State Consumer Disputes Redressal Commission
National Insurance Company Ltd vs Tanoj Kumar Samantaray on 22 July, 2009
STATE CONSUMER DISPUTES REDRESSAL COMMISSION:ORISSA:CUTTACK STATE CONSUMER DISPUTES REDRESSAL COMMISSION:ORISSA: CUTTACK FIRST APPEAL NO.258 OF 2008 From an order dated 15.01.2008 passed by the District Consumer Disputes Redressal Forum,Koraput at Jeypore in C.D. Case No.16 of 2005 National Insurance Company Ltd. Chennai Division V, Ad-I, II Avenue, Anna Nagar, Chennai-600 040 Represented through Branch Manager, National Insurance Co. Ltd., Main Road, Jeypore, Dist. Koraput and Further represented through its Power of Attorney Holder, Officer Incharge (Legal Cell), Natioonal Insurance Co. Ltd., Cantonment Road, P.S. Mangalabag, Dist. Cuttack Appellant -Versus- 1. Tanoj Kumar Samantaray, Qr. No. F/167, At Manikapatna, P.O. Kolabnagar, Dist. Koraput 2. Managing Director, Road Safety Club Pvt. Ltd., Admn. Office 2A, II Floor, Prakasam Road T. Nagar, Chennai-600 019 3. Area Managar, Road Safety Club Pvt. Ltd., 4th Floor, Janpath Tower, Ashok Nagar Bhubaneswar-751 009 Respondents For the Appellant : Mr.N.C. Misra & Associates For Respondent No.1 : Mr. R.K.Samantasinghar & Associates For Respondents 2&3 : Mr. D.P.Dhal & Associates P R E S E N T : THE HONBLE SHRI JUSTICE A.K. SAMANTARAY, PRESIDENT, AND SHRIMATI BASATI DEVI, MEMBER O R D E R
DATE:- The 22nd July, 2009.
Justice A.K. Samantaray, President.
This First Appeal is by the National Insurance Company challenging the judgment and order of the District Forum, Koraput at Jeypore dated 15.01.2008 passed in C.D. Case No.16 of 2007. The said consumer complaint was filed by respondent no.1-Tanoj Kumar Samantaray against the Managing Director, Road Safety Club Pvt. Ltd. having its Administrative Office at 2A, II Floor Prakasam Road, T.Nagar, Chennai, the Area Manager, Road Safety Club, Road Safety Club Pvt. Ltd., 4th Floor, Janpath Tower, Ashoknagar, Bhubaneswar, and the National Insurance Co. Ltd., represented through its Branch Manager, Jeypore.
2 The brief facts of the complainants case were that opposite parties 1 and 2 had launched a scheme known as Road Safety Club Programme and had issued Road Safety Card to the complainant on receipt of membership fee of Rs.1,800/- vide Certificate No.741859 dated 10.06.2005. It is stated in the complaint that under the Scheme, the complainant is eligible to receive complimentary insurance cover, i.e., personal accident insurance cover. It is further stated that opposite parties 1 and 2, the Road Safety Club have tie up with opposite party no.3- the National Insurance Company. The Road Safety Club being the insured under opposite party no.3 had covered the complainant under Policy Certificate No. SC3-EE000001770 for the period from 10.06.2005 to 09.06.2006. During the subsistence of the policy, the complainant met with an accident on 05.09.2005. He immediately intimated the fact of the accident to opposite parties 1 and 2, i.e., the Road Safety Club having tie up with the Insurance Company. It is further stated in the complaint that the complainant had to undergo prolonged treatment for his recovery and he preferred his claim, but till the date of filing of the complaint, in spite of several reminders, the opposite parties did not listen to his grievance. Ultimately, finding no other way he filed the complaint claiming Rs.25,000/- towards in-patient hospitalization along with interest. He also claimed Rs.55,000/- towards compensation and cost from the opposite parties.
3. Opposite parties 1 and 2 filed joint written version admitting the claim and membership of the complainant under the Scheme. It is stated by them that as per the Road Safety Club Scheme, the complainant is entitled to a group personal accident master policy and opposite party no.3 had issued Master Policy No.12-29-14-001209-05 and the complainant is covered under the said Scheme. They also admitted that the complainant had sent a claim towards his accident, which was forwarded to the insurer-opposite party no.3, and the same is pending with opposite party no.3. It is further stated in the written version that the contract of insurance benefits is only between the complainant and opposite party no.3, and opposite parties 1 and 2 have performed their obligation by forwarding the claim of the complainant to opposite party no.3. Any defect in the insurance cover, recovery or payment of compensation, processing or settlement of claims or otherwise, however, shall be sorted out directly with opposite party no.3. They also contended that there is an arbitration clause provided in the terms and conditions of the Scheme and the complainant, without availing such clause, has filed the consumer complaint directly. Finally, it was stated by opposite parties 1 and 2 that on their part, they have nowhere shown any negligence; rather they have immediately intimated opposite party no.3, i.e., the Insurance Company, about the accident met by the complainant and as such there is no deficiency in service on their part so as to make them liable or responsible in any manner.
