is not maintainable.  As per the memorandum of agreement the opposite party No.1 agreed to extend the insurance coverage to the members of opposite parties 2 and 3.  On receipt of premium, opposite party No.1 issued policy certificate.  After receiving the claim documents opposite party No.3 submitted the same to opposite party No.1.  Opposite party No.3 has no knowledge about the injuries sustained by the complainant.  There is no deficiency of service on the part of opposite party No.3.  The complaint is liable to be dismissed.

4.     On behalf of the complainant Ex.A1 to A5 are marked and sworn affidavit of the complainant is filed. On behalf of the opposite parties Ex.B1 to B7 are marked and sworn affidavit of the opposite party No.1 is filed.

5.     Both sides filed written arguments.

6.     The points that arise for consideration are:

1. Whether there is deficiency of service on the part of Opposite Parties?

1. Whether the complainant is entitled to the reliefs as prayed for?

1. To what relief?

7.      POINTS 1 and 2:- Admittedly the complainant took Janatha Personal Accident Policy Ex.A1 (Ex.B1) from opposite party No.1 through opposite parties 2 and 3 for an assured amount of Rs.1,00,000/-.  The period of the policy is from 15-10-2008 to 14-10-2013.  The policy was issued subject to the terms and conditions.  The scale of compensation mentioned in the policy Ex.A1 is as under:

1. Death                                        …..    100% sum insured
2. Loss of sight on both eyes             ……    100% sum insured

1. Loss of both hands                       …..    100% sum insured
2. Loss of both feet                         …..    100% sum insured
3. Loss of one hand and one foot       …..    100% sum insured
4. Loss of one eye and one hand       …..    100% sum insured
5. Loss of one eye and one foot                …..    100% sum insured
6. Loss of one eye or one foot or one hand…         50% sum insured.

Admittedly the complainant submitted the claim to opposite party no.1 through opposite parties 2 and 3 and the said claim was not settled by the opposite party No.1.

8.     It is the case of the complainant that she received injuries in the road accident that took place on 04-09-2009 at about 7-00 A.M. near Thatoor Village.  The complainant in her sworn affidavit stated about the accident.  She filed Ex.A2 copy of the F.I.R. in Crime No.106/2009 of Government General Hospital OP Kurnool.  As seen from Ex.A2 it is very clear that on the statement of the complainant Government General Hospital OP Kurnool registered a case.   It is mentioned in Ex.A2 that on 04-07-2009 the complainant along with some others boarded auto to go to Nandikotkur, that the said auto turtiled when it reached Thatoor Village and that the complainant received injuries on legs and chest.  It is further case of the complainant that after the accident she was shifted to Government General Hospital.  Ex.A3 is the medical certificate issued by Civil Assistant Surgeon Government General Hospital, Kurnool.  It is mentioned in Ex.A3 that the petitioner was suffering with injuries to both legs.  As seen from Ex.A2 and A3 it is very clear that the complainant on 04-07-2009 received injuries in the accident.

9.     The complainant filed the present complaint claiming an amount of Rs.1,00,000/- alleging that there was deficiency of service on the part of opposite party No.1.  It is the contention of opposite party no.1 that the complainant failed to establish that she sustained grievous injuries on 04-07-2009 and that she is not entitled to any amount.  In Ex.A2 F.I.R. it is simply mentioned that the complainant received injuries on legs and chest.  In Ex.A3 medical certificate also nature of injuries sustained by the complainant are not at all mentioned.  There is no medical evidence on record to show that the complainant got permanent disablement because of injuries received by her.  It is mentioned in Ex.A1 policy that in the case of loss of both feet or loss of one hand and loss of one foot the total sum assured is payable.  It is not the case of the complainant that she lost both feet due to the accident that took place on 04-09-2009.  No doubt it is mentioned in the complaint that the complainant sustained grievous injuries in the road accident, but the said fact is not establish by the complainant.  The complainant failed to establish permanent disablement an account of the injuries received by her.   No disablement certificate is filed by the complainant to show that she got permanent disablement because of injuries received by her in the accident.  The complainant filed to satisfy the terms and conditions of the policy.  Therefore the complainant is not entitled to any amount under the policy Ex.A1.

10.    It is also the case of the complainant that in spite of the claim made by her opposite party No.1 failed to settle her claim.  Admittedly opposite parties 2 and 3 need not pay any amount to the complainant under Ex.A1 policy.  The policy was issued by opposite party No.1.  It is submitted by the learned counsel appearing for the opposite party No.1 that after receiving the claim from the complainant, opposite party No.1 demanded the complainant through registered letter to submit the documents.  Ex.B2 and B4 go to show that opposite party No.1 issued reminders to the complainant to submit the required documents.  In spite of the reminders issued by opposite party No.1 the complainant did not take steps to comply.   Opposite party No.1 closed the claim under Ex.B5 dated 27-10-2009 as the complainant did not extend his co-operation to settle the claim.  There is no deficiency of service of the part of the opposite party No.1.  Therefore the complainant is not entitled to the reliefs as prayed for.

11.    In the result, the complaint is dismissed without costs.

        Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 2^nd day of September, 2011.

        Sd/-                                      Sd/-                                Sd/-

MALE MEMBER                      PRESIDENT                 LADY MEMBER

                                 APPENDIX OF EVIDENCE

                                    Witnesses Examined

For the complainant : Nil                  For the opposite parties : Nill

List of exhibits marked for the complainant:-

Ex.A1                Photo copy of Insurance

Policy No.06-09-2401-6401-00445413.

Ex.A2.       Photo copy of F.I.R. in Crime No.106/2009

dated 20-07-2009.

Ex.A3                Photo copy of Medical Certificate issued by Civil Assistant

Surgeon Government General Hospital, Kurnool

dated 19-10-2009.

Ex.A4                Photo copy of Out Patient Slip No.74815 of Government

General Hospital, Kurnool dated 04-07-2009.

Ex.A5                Photo copy of Claim Form dated 22-07-2009.

List of exhibits marked for the opposite parties:-

Ex.B1                Bajaj Allianz General Insurance

Policy No.06-09-2401-6401-00445413.

Ex.B2                Office copy of Requirement letter dated 04-08-2009.

Ex.B3                Office copy of 1^st Reminder letter dated 08-09-2009.

Ex.B4                Office copy of 2^nd Reminder letter dated 08-10-2009.

Ex.B5                Office copy of Claim Closure Letter dated 27-10-2009.

Ex.B6                Returned Postal Cover along with acknowledgement.                         

Ex.B7                Returned Postal Cover.                         

        Sd/-                                  Sd/-                                     Sd/-

MALE MEMBER                 PRESIDENT                   LADY MEMBER

    // Certified free copy communicated under Rule 4 (10) of the

A.P.S.C.D.R.C. Rules, 1987//

Copy to:-

Complainant and Opposite parties  :

Copy was made ready on             :

Copy was dispatched on               :