State Consumer Disputes Redressal Commission
Anil Ramkrishna Inamdar vs The New India Assurance Company Limited on 31 August, 2009
BEFORE THE HON BEFORE THE HONBLE STATE CONSUMER DISPUTES REDRESSAL COMMISSION, MAHARASHTRA, MUMBAI FIRST APPEAL NO. 1413 OF 2008 Date of filing: 03.11.2008 IN CONSUMER COMPLAINT NO.178/2008 Date of order: 31.08.2009 DISTRICT CONSUMER FORUM: SATARA Anil Ramkrishna Inamdar, F-1, Rasika Park, 1st Floor, City Survey No. 460/A/6, Plot No.13, Shinde Colony, ..Appellant/ Sadar Bazar, Satara. (Org. Complainant) V/s. The Branch Manager, The New India Assurance Company Limited, L.I.C. Building, First Floor, In front of Collector Office, Sadar Bazar, ..Respondent/ Satara, District Satara. (Original Opposite Party) Corum: Shri P.N. Kashalkar, Honble Presiding Judicial Member
Smt. S.P. Lale, Member Present: Mr. M.H. Oak, Advocate for Appellant. Mr. A.S. Vidyarthi, Advocate for Respondent. -: ORDER :- Per Shri P.N. Kashalkar, Honble Presiding Judicial Member.
This appeal is filed by Original Complainant in Complaint No.178/2008, which has been dismissed on merits by District Forum, Satara in Consumer complaint by judgement and order dated 06.10.2008.
Facts to the extent appeal stated as under:
The Complainant had purchased Personal Accident Policy from New India Assurance Co. Ltd., Original Opposite party. On 18.01.2007 when he was driving a Motor Cycle on road leading to Civil Hospital at Satara, met with an accident and was seriously injured. His right hand wrist was fractured and he cannot straiten his fingers. He had taken treatment from various Doctors and spent Rs.10,285/- on medical treatment. He submitted claim form with the Opposite Party. Opposite Party sanctioned amount of Rs.28,022/-. He was not satisfied with the offer made by Insurance Company Opposite Party. Hence, he sent registered notice through his Advocate to the Insurance Company and claimed amount of Rs.1,41,356.74. The Insurance Company sent reply. Complainant was not satisfied with the reply and therefore, he filed present complaint claiming Rs.1,41,356.74 together with interest and also claiming cost of proceeding.
Opposite Party Insurance Company filed Written statement and denied the averments made by the Complainant. According to the Opposite Party as per averments made in complaint, when Complainant was going on motorcycle a stray dog followed him and bite him, because of biting, the vehicle skidded and he fell down from the vehicle and thereby he sustained some injury. Opposite Party pleaded that thereafter he approached Dr. Lawand to whom Complainant told that he had suffered injury because of dog bite. The Complainant was referred to Suyog Digital Diagnostic Centre to know if there was any fracture to him, but, the Lab gave report that there was no fracture. The Opposite Party sent Complainants treatment papers to Dr. Gondhalekar. According to Dr. Gondhalekars report there was small injury to the right hand wrist of the Complainant, but, no fracture. Dr. Gondhalekar recommended that Complainant should be given personal accident benefit only for two months and acting upon the report of Dr. Gondhalekar, the Insurance Company pleaded that they had sanctioned a claim of Rs.28,022/- in favour of the Complainant. Complainant wanted Insurance Company to revise the said decision, but, when matter was referred to Dr. Yogesh Mokashi, another Doctor, he gave opinion that at the most Complainants injury would be cured within two months. Thereafter, the Complainant was again offered Rs.28,022/-, but, Complainant did not accept the said amount. As such the Insurance Company pleaded that it was not guilty of deficiency in service and it prayed that complaint should be dismissed with cost. On the basis of affidavits and documents placed on record by both the parties, Forum below held that there was no deficiency in service on the part of the Insurance Company and it was pleased to dismiss the complaint. Aggrieved thereby, the Complainant has filed this appeal.
We heard Advocate Mr. M.H. Oak for the Appellant and Advocate A.S. Vidyarthi for the Insurance Company We are finding that there was no fracture at all in the accident in question. The Complainants right hand wrist was simply injured and he had taken treatment from 18.01.2007 to 26.10.2007 from various Doctors. Those Doctors were, Dr. S. E. Lawand, Dr. C.S. Kenjale OF Suyog Digital Diagnostic Centre, Dr. Sunil Pise of Panchgani Orthopaedic Centre. However. Forum below noted that there was no fracture at all to the right hand wrist of the Complainant. Fracture was not established by the Complainant adducing cogent evidence. The Complainant had also not produced medical treatment bills to show that he had spent more than Rs.1,00,000/- to take treatment from three Doctors. Moreover, Forum below noted that Insurance Company has filed Affidavit of Dr. S.E. Lawand, Exhibit-18 and in the said Affidavit treating Doctor simply mentioned that Complainant had come to him with a small injury caused due to dog bite, but, Complainant had not sustained any fracture. He had given him treatment. He had referred Complainant to Suyog Digital Diagnostic Centre and Dr. Kenjale of the said Centre examined the Complainant thoroughly and reported that Complainant did not have any fracture. Dr. Pise of Panchgani Orthopaedic Centre has also mentioned in his report that there was no fracture to the Complainant. In the circumstances, the Forum below rightly held that the Complainant had suffered simple injury which could be cured within two months. The amount offered by the Insurance Company to the Complainant of Rs.28,022/- was proper, but, Complainant had obstinately not taken the said amount and he filed consumer complaint. The Forum below therefore held that the Complainant is entitled to get the amount offered by Insurance Company and nothing else. Therefore, it was pleased to dismiss the complaint.
We are finding that the order passed by the Forum below is just, proper and it does not call for any interference of this Commission sitting in appeal. Affidavit of Dr. Gondhalekar, Affidavit of Yogesh Mokashi and Dr. S.E. Lawand, have been produced on record by Respondent Company herein. They categorically stated that Complainant was not having any fracture and he had simply sustained dog bite injury and he was properly treated. Thus, in our view the Complainant was offered appropriate amount of Rs.28,022/- for the medical expenses incurred and for the two months temporarily disability suffered by him. He should have accepted the said amount, but, he preferred not to accept it and therefore, the Forum below had no option to dismiss the complaint. The appeal also appears to be devoid of any substance. However, in the course of arguments Ld. Advocate Shri Vidyarthi for the Insurance Company fairly conceded that, his client was still willing to pay Rs.28,022/- to the Complainant, if he signs voucher. In the circumstances, we pass the following order:
-: O R D E R :-
1) Appeal stands summarily rejected. However, the Insurance Company is directed to honour its commitment of paying Rs.28,022/- to the Complainant.
2) No order as to costs.
3) Copies of this judgement be sent to the parties.
(S.P. Lale) (P.N. Kashalkar) Member Presiding Judicial Member ep