4. Opposite party no.3, the Insurance Company filed counter denying the allegations leveled against them by the complainant. It is contended by the Insurance Company that the complainant has never intimated the fact of accident directly to them, nor have opposite parties 1 and 2 lodged any claim on behalf of the complainant immediately after the accident. It is stated that the complainant is not the insured under opposite party no.3. He has also not filed any authority of opposite parties 1 and 2 as beneficiary under the Scheme to file the complaint. Opposite party no.3 has also stated that the complainant is not entitled to any claim for the alleged accident as the claim does not satisfy the terms and conditions of the policy. They have also challenged the maintainability of the claim for want of jurisdiction and prayed for dismissal of the consumer complaint of the complainant.
5. Before the District Forum, the complainant as well as opposite party no.3 filed documents and all the parties filed their affidavits in support of their respective cases. The District Forum, while discussing about the merits of the case of the complainant, has looked to the voluminous documents filed by the complainant before it showing that he was not only an indoor patient but was an in-patient and had undergone surgery at Bhubaneswar in Rajdhani Nursing Home and the Surgeon, who operated upon him under spinal anesthesia to set right his fractured right patella, had conducted Tension Band Wiring (TBW). The documents filed including the copy of the F.I.R. regarding the accident on 05.09.2005 and admission of the complainant in the District Headquarters Hospital, Koraput wherefrom he was referred to the S.C.B. Medical College for his treatment sufficiently prove the fact that the complainant had met with an accident of considerably serious nature, for which he had received treatment at Bhubaneswar under the Orthopaedic Specialist Dr. Rabindra Kumar Mohapatra in his orthopaedic clinic at Sahidnagar. He was also advised before the aforesaid operation various tests. He had undergone those tests and obtained receipts, which are there in the L.C.R.
6. As regards the membership of the complainant in the Road Safety Club Pvt. Ltd., he has produced the certificate issued by the authorized signatory and issuing authority of the said Club, which contains the details of his membership and its period. He has also produced the certificate of insurance showing the fact that the Road Safety Club Pvt. Ltd. has a tie up with the National Insurance Company and the insurance certificate was issued in his name showing that he is a member of the Road Safety Club Pvt. Ltd. The scope of coverage and the capital sum assured have been detailed in the said certificate. Under the scope of coverage in clause (d), the capital sum insured for in-patient hospitalization expenses following an accident is Rs.25,000/-. From the documents available in the L.C.R., it is noticed that the complainant, immediately after the accident, had intimated the fact of accident and the injury sustained by him to the Road Safety Club, i.e., opposite parties 1 and 2, who, in their turn, had also intimated the same to opposite party no.3, the Insurance Company. The complainant, after failing in his attempt to get his grievance redressed, as the opposite parties remained silent over the matter, filed the complaint and the District Forum has allowed the same in part and directed opposite party no.3, i.e., the Insurance Company, to pay the insured sum of Rs.25,000/-, which is the claim of the complainant, and also directed payment of Rs.20,000/- towards compensation and Rs.5,000/- as cost of litigation within 45 days from the date of dispatch of the order, failing which the awarded amount would bear interest at the rate of 12% per annum from the date of accident, i.e., 05.09.2005, till the actual date of payment. However, the District Forum did not pass any order as against opposite parties 1 and 2, i.e., the Road Safety Club Pvt. Ltd.
7. We have heard the learned counsel for the appellant-Insurance Company. He submitted that since intimation regarding the accident was not received and the details of the hospitalization were not supplied by the insured Club, for want of documents the claim was not settled, for which the complaint was filed. He further submitted that the complainant has not actually spent that much in undergoing treatment for the fractured patella and has made exaggerated claim, and the District Forum, while allowing payment of the assured sum of Rs.25,000/-, which is for in-patient hospitalisation expenses, has awarded compensation of Rs.20,000/-, which is quite exorbitant, without taking into consideration the fact that opposite party no.3 was in no way deficient in providing service or in the matter of settlement of the claim. He reiterated that the claim could not be settled as because the relevant documents were not supplied by the club authorities.
8. Learned counsel for respondents 2 and 3 submitted that immediately after receipt of intimation regarding accident from the complainant, the same was dispatched to the appellant-Insurance Company. Whatever communication has been received from the complainant has immediately been dispatched to the appellant- Insurance Company.
9. After going through the L.C.R., considering the factual aspect and hearing learned counsel for the parties, we find no reason to disagree from the findings recorded by the District Forum in its judgment and order, which is assailed before us by the appellant-Insurance Company. The evasive way in which the Insurance Company has dealt with the matter after issuance of insurance certificate having tie up with opposite parties 1 and 2 very much manifests their deficiency in service, for which the District Forum in its wisdom has rightly imposed compensation and cost along with payment of the assured amount of Rs.25,000/-, with which we are not inclined to interfere.
10. In the result, therefore, the appeal is dismissed, however, without awarding any cost.
Records received from the District Forum may be sent back forthwith.
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(Justice A.K. Samantaray) President ........
(Basanti Devi) Member