STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA
Date of Institution:25.04.2018
Date of final hearing: 26.04.2023
Date of pronouncement: 11.05.2023
First Appeal No.524 of 2018
IN THE MATTER OF:
Daya Ram S/o Sh. Chhaju Ram Yadav (Retired Havildar/G.D.No.850850806), Resident of Village and Post Office Santor, Tehsil Buhana, District Jhunjhanu, at present R/o H-20, Madhuban Colony, Kisan Marg, Tonk Road, Jaipur (Rajasthan).
…..Appellant
Versus
1. Commandant, 33 Battalion, Central Reserve Police Force, Tinsukiya, Assam.
2. D.G.P. Directorate General, Central Reserve Police Force, CGO Complex, Lodhi Road, New Delhi.
3. I.G. (Northern Sector), Central Reserve Police Force, Delhi.
4. Deputy Inspector General of Police, Range 1st, Ajmer.
5. National Insurance Co. Ltd. through Nirgaman Adhikari, Divisional Office-8, 1stFloor, C-3, Pusa House, Community Centre, Karampura, New Delhi-110015.
6. National Insurance Co. Ltd, Regional Office-Jeevan Nidhi Building, BhagwanDass Road, Ambedkar Circle, Jaipur..
…..Respondents
CORAM: Naresh Katyal, Judicial Member
Present:- Sh. A.K. Yadav, Advocate for theappellant.
Sh. S.C.Sharma, Advocate for the respondents No.1 to 4.
Sh. Nitin Gupta, Advocate for respondents No. 5&6.
ORDER
NARESH KATYAL, JUDICIAL MEMBER:
Delay of 126 days in filing of present appeal stands condoned, for the reasons stated in the application for condonation of delay.
2. Vide order dated 17.11.2017,complainant’s complaintso filed before District Consumer Disputes Redressal Forum, Narnaul(In short “District Commission”) has been partly allowed.Still feeling dissatisfied, he has filed this appeal.
3. As per case set up by complainant; he retired from 33 Battalion Central Reserve Police Force. He availed annual vacation for 30 days on 03.01.2005 for marriage of his younger brother. On 22.01.2005, he was returning back from village Paneda to his village Santor, when he met with an accident with tractor trolley,coming from opposite direction at about 03.00 am. Information about accident was given to P.S. Nangal Chaudhary, District Mahendergarh. FIR No.17 of 2005 was registered. He also informed Commandant 33 Battalion, CRPF, Faizabad on 31.01.2005 through registered post and again apprised about accident on 14.05.2005.
4. In connection with this accident, he submitted all documents with OPs for claim amount under Group Personal Accident Insurance. No claim amount was paid to him. Eventually, his claim has been repudiated by OPs vide letter dated 15.02.2010 on ground of delay of intimation to OPs-Insurance Company, whereas,as per his case he informed about the accident on 31.01.2005 to the Commandant 33 Battalion, CRPF, Faizabad through registered cover. He served legal notice on 20.10.2010 to claim amount of Rs.3 Lacswithin 15 days.Despite that,no claim has been paid. Earlier he filed complaint before District Consumer Disputes Redressal Forum, Jaipur-IV, Jaipur bearing Complaint No.213/2013(Old Complaint No.150/2011) and same was disposed of vide order dated 22.07.2016 on the ground of territorial jurisdiction because the cause of action arose within territorial jurisdiction of District Consumer Disputes Redressal Forum, Mahendergarh. On these pleas, by asserting cause of action; complaint was filed.
5. OPs No.1 to 4 in their defence have asserted that there was coverage of Rs.3 Lacs on account of personal accident insurance. It does not give right to complainant to get amount of insurance, till he submitted claim form with documents. In this case, complainant lodged claim after three years i.e.on 12.10.2008.As per terms and conditions of insurance policy; claim should be lodged within a period of one month. Identical fact has been mentioned in letter bearing No.W-5/72/2009-10 GPIS dated 01.02.2010 issued by Directorate General. OPs-Insurance Company has vide letter No.360300 dated 04.04.2008 intimated the complainant that claim should be lodged within a period of one calendar month but as intimation has been given on 18.03.2008 regarding accident occurred on 22.01.2005, so, the matter cannot be processed. Complainant was also informed vide letter bearing No.F-4-4/09-10-Accounts-2 dated 15.02.2010. While denying other pleas of complaint on the ground that same are concocted and manipulated; dismissal of complaint has been prayed.
