Sartuka Nath - Complainant(s)


Branch Manager, UCO Bank - Opp.Party(s)

21 Jun 2023


Complaint Case No. CC/22/2019
( Date of Filing : 06 Mar 2019 )
1. Sartuka Nath
At- Talamul Sasan, P.O-Talamul,P.S-Banarpal,Dist-Angul
1. Branch Manager, UCO Bank
Talamul Branch, P.O-Talamul,via-Hindol,Dist-Angul
2. Chief Manager, Reliance Inquiry
Cuttack Branch,At/P.O/Dist-Cuttack
3. Claim manager, Reliance General Insurance Co. Ltd.
301, 3rd Floor,Mishra Block, Krishe Sapphire,Madhapur,Hyderabad,PIN-50081
4. Registered Office, Reliance Centre, Bombay
 HON'BLE MR. Saroj Kumar Sahoo PRESIDENT
 HON'BLE MS. Sasmita Kumari Rath MEMBER
Dated : 21 Jun 2023
Final Order / Judgement

Sri S.K.Sahoo,President.

             The  complainant has filed  a petition U/s. 12 of C.P.Act, 1986.

2.       The case of the  complainant is that he is  an account  holder of UCO Bank Talmul Branch, having account No. 13123211001362. An amount of Rs.12.00 was deducted from his account each year towards Pradhan Mantri Surakhya Yojana, for policy No. 1518962945669631. The  left leg of the complainant was not functioning  properly which was reported to opp.party No.1. The  complainant  has also submitted his claim by letter dtd.22.11.2016 bearing claim No.2171010784. A letter was also submitted to the opp.party No.3 on 07.10.2017. The complainant  also  submitted reply to such letter by his letter dtd.12.10.2017 through Regd. post with A.D. A copy of the said  letter was sent to C.D.M.O,Angul vide Memo No. 555 dtd.18.07.2017.No reply was received by the  complainant relating to the aforesaid communication. As there was a defect in the  disable  certificate, the  complainant approached the C.D.M.O,Angul by his letter dtd.01.02.2017. On 24.12.2018 a fresh certificate was issued to the complainant. The complainant  failed to get  his insurance  amount, for which he reported opp.party No.1 by his letter dtd.04.12.2017 but no reply has been received from  him.  Hence this case.

3.       Notice was  issued  to  all the opp.parties through Regd. Post with A.D on 08.04.2019. During hearing the complainant wants to delete opp.party No.2 and accordingly he has been deleted vide order dtd.01.11.2019. Opp.party No.1 filed  show cause where as opp.partyNo.2 to 4 filed separate show cause signed by the authorised signatory of Reliance General Insurance Corporation Ltd.

4.       The case  of opp.party No.1 is that  the   case filed by the complainant  is not maintainable either in law  or in facts. It is barred by law of limitation in view of  Section-24 A of C.P. Act, 1986. There is  no cause  of action to file this case against opp.party No.1. The  complainant is  not  a consumer. The complaint is barred for non-joinder for necessary party and  mis-joinder of  unnecessary parties. There is  no specific  allegation regarding the  deficiency in service as defined  U/s.2(g) of the C.P. Act, 1986. It is  admitted that  an amount of Rs.12.00 was deducted from the  account of the complainant  with  his active consent  for PMSBY. The  complainant  has not intimated about the accident dtd.22.11.2016 to opp.party No.1 within 30 days as stipulated by the  policy. Only on 04.12.2017 the  complainant  intimated the fact to the opp.party. After receipt of the  said  complaint dtd.04.12.2017 from the complainant immediately opp.party No.1  referred the matter  to other  opp.parties within a period of  30 days. The opp.party No.1  has  received the  claim form from the complainant only on 15.07.2017. He  has neither filed the FIR copy nor the  preliminary treatment  report/ prescriptions of  his treatment. On the other hand he has filed the copy of OPD documents of AIIMS ,Bhubaneswar dtd.25.04.2017. The opp.party No.1 duly intimated the  complainant that  his claim is not admissible by the higher authority due to barred by limitation. Absolutely there is no deficiency in service on the part of the  opp.party No.1.

