State Consumer Disputes Redressal Commission
1. National Insurance Company Ltd., vs 1. B. Janardhan on 3 November, 2017
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL FORUM Telangana First Appeal No. A/33/2016 (Arisen out of Order Dated 29/12/2015 in Case No. Complaint Case No. CC/55/2015 of District Hyderabad) 1. 1. National Insurance Company Ltd., A govt of India Undertaking, Rep.by its Senior Divisional Manager, Division III, National Insurance Building 8, India Exchange Place, Ground Floor, Kolkata 700001 ...........Appellant(s) Versus 1. 1. B. Janardhan S/o Manoj, aged 44 years, Occ. Unemployee, R/o H.No 22/195/3, Rallaguda Road, Shamshabad, Ranga Reddy District, Telangana State, Pin 501218 2. 2. GTFS Multi Services Ltd., Rep by its Branch Manager 3-6-111/8, Far East Plaza, 4th floor, Street No 18, Himayat Nagar, Hyderabad 500029 ...........Respondent(s) BEFORE: HON'BLE MR. JUSTICE B. N. RAO NALLA PRESIDENT HON'BLE MR. Sri. PATIL VITHAL RAO JUDICIAL MEMBER For the Appellant: For the Respondent: Dated : 03 Nov 2017 Final Order / Judgement STATE CONSUMER DISPUTES REDRESSAL COMMISSION OF TELANGANA : At HYDERABAD FA 33 of 2016 AGAINST CC No. 55 of 2015, DISTRICT FORUM-1, HYDERABAD Between : 1) The National Insurance Co., Ltd., (A Govt. of India undertaking), Rep. by its Senior Divisional Manager, Division-III, National Insurance Building, 8, India Exchange place, (Ground Floor), Kolkata - 700001.... Appellant/1st opposite party And B.Janardhan, S/o. Manoj, Aged about 44 years, Occ: Un-employee, H.No.22/195/3, Rallaguda Road, Shamshabad, Ranga Reddy District, Telangana State, pin code : 501218. ... 1st respondent/Complainant 2) GTFS Multi Services Ltd., Rep. by its Branch Manager, 3-6-111/8, Far East Plaza, 4 th Floor, Street No.18, Himayat Nagar, Hyderabad - 500029. ..2nd respondent/2nd opposite party Counsel for the Appellant : Sri Nisaruddin Ahmed Jeddy Counsel for the Respondents : M/s K. Yadagiri Reddy for R-1 Smt. K. Kalpana for R-2 Coram : Honble Sri Justice B. N. Rao Nalla ... President And Sri Patil Vithal Rao ... Member
Friday, the Third Day of November Two Thousand Seventeen Oral order : ( per Hon' ble Sri Justice B.N.Rao Nalla, Hon'ble President ) ***
1) This is an appeal filed under Section 15 of the Consumer Protection Act by the 1st opposite party praying this Commission to set aside the impugned order dated 29.12.2015 made in CC 55/2015 on the file of the DISTRICT FORUM-1, Hyderabad and allow the appeal.
2) For the sake of convenience, the parties are described as arrayed in the complaint before the District Forum.
3). The case of the complainant , in brief, is that he has taken Group Janata Personal Accident Insurance Policy for a sum of Rs.5,00,000/- vide policy bearing No.100300/47/01/9600022/04/96/30017 for the period from 08.04.2004 to 07.042019 from the 1st opposite party by paying a sum of Rs.3,037/- towards premium amount. While the policy was in force, while he was cutting wood at his house on 25.12.2008, a wooden piece inserted into his Right eye, at that time his wife namely B.Shoba and one of his friend namely Khader were also present at his house and he has taken quack treatment for some time but there was no improvement. Hence, on 21.01.2009 he was admitted in Sarojini Devi Eye Hospital, Hyderabad for treatment. The concerned doctor of the said hospital informed him that the said eye has been completely damaged, conducted operation on 25.02.2009 and removed the damaged right eye and fixed an artificial eye and discharged on 10.03.2009 by issuing case sheet dated 10.03.2009 and the complainant has lost complete vision in his right eye. As per the terms of the said policy loss of sight of one eye benefit is 50% of sum assured and he submitted claim to the opposite parties along with all relevant documents including the certificate issued by Sarojini Devi Eye Hospital on 23.07.2010, stating that Right eye Prosthetic (i.e., artificial eye) and left eye vision 6/24 and also stated "Visual disability 50%", and the said certificate copy submitted to the opposite party No.2 on 24.07.2010. The claim papers were sent to the second opposite party which forwarded the same to the second opposite party. But the opposite parties did not settle the claim which amounts to deficiency in service. Hence the complaint to direct the opposite parties to pay a sum of Rs.2,50,000/- along with 24% interest per annum from the date of claim on 20.04.2009, Rs.1,00,000/- towards compensation and costs of Rs.5,000/-.
