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& SRI R. L. NARASIMHA RAO, MEMBER   TUESDAY, THIS THE TWENTY SECOND DAY OF MARCH TWO THOUSAND ELEVEN   Oral Order: (Per Honble Justice D. Appa Rao, President)   ***  

1) Appellant is unsuccessful complainant.

   

2) The case of the complainant in brief is that he had taken Group Janata Personal Accident Policy (JPA) from R1 insurance company through its agent Kurnool District Motor Workers Union R2 for a sum of Rs. 1 lakh covering the period from 16.4.2001 to 15.4.2006. His name was mentioned at S.No. 34 in the policy. While so on 16.3.2003 while he was driving the lorry at Machavaram village accident took place resulting in grievous injuries on his person. The said fact was intimated to the police which in turn registered as a case in Crime No. 30/2003 u/s 337 IPC. R2 informed the said fact to R1. He was shifted to Govt. Hospital, Mahaboobnagar and there after to Govt.

 

7) Aggrieved by the said decision, the complainant preferred the appeal contending that the Dist. Forum did not appreciate the facts or law in correct perspective. It ought to have seen that immediately after the accident he was remained as in-patient in the Govt. Hospital, and as such he could not have intimated. At any rate the police registered a case in Crime No. 30/2003 u/s 337 IPC. Even a charge sheet was filed disclosing that he was injured and therefore the insurance company ought to taken cognizance of these facts and settled the claim.

 

8) The point that arises for consideration is whether the order of the Dist. Forum is vitiated by mis-appreciation of fact or law?

 

9) It is an undisputed fact that the complainant was a driver involved in an accident sustained fracture of hand and legs evidenced from FIR Ex. A2. The police registered as a case in Crime No. 30/2003 u/s 337 IPC on a report given by the cleaner of the lorry bearing No. UP-70H-9558. The police lodged charge sheet against the very complainant before the Judicial Magistrate of First Class, Jadcherla vide Ex. A1 wherein there was a categorical mention that he had crushed injury, fracture of lower hand. Amputation was done on 12.3.2003 for the accident that took place on 6.3.2003. He was admitted in the hospital on 7.3.2003 and was discharged on 3.7.2003. Four months there after, according to the complainant he has informed R2 through whom policy was issued evidenced under Ex. B1 terms and conditions of the policy. It is a group insurance policy wherein the     complainants name was mentioned at S.No. 34. The Dist. Medical Board, Kurnool issued disability certificate Ex. A9 mentioning that the disability was 50% in view of amputation. The averment that he informed to its agent R2 in view of his confinement to the hospital due to amputation of his leg was not disputed by R2. The fact that originally he was joined in Govt. Hospital, Mahaboobnagar, and later shifted to Govt. Hospital, Kurnool was not disputed. All through he was in the hospital. It may be stated herein that since R2 did not take any action he intimated the said fact by his letters Exs. A4, A5 which were received by the insurance company. Evidently the claim of the complainant was not repudiated. By letter Ex. A6 dt. 9.6.2006 the insurance company while acknowledging receipt of claim intimation as well as related papers observed that there was delay in giving intimation. On that they sought clarification for delay. They also requested to submit the hospital record in connection with treatment. The complainant while responding to the said notice furnished documents evidenced under Ex. A7 & A8 along with enclosures. It is also not in dispute that the complainant approached the Dist. Legal Services Authority, Kurnool but the insurance company did not respond, and therefore he has chosen to file the complaint.