IN THE CONSUMER DISPUTES REDRESSAL FORUM, PATHANAMTHITTA, Dated this the 25th day of August, 2011. Present : Sri. Jacob Stephen (President). Sri. N. Premkumar (Member) C.C. No. 26/2011 (Filed on 31.01.2011)Between: Manathazhathil Sukumaran Sreenivasan, Manathazhathil House, 648, Parumala, Thiruvalla, Pathanamthitta. (By Adv. AbrahamVarghese Kadavil) .... Complainant. And: 1. United India Insurance Co. Ltd., Perigol Head Office, United India House 24, Whites Road, Chennai – 600 014. 2. Branch Manager, Branch Office 021001, Stadium House, 4th Floor, Veer Nariman Road, Churchgate, Mumbai – 400 020. 3. The Branch Manager, United India Insurance Co. Ltd., Changanassery, Kottayam Dist. 4. Divisional Manager, Divisional Office, United India Insurance Co. Ltd., Pathanamthitta. (By Adv.P.D. Varghese) .... Opposite parties. ORDERSri. Jacob Stephen (President): The complainant has filed this complaint against the opposite parties for getting a relief from the Forum. 2. The complainant’s case is that he was a policy holder of the opposite parties under Pravasi Bharatiya Bima Yojana Policy 2006, vide policy No. 021001/48/05/308434 and it was valid from 04.08.2006 to 03.08.2008. The said policy was taken by the complainant while he was working at Qatar as a Mason. While so on 16.07.2007, he met with an accident at the work site in Doha, Qatar and sustained serious injury to his back. He had undergone treatment at Hamad General Hospital, Doha from 16.07.2007 to 12.08.2007 and at Rimailah Hospital, Doha upto 14.01.2008. He was completely paralysed, he was given rehabilitation course also. But still there was no improvement in his health condition and he is bedridden. Thereafter he continued his treatment for 8 months as inpatient at Doha Hospital and at last he was returned to India on 20.03.2008. After reaching India, he continued his treatment as outpatient and inpatient at Medical College, Kottayam and Sree Ramakrishna Ayurvedic Hospital at Chingoli, Alappuzha. But his health condition was not improved and his health condition remained same and even now he is bedridden and with great difficulty. He occasionally moves in wheel chair and now he is in a condition of permanent disability. Due to the above said accident, he had lost his orientation and memory. While so on 25.12.2009 he got the original insurance documents while he was searching his other documents. So on 01.01.2010 and on 01.03.2010, the complainant’s mother approached the third opposite party with the original policy document for getting the claim form and on both occasions, the third opposite party seeks time for the processing and at last on 31.10.2010 the complainant’s mother approached the third opposite party for getting the claim form. But 3rd opposite party was not willing to issue the claim form and rejected her request. The complainant is a mason by profession and is not educated and he is from the lower strata of the society and he is suffering financially and physically after the accident. But the opposite parties did not considered the difficulties of the paralysed complainant. So the complainant sent a legal notice to the first and second opposite parties on 01.11.2010 demanding the insurance claim of ` 5 laks, which was replied by the opposite parties with untenable contentions and denied the complainant’s demand. The above said act of the opposite parties is an unfair trade practice and deficiency of service, which caused mental agony, financial loss and other sufferings to the complainant. Hence this complaint for the realisation of the claim amount of ` 5 lakhs with 12% interest from the opposite parties. 3. Opposite parties entered appearance and filed a common version with the following main contentions: According to the opposite parties, this complaint is barred by limitation, as the alleged accident was occurred on 16.07.2007 whereas the complaint is filed only on 31.01.2011. Opposite parties admitted the issuance of the policy to the complainant. But the opposite parties denied the alleged accident occurred on 16.07.2007 at Doha, Qatar and they are not aware of the ailments, disability and the treatments of the complainant. As per the policy condition, the insured has to file claim before the insurer immediately on the occurrence of any event, which will give rise to a claim for insurance benefits. The statement of the complainant that his mother approached the third opposite party is wholly incorrect. The complainant never filed any claim form before the opposite parties as per the terms and conditions of the policy. The complainant’s statement that he is a mason by profession and he is suffering financially and physically has to be proved by the complainant. Opposite parties admitted the notice issued by the complainant but they have sent proper reply to the said notice. In the above said circumstances, they have not committed any deficiency of service to the complainant. With the above contentions, opposite parties pray for the dismissal of the complaint. 4. On the basis of the pleadings of the parties, the following points were raised for consideration: (1) Whether the complaint is maintainable before this Forum? (2) Whether the reliefs sought for in the complaint are allowable? (3) Reliefs and Cost? 5. The evidence of this complaint consists of the oral deposition of PW1 based on the proof affidavit of the complainant and the proof affidavit of the opposite party and Exts.A1 to A7 and Exts.B1 and B1(a). After closure of evidence, both sides were heard. 