6. OPs No.5 & 6 in their defence have pleaded that complaint is time barred. OPs-Insurance Company only paid insurance claims after completing the terms and conditions of insurance policy as insurance policy is a contract between the parties. Neither intimation regarding accident dated 22.01.2005 was given to insurance company, nor any document was provided to them. Thus, there was violation of terms and conditions of insurance policy on the part of complainant. OPs No.5 & 6 issued Group Personal Accident Insurance Policy bearing No.360300/42/04/8200000307 valid from 06.09.2004 to 05.09.2005 subject to its terms and conditions and at the time of accident; complainant was not working or doing job under the instructions of the employer or for the benefit of employers,as per condition No.7 of policy in area of desert of Rajasthan, in battle area of Gujarat, altitude area of Jammu & Kashmir and Forest area of North-East. Complainant has not received multiple injuries during the above noted duties or on duty, hence, complainant is not entitled to get any relief. Forum has no territorial jurisdiction to entertain and try complaint because as per documents provided by complainant, he is resident of village Santor, Tehsil Buhana, District Jhunjhanu(Rajasthan). On merits,by denying all the contents of complaint;its dismissal has been prayed.
7. Parties led their respective evidence (oral and documentary) before learned District Commission. On subjectively analyzing the same, learned District Commission, Narnaulvide impugned order dated 17.11.2017 has partly allowed the complaint by issuing direction toOPs No.5 & 6 to pay Rs.1,43,100/- as assessed by the competent authority of OPs No. 1 to 4 vide their letter (Annexure R-5) to complainant along with interest @ 7% p.a. from the date of filing of complaint till its actual realization. OPs No. 5 & 6 have further directed to pay Rs.5,000/- as compensation and Rs.2200/- as litigation expenses to the complainant.
8. Learned counsel for complainant has assailed this order in the present appeal while attacking its legality on the premises that complainant is entitled to full amount of Rs.3,00,000/- as per Group Personal Accident Insurance as at the time of accident (22.01.2005) this policy was live, effective and operative as its period was 06.09.2004 to 05.09.2005. It is further urged that by paying Rs.1,43,100/- under policy; deficiency in service on the part of OPs is visible on its face and there is also unfair trade practice on their part. It is urged that complainant has been forced to file this appeal, only because, OP No. 2 has not correctly interpreted the Group Personal Accident Insurance Policy in its right spirits and confined the claim only to Rs.1,43,100/- through its letter Annexure R-5.
9. Refuting the contention learned counsels appearing for respondents/OPs, in common voice, have contended that despite that the claim was lodged by complainant at belated time, after accident and there is contravention of terms and conditions of policy which mandates for filing of claim within one month; OPs have adopted consumer-oriented approach towards complainant and allowed claim to the tune of Rs.1,43,100/- which is, as per extent of disability suffered by complainant, as consequence to accidental injuries suffered by him. It was further urged that impugned order of learned District Commission is legally justified, on given facts and no further interference is warranted to modify the impugned order dated 17.11.2017 in this appeal, as urged by appellant/complainant.
10. Undisputedly, complainant/appellant was an employee, serving under Commandant 33 Battalion CRPF, Faizabad. He suffered an accident on 22.01.2005 at 03:00 am and FIR No. 17 of 2005 was registered regarding the accident at P.S. Nangal Chaudhary, District Mahendargarh. Admittedly intimation about accident had been given to Commandant 33 Battalion CRPF, Faizabad through regd. post. OPs No. 5 & have admittedly given Group Personal Accident Policy (Annexure R-9) to OPs No. 1 to 4, thereby covering risk to the extent of Rs.3 lacs each in case of non-gazatted officer, and Rs.5 lacs each in case of gazatted officer. Complainant was under employment of Commandant 33 Battalion CRPF, Faizabad at that time when insurance policy was given to OPs No. 1 to 4 which has currency of its validity from 06.09.2004 to 05.09.2005. Hence, on the day of accident this insurance policy (Annexure R-9) was live, valid and operative.