4) The 1st opposite party opposed the above complaint by way of written version contending that the complaint is barred by limitation the complainant has not submitted any authentic documents, FIR, Charge sheet, Final report of Police to show that he sustained injury in the accident. As per the complaint that the complainant has taken quack treatment for some time but there was no improvement thus there is a violation of clause NO.1, 2 & 4 of the terms and conditions of policy that he himself indulged in negligent Act and contributed to damage of the eye sight by taking quack treatment or medically unqualified doctor and no evidence was filed to support his claim and the certificate issued by Sarojini Devi Eye Hospital mentions 30% disability which is not payable as per terms and conditions of the policy while another certificate from the same hospital mentions Visual Disability as 50%. There is no deficiency in service on their part and prayed to dismiss the complaint.
5) The 2nd opposite party though served with notice, did not choose to contest the matter.
6) During the course of enquiry before the District Forum, in order to prove his case, the complainant filed his evidence affidavit and got marked Ex.A1 to A-14 and the 1st opposite party filed evidence affidavit by reiterating the contents of the written version and also got marked Ex. B1 to B3. Both sides filed their respective written arguments. Heard both sides.
7) The District Forum, after considering the material available on record, allowed the compliant in part directing the opposite parties 1 & 2 jointly and severally to pay a sum of Rs.2,50,000/- along with interest @ 9% from the date of complaint till realization and costs of Rs.5,000/- within 30 days.
8) Aggrieved by the said order, the opposite parties preferred this appeal before this Commission.
9) Both sides have advanced their arguments reiterating the contents in the appeal grounds, rebuttal thereof along with written arguments. Heard both sides.
10) The points that arise for consideration are, (i) Whether the impugned order as passed by the District Forum suffers from any error or irregularity or whether it is liable to be set aside, modified or interfered with, in any manner? (ii) To what relief ? 11). Point No.1 :
There is no dispute that the 1st respondent/complainant has obtained Group Janata Personal Accident Insurance Policy for a sum of Rs.5,00,000/- vide policy bearing No.100300/47/01/9600022/04/96/30017 for the period from 08.04.2004 to 07.04.2019 from the 1st opposite party by paying a sum of Rs.3,037/- towards premium amount. There is no dispute that the first respondent/complainant sustained injury to his right eye, he took treatment from the quack doctor initially, later he joined Sarojinidevi Eye hospital at Hyderabad, his eye was damaged. There is also no dispute that the policy was in force on the date of the alleged accident.
12). The first contention of the appellant /1st opposite party is that the complaint is barred by limitation. i.e., the accident occurred on 25.12.2008 and the complaint was filed on 08.01.2015, ;i.e., after a delay of 7 years. Counsel for the first respondent/complainant rebutted that he met with an accident on 25.12.2008, and subsequently he had taken quack treatment for some time and went to Sarojini Devi Eye Hospital on 21.01.2009 and operation was conducted on 25.01.2009 and his right eye was removed and an artificial eye was inserted. We have perused the documents. The first respondent/complainant submitted claim on 20.04.2009 with all relevant documents. Ex.A5 is letter dated 27.03.2014 from the opposite parties to the 1st respondent/complainant to send some documents, in turn, he sent the same vide Ex.A6 on 21.06.2014. The complainant filed the complaint on 19.11.2015. From 27.03.2014, the complaint was filed within two years and hence the complaint is not barred by limitation as rightly held by the District Forum.