6. Point No.1: The opposite parties challenged the maintainability of this complaint on the ground that this complaint is barred by limitation. According to the opposite parties, the alleged accident was occurred on 16.07.2007 and this complaint is filed only on 31.01.2011. The date of filing of this complaint is after the expiry of 2 years from the date of accident. Further, opposite parties have an argument that the complainant never filed any claim form before the opposite parties and hence there is no occasion for any deficiency in service and hence the complainant has no cause of action against the opposite parties. So they argued that this complaint is barred by limitation and the complainant had no cause of action against the opposite parties. 7. At the same time, the argument of the complainant against the question of limitation and the question of cause of action is that the complainant was totally bedridden since from the date of accident and he had also lost his memory for some time due to the accident. Therefore, he could not found out the original policy certificate and it was traced out only on 25.12.2009. Thereafter, his mother approached the third opposite party several time for getting a claim form, which was not given by the opposite parties. Because of the above said reason and due to the physical disabilities and due to the continuing treatment of the complainant, he could not filed this complaint and he could not submitted the claim form at an earlier stage. 8. On a perusal of the available materials on record, it is true that this complaint is filed after the expiry of 2 years from the date of accident and the complainant had not filed any claim form before the opposite parties so far. But the complainant had an explanation for the delay in filing the complaint and for the non-submission of the claim form. But he had not adduced any evidence to substantiate the above said explanation. In view of the above said facts, technically this complaint can be treated as not maintainable due to limitation and for want of cause of action. 9. As per Ext.A1, the complainant is a policy holder of the opposite parties and as per Exts.A2, A3 and A4, the complainant had sustained serious injuries due to an accident during the policy period and he had 75% permanent disability also. His present position is also very sympathetic. In such a situation no one will abstain from filing a claim willfully. So we don’t find any malafides for the non-filing of the claim by the complainant. Insurance companies are established for the well being of the society. Considering this aspects and the sympathetic condition of the complainant, we are not inclined to shut our eyes against the sympathetic condition of the complainant even though the technical objections raised by the opposite parties have some effect. However, the opposite parties have a case that the complainant had not filed any claim form before them so far. The complainant also admitted the same. The submission of a claim form is the primary formality for getting an insurance claim. Here, the complainant has not submitted his claim form so far. We have no doubts in the bonafides of the complainant. Therefore and in the circumstances of this case, submission of a claim form by the complainant will not prejudice the opposite parties. So the complainant is directed to file his claim form along with proper documents before the second opposite party, who had issued the policy through the third opposite party as per the terms and conditions of the policy within 15 days from the date of receipt of this order and the opposite parties are directed to consider the claim of the complainant leniently without considering the delay caused in filing the complainant’s claim. The opposite parties are also directed to dispose the claim within 60 days from the date of receipt of the claim form. 10. Points 2 & 3: On the basis of the observations, findings and the directions in Point No.1, these points are not considered. 11. In the result, this complaint is disposed accordingly. No cost. Pronounced in the Open Forum on this 25th day of August, 2011. (Sd/-) Jacob Stephen, (President) Sri. N. Premkumar (Member) : (Sd/-) Appendix: Witness examined on the side of the complainant: PW1 : Sreenivasan. M.S. Exhibits marked on the side of the complainant: A1 : Photocopy of the Pravasi Bharatiya Bima Yojana Policy 2006. A2 : Photocopy of the Transfer summary of the complainant issued by Hamad General Hospital, Doha- Qatar. A3 : Discharge summary dated 09.01.2008 issued by Rumailah Hospital, Doha- Qatar. A4 : Photocopy of the disability certificate issued by the Chairman, Medical Board, General Hospital, Pathanamthitta. Witness examined on the side of the opposite parties: Nil. Exhibits marked on the side of the opposite parties: B1 : Photocopy of the Pravasi Bharatiya Bima Yojana Policy 2006. B2 : Photocopy of the terms and conditions of Pravasi Bharatiya Yojana Policy, 2006. (By Order) Senior Superintendent Copy to:- (1) Manathazhathil Sukumaran Sreenivasan, Manathazhathil House, 648, Parumala, Thiruvalla, Pathanamthitta. (2) United India Insurance Co. Ltd., Perigol Head Office, United India House 24, Whites Road, Chennai – 600 014. (3) Branch Manager, Branch Office 021001, Stadium House, 4th Floor, Veer Nariman Road, Churchgate, Mumbai – 400 020. (4) The Branch Manager, United India Insurance Co. Ltd., Changanassery, Kottayam Dist. (5) Divisional Manager, Divisional Office,United India Insurance Co. Ltd., Pathanamthitta. (6) The Stock File. | 