11. Complainant suffered multiple injuries which is evident from proceedings of Medical Board. It would be apt to reproduce below; the diagnoses regarding injury suffered by complainant so apparent from History of Medical Board’s proceedings (Annexure C-8) bearing date 18.10.2007.
“HISTORY:- No. 850850806 HC/GD. Daya Ram aged 43 (Male) of 33 Bn, CRPF, of 33 Bn, CRPF, sustained road side accident on 22/1/2005 at Dist. MahinderGarh (Haryana). He was diagnosed as a case of compound injury Right ankle with fracture Right medial malleolus with fracture Left humerus with fracture posterior lip of Acetabulum with posterior dislocation of hip (Left) with fracture Dislocation of Right first MTP Joint.
He was treated at SMS Medical College, Jaipur, Rajasthan and CRPF Hospital GC-I, Ajmer. His present complaint is limpling.”
12. Disability certificate concerning complainant is Annexure C-8/A. It is also dated 18.10.2007 and issued by Medical Board. As per this; complainant has suffered 47.87% disability. There is shorting of limp length of left limp by 1.5 inches. Claim was lodged by complainant on 18.03.2008. In opinion of this Commission, before disability certificate (Annexure C-8/A) got the light of its day; claimant had no occasion to file claim as there was no credible base before him.Reason is: he fortunately survived from the accidental injuries, and his claim was based on extent and magnitude of disability suffered by him because of accidental injuries.
13. He had also intimated his employer (OP No. 1) through regd. post on 31.01.2005 about the accident. He also got lodged FIR regarding incident of road accident. Meaning thereby, his information to concerned authorities was prompt and as observed above he had no cause of action, till Medical Board assessed his disability on 18.10.2007. May be, even after 18.10.2007 complainant had consumed five months in filing his claim but this Commission is conscious of the fact that pains and sufferings of complainant because of accidental injuries, had already taken tale of his woes.
14. Regarding the quantum of compensation, this Commission is of the view that compensation to be paid to him by OPs No. 5 & 6 was assessed at Rs.1,43,100/- by OP No.2 and it was conveyed by OP No. 2 vide letter Annexure R-5 to OP No. 5. This assessment of claim by OP No. 2 was on the subject of Group Personal Accident Insurance Claim. In letter Annexure R-5 there is a mention that disability certificate reflects disability at 47.7% and it has been requested by OP No. 2 to OP No. 5 that documents be accepted and insurance cover of Rs.1,43,100/- only may please be remitted to it, so that it can be remitted to officer. Despite this letter (Annexure R-5);OP No. 5 through its communication dated 04.04.2008 Annexure R-6 has conveyed to OP No. 2 that claim cannot be entertained. Learned District Commission has rightly held in its order dated 17.11.2017 that repudiation by OP No. 5 & 6 is wrong and illegal which constitute deficiency in its service. Obviously, OPs No. 1 to 4 (mainly OP No. 2) had assessed the claim of complainant, at Rs.1,43,100/- which commensurate with the extent of disability (47.7%) suffered by complainant. Legal position in this regard is no more res-integra that compensation has direct nexus with extent of disability to any victim of accidental injuries and there can be no exception to complainant/appellant.
15. This Commission has no material base before it to enhance the compensation to the full amount of Rs.3,00,000/-, as apparent from insurance policy (Annexure R-9) and urged as such by learned counsel for appellant. Hence, it is held that compensation amount awarded to complainant by learned District Commission through its order dated 17.11.2017 is just and proper. No further indulgence can be shown to complainant/appellant. Hence, impugned order dated 17.11.2017 does not warrant any modification regarding enhancement of compensation. Impugned order dated 17.11.2017 is affirmed and maintained.
16. As a sequel thereto this appeal being devoid of merits is hereby dismissed.
17. Applications pending, if any stand disposed of in terms of the aforesaid judgment.
18. A copy of this judgment be provided to all the parties free of cost as mandated by the Consumer Protection Act, 1986/2019. The judgment be uploaded forthwith on the website of the Commission for the perusal of the parties.
19. File be consigned to record room.
Date of pronouncement: 11thMay, 2023