13) The further contention of the appellant is that while Ex.A3 says 30% visual disability and Ex.A4 says 50% visual disability to the respondent and no doctor was examined and no expert opinion was filed. Ex.A-5 Report issued by the Medical Board consisting of five qualified doctors after examining the first respondent/complainant shows that the patient is 75% visually handicapped. Admittedly, as per Clause-7 loss of sight of one eye, entitled 50% of sum assured and as per Ex.B1 policy the sum insured was Rs.5,00,000/-. When the panel of doctors examined the first respondent/complainant and issued report, no further expert opinion is required. Further the quack doctor did not conduct any operation to his eye. It is for the appellant/1st opposite party to engage expert doctor, if required, but it did not do so. There is no evidence on record produced by the appellant/1st opposite party that the treatment of the Quack doctor damaged the eye of the first respondent/ complainant as alleged by the appellant insurance company. Hence, contributory damage to the eye of the first respondent/complainant by the quack doctor not be proved.
14). With regard to the contention of the appellant Insurance company that the FIR/Charge Sheet is required, counsel for the first respondent/complainant relied on the decision in Oriental Insurance Company Ltd., Vs. Suresh Singh & Another reported in II (2009) CPJ 216 (NC), wherein, it was held that filing of FIR is not compulsory under the policy and 50% assured sum payable for loss of one limb/eye due to accident as per policy and Insurer held liable to pay 50% of sum assured with interest. The District Forum relying on the above decision, partly allowed the complaint on the ground that the quack doctor did not conduct any operation to the first respondent/complainant, the right eye of the first respondent/complainant was removed and an artificial eye was inserted and as per Ex B1 policy for the loss of one eye, he is entitled to 50% of the sum assured and hence the first respondent/complainant is entitled to Rs.2,50,000/- out of the assured sum of Rs.5,00,000/- along with costs of Rs.5,000/-.
15) Counsel for the second respondent/2nd opposite party argued that being the Insured-facilitator cannot be fastened with any liability under the insurance contract arranged by them for the insured person, the complainant has applied for group medical insurance to the appellant through the second respondent/2nd opposite party. As per the terms of the policy, in case any claim arose, the member, who is the insured, has to claim from the appellant insurance company by submitting all the documents to it for settlement of the claim. Thus, the second respondent/second opposite party has no role in settlement of the claim of the complainant and it acted as facilitator in obtaining Insurance policy and nothing else. He relied on the decision of the Hon'ble National Commission in FA 191 of 2009 in between Road Safety Club Pvt. Ltd Vs. Smt. Kodi Lakshmi Narayanamma and others and the decisions of the A. P. State Consumer Disputes Redressal Commission in RA No. 797 of 2007, FA No. 850 of 2007 and FA No. 953 of 2007 filed by the Golden Multi Services Club Ltd, wherein, it was held that the Road Safety Club and Golden Multi Services Club are only a facilitator and set aside the liability of these companies holding that the Insurance company is liable to pay the awarded amounts. It is argued on behalf of the first respondent/complainant that he has taken the policy in question from the appellant/first opposite party through the second respondent/second opposite party on repeated requests and hence the second respondent/2nd opposite party is also responsible. Admittedly, as per the averments of the first respondent/complainant, the 2nd respondent/2nd opposite party forwarded the claim papers to the appellant/1st opposite party vide their letters dated 30.04.2009 and 25.06.2014 and it has fulfilled its responsibility as facilitator, and in fact, it has no role either in accepting or rejecting the claim. The first respondent/complainant or the appellant Insurance company failed to prove that there is any negligence or deficiency in service on the part of the 2nd respondent/2nd opposite party. Hence the claim against the second respondent/2nd opposite party is liable to be dismissed.
16). After considering the foregoing facts and circumstances and also having regard to the contentions raised on both sides, this Commission is of the view that there is no infirmity or irregularity in the order passed by the District Forum as far as the claim against the appellant/1st opposite party is concerned. There are no merits in the appeal and hence the appeal is liable to be dismissed. However, the claim against 2nd respondent/2nd opposite party is concerned, it is liable to be dismissed in view of the above observations and the same is hereby dismissed.
17). Point No. 2 :
In the result, the appeal is dismissed confirming the impugned order dated 29.12.2015 passed by the District Forum I, Hyderabad in CC 55 of 2015 as far as the appellant/1st opposite party is concerned. There shall be no order as to costs. Time for compliance four weeks.
PRESIDENT MEMBER Dated : 03.11.2017. [HON'BLE MR. JUSTICE B. N. RAO NALLA] PRESIDENT [HON'BLE MR. Sri. PATIL VITHAL RAO] JUDICIAL MEMBER