5.       Opp.party No.2  to 4 in their joint written statement  alleged that the case filed by the  complainant is not  maintainable  in law or in facts. The dispute  raised by the  complainant  is not  coming under the  ambit of  C.P.Act, 1986. He is  not a consumer as defined U/s. 2 (d) of  the Act. The  complainant  took a policy bearing No. 1518962945669634 under Pradhan Mantri Surkhya Yojana, covering the risk  from 01.06.2016 to 31.05.2017. The alleged occurrence took place on 22.11.2016 i.e  within  the  policy coverage. The  complainant  alleged that he has  sustained disability in an accident by which his  knee was affected. As per the disability certificate submitted  by the  complainant, disability assessment was done for  right  leg by the  Medical Board,Angul. Since the part of the  body which  was allegedly affected in the accident as has been stated in the claim form submitted by him, the  claim of the  complainant  was rightly repudiated. The repudiation of the  claim of the  complainant  was  duly intimated to  him on 07.09.2017 and the reasons  of repudiation was  written in it. He was also advised to  contact the opp.parties within a period  of two weeks  in case of any query. The complainant  did not made any query and remained silent  for about  seventeen months. Only thereafter he has  approached the Consumer Forum/Commission. There  is  no deficiency in service  by the opp.party No.2  to 4. The complaint  filed by the complainant  be dismissed.

6.       Admittedly the  complainant is a policy holder under Pradhan Mantri Surkhya Yojana with policy No. 1518962945669634 .It is also admitted that the risk period under that policy was  01.06.2016 to 31.05.2017. Although  the complainant in his  complaint  petition has not mentioned about the  date of accident relating  to  his  claim,  from the documents  filed by opp.party No.1, it appears that in his application the  complainant has mentioned  that  accident took place on 22.11.2016 due to a mutual fight in  between a cow and  the ox on the village road. The opp.party No.1  has also  filed  the  photo copy of the claim  procedure relating to Pradhan Mantri Surkhya Bima Yojana. It is clear  from the  said procedure that the  claim form  shall be completed by the insured or  at the case may be by the nominee and be  submitted to the  Bank within 30 days  of the occurrence giving rise to the  claim  under the policy. It  further appears that  the said claim form  shall be supported  with  all other documents along with a  disability certificate issued  by the Civil Surgeon. The  complainant  has not filed any documents relating to  the  alleged  accident dtd.22.11.2016. From  letter dtd.07.09.2017 of the Claim Manager (opp.party No.3)  addressed to the complainant, it appears that as per  the claim documents and  the disability certificate it  is  observed that the disability assessment  is  done for  right leg where as the injury occurred in the above  incident on the left leg. There was  no amputation/disability occurred. Under benefit-C total and irrevocable  loss  sight  of  one eye or  loss of the use  of one hand or foot is covered under the policy. So  the  claim of the  complainant  was repudiated  by the insurance company, as the  complainant  is not entitled to  any amount under insurance  policy. As it appears the complainant has relied on a certificate for the persons with disability issued by the then CDMO-cum-Chairman, District Medical Board, Angul dtd.10.05.2013. As it appears to be manipulated one, by this Office letter No.577/dtd.13.05.2023 the Commission sent a copy of such certificate to the CDMO & Public Health Officer,Angul for his report. In pursuance of such letter the CDMO,Angul by his letter No.475/dtd.18.05.2023 sent the copy of the register maintained by his Office. On perusal of the said letter, it appears that certificate No.944/dtd.10.05.2013 having 60% permanent disability was issued in favour of the complainant but the complainant tampered the said certificate making it 20% permanent disability. I also verified the said disability certificate filed by the complainant which appears to be manipulated and tampered one. The present certificate has been issued only on 01.06.2017 bearing certificate No.OD1510619550042961 in view of the Govt. guidelines. So it is clear from the materials from the record that the complainant was permanent disable of 60% on 10.05.2013 but he tried to manipulate the document in support of the present claim.

          From the documents  filed by the opp.party No.1, it is also clear that  the  claim raised by the complainant  is  barred by limitation, as the complainant  failed to  submit the claim form along with  documents  to the opp.party No.1 within 30 days  from the date of  alleged accident i.e on 21.11.2016. There is  no deficiency in service  by the opp.parties.

7.       Hence order :-

: O R D E R :

           The complaint filed by the complainant  is  dismissed on contest against opp.party No.1,3 & 4.

[HON'BLE MR. Saroj Kumar Sahoo]
[HON'BLE MS. Sasmita Kumari Rath]

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