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
Thursday the 13th day of November, 2008
C.C.No. 58/08
Between:
Vanka Subba Sekhar, S/o. Vanka Balaiah,
Jilella Village, Gospadu Mandal, Kurnool District.
… Complainant
Versus
United India Insurance Company Limited, Represented by its Branch Manager,
Branch Office ,2-415-B, N.K.Road, Nandyal.
United India Insurance Company Limited, Represented by its Divisional Manager,
Divisional Office, Kurnool. .. Opposite parties
This complaint is coming on this day for orders in the presence of Sri. P.Siva Sudharshan, Advocate, for the complainant, and Sri. A.V.Subramanyam, Advocate, for the opposite parties and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt. C.Preethi, Lady Member)
.C.No.58/08
1. This consumer complaint of the complainant is filed U/S 12 of C.P.Act, seeking direction on the opposite parties to pay Rs.1 lakh policy amount with 18% interest p.a., Rs.20,000/- as 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 complainants case is that the complainant as a member of opposite party No.1 has obtained a Group Janatha Personal Accident Policy bearing No.051102/42 /03/ 00119 through opposite party No.2 for Rs.1 lakh and the policy was valid from 31-07-2003 to 30-07-2008 and nominated V.Lakshmi Devi as nominee. On 27-02-2004 the complainant met with accident and sustained grievous injuries and due to said injuries the complainant was unable to attend his regular duties without assistance and he lost his livelihood as he is suffering with permanent total disability . On 28-12-2005 the complainant approached opposite party No.2 and obtained a claim form and submitted it with documents such as original policy, handicapped certificate , FIR, remand report etc., Even after submitting said reports the opposite parties did not settle the claim nor repudiated it and there was no response . Hence, the complainant approached the forum for reliefs.
3. In support of his case the complainant relied on the following documents viz., (1) certified copy of FIR in Cr.No.05/04 of Shyvalyapuram P.S , (2) certified copy of charge sheet along with part – II statement, (3) certified copy of x-ray report of complainant , (4) certificate of arthopadically handicapped of complainant , (5) Xerox copy of claim form dated 24-07-2006 and (6) Xerox copy of letter dated 30-11-2007 of complainant to opposite party No.1 , besides to the sworn affidavit of complainant in reiteration of his complaint averments and the above documents are marked as Ex.A1 to A6 for its appreciation in this case and replies to the interrogatories exchanged.
4. In pursuance to the notice of this forum as to this case of the complainant the opposite parties appeared through their standing counsel and contested the case the opposite party No.2 filed written version and opposite party No.1 filed adoption memo.
5. The written version of opposite parties denies the complaint as not maintainable either in law or on facts, but admits the complainant obtained a
Group Janatha Personal Accident Policy bearing No.051102/42 /03/ 00119 for Rs. 1 lakh and nominated V.Lakshimi Devi as his nominee, but denies that the grievous injuries received by the complainant are not out of the accident occurred on 27-02-2004 . It further submits that as per the terms and conditions of the policy the claim form and required documents should be furnished to the opposite parties within 12 months from the date of the accident to settle the claim , where as the complainant submitted claim from and other relevant documents after the stipulated period of 12 months. The opposite party there after addressed letters to complainant requiring the complainant to give reasons for delay in submitting claim papers, thereafter there was no response from the complainant and the opposite party closed the claim as no claim. Finally on 30-11-2007 after lapse of three years the complainant submitted claim form and other relevant documents. As and there is no record to show that the complainant suffered permanent disability in the accident occurred on 27-02-2004 the claim of the complainant is not maintainable and he is not entitled for any reliefs as prayed and there is no deficiency of service on part of opposite parties and lastly seeks for the dismissal of complaint with costs.
6. In support of their case the opposite parties relied on the following documents viz., (1) letter dated 16-08-2006 of opposite party No.1 to complainant , (2) letter dated 28-09-2007 of opposite party No.1 to complainant, (3) Xerox copy of policy bearing No.051102/42 /03/ 00119 , besides to the sworn affidavit of opposite party No.2 in reiteration of his written version averments and the above documents are marked as Ex.B1 to B2 for its appreciation in this case and replies to the interrogatories exchanged.
7. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties ?.
8. It is the case of the complainant that he has obtained a Janata Personnel Accident Policy bearing No. .051102/42 /03/ 00119 vide Ex.B3 from opposite parties and the policy was valid from 31-07-2003 to 30-07-2008 . During the risk period the complainant met with accident on 27-02-2004 and sustained injuries. The Ex.A1 is the certified copy of FIR in Cr.No.5/04 of Shyvalapuram (PS) on the statement of Istala Lazar says as to the accident to lorry bearing No. AAB 4604 with another lorry bearing No. AP04 75387. The Ex.A2 is certified copy of charge sheet along with part II statement in Cr.No. 5/2004. The complainant submits that he was traveling in lorry bearing No. AAB 4604 and sustained injuries in the said accident and an x-ray was taken and Ex.A3 is the report of X-ray. The Ex.A4 is the Medical Certificate in respect of orthopadically Handicapped candidates issued by Orthopadic Surgeon Unit, Government General Hospital , Kurnool to the complainant where in it shows 50% disability to the complainant.
9. While such is so with the complainant , the opposite parties on the other side submits that the accident occurred on 27-02-2004 and the claim form was submitted to the opposite parties on 30-11-2007 after a lapse of 3 ½ years and failed to submit relevant documents to prove the disability occurred to him along with claim form. As per the conditions of the policy the intimation should be given to the insurance company about the accident with in one month and as per the CL (d) of the terms , if such injury shall within twelve calendar month of its occurrence be the sole and direct cause of permanently totally and absolutely disability to the insured the insurance company shall pay the assured amount under the policy. The complainant in this case relied on Ex.A4 Handicapped Certificates issued by Medical Board, the said certificate was issued to the complainant on 02-06-2006 and the said certificate no where envisages that the disability to the complainant was due to the accident occurred on 27-02-2006 and more over the said certificate in Ex. A4 was issued on 02-06-2006 i.e., after a lapse of two years and four months after the date of accident. Hence, what appears is that the certificate in Ex.A4 was not issued to injuries occurred in accident on 27-02-2006 but may be due to some other reasons.
10. The liability of opposite parties to pay sum assured to the complainant arises only when the complainant received injuries in an accident and which was sole or direct cause for said injuries, in this case on hand , the complainant did not place any material on record to show that the injuries occurred in the said accident are the sole and direct cause for issuing Ex.A4 certificate. The doctor who issued the Ex.A4 certificate was neither examined nor his affidavit is filed to show that injuries the complainant received on 27-02-2004 accident are the sole cause for issuing the said handicapped certificate in Ex.A4.
11. There is nothing on record to show that handicapped certificate in Ex.A4 was issued to the complainant for the injuries he received on 27-02-2004 accident. Hence, it cannot be said that the 50% disability to the complainant was due to accident occurred on 27-02-2004 only. The opposite parties shall pay the insured sum only when there is permanently totally and absolutely disability to the insured, received from the sole and direct cause of accident only and when the said disability due to accident is not proved, the opposite parties are not liable to pay any amount to the complainant and therefore the complaint is dismissed.
12. In the result, the complaint is dismissed.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 13th day of November, 2008.
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MEMBER PRESIDENT APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties :Nil
List of exhibits marked for the complainant:-
Ex.A1. Certified copy of FIR in Cr.No.5/04 of Shyvalya Puram (PS)
Ex.A2. Certified copy of charge sheet along with part II statement.
Ex.A3. Certified copy of X-ray report as to V.Sekhar.
Ex.A4. Certificate of orthopaedically Handicapped candidates of
V.Subba Sekhar.
Ex.A5. Xerox of claim form dated 24-07-2006.
Ex.A6. Xerox of letter dated 30-11-2007 of complainant to OP.No.1.
.
List of exhibits marked for the opposite parties:
Ex.B1. Letter dated 16-08-2006 of OP.No.1 to complainant.
Ex.B2. Letter dated 28-09-2007 of OP.No.1 to complainant
along with acknowledgement.
Ex.B3. Copy of the policy No.051102/47/03/51 00000119 of
Complainant .
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MEMBER PRESIDENT
// 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 :
