BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MYSORE-570023

CONSUMER COMPLAINT NO.109/2014

DATED ON THIS THE 18^th September 2015

      Present:  1) Sri. H.M.Shivakumara Swamy

B.A., LLB., - PRESIDENT   

    2) Smt. M.V.Bharathi                    

                                   B.Sc., LLB., -  MEMBER

                     3) Sri. Devakumar.M.C.                  

                                                          B.E., LLB.,    - MEMBER

Sri Devakumar.M.C.

Member

1.     The complainant has filed the complaint under section 12 of the C.P.Act, 1986, against the opposite party, seeking a direction to pay a sum of `5,00,000/- towards loss, injuries suffered and expenses and to pay compensation for the damages and other reliefs.

2.     The complainant’s car has been insured with the opposite party w.e.f. 14.06.2013, which met with a road accident and the complainant got injured.  The complainant spent huge amount for his treatment.  The complainant submitted all the relevant documents to opposite party, seeking the benefits under personal accident claims under the motor insurance package policy on 08.11.2013.  On repudiation of the claim, the complainant alleging the deficiency in service filed this complaint and sought for reliefs.

3.     The opposite party contended that the complaint is not maintainable and liable to be dismissed.  The opposite party admitted the issuance of motor vehicle insurance package policy to the complainant, also admitted the payment of `100/- towards personal accident insurance benefits limiting to a sum `2,00,000/-.  The opposite party submits that the risk under taken by it is subject to the terms and conditions of the Indian Motor Tariff Regulations and the injuries sustained does not fall under any of the categories, thereby it has repudiated the claims, hence there is no deficiency in service and as such the complainant is not entitled for any of the reliefs sought.
4.     On perusal of the evidence, documents and written arguments, the matter posted for orders:-

5.     The following points arises for our consideration:-

1. Whether the complainant proves the deficiency in service on the part of the opposite party on repudiation of the personal accident claim benefits and that he is entitled to the relief sought?
2. What order?

6.    Our findings on the aforesaid points are as follows:

Point No.1 :- In the negative.

Point No.2 :- As per final order for the following

:: R E A S O N S ::

7.    Point No.1:- The complainant had taken a motor vehicle insurance package policy for his car and also paid an additional sum of `100/- towards personal accident insurance benefits.  The complainant got injured in a road accident on 24.08.2013 and suffered fracture of humours and fracture of fibula right and took treatments as in patient from 24.08.2013 to 29.08.2013.  The complainant preferred personal accidents claims under various heads amounting to sum `5,00,000/-.  The opposite party repudiate to honour the claims, thereby the complainant alleged the deficiency in service.
8.    The opposite party admitted the issuance of motor vehicle insurance package policy and also the payment of additional premium of `100/- towards the personal accident insurance limiting to a sum `2,00,000/-.  Further, the risk covered under the policy is as per the terms and conditions laid down in the Indian Motor Tariff Regulations under Rule 15.  The compensation and extent of liability for payment is specifically mentioned.  The injuries suffered by complainant, does not fall under any of the category to claim and compensate, as such, the opposite party has repudiated the personal accident insurance benefits to opposite party.  Thereby contended that there is no deficiency in service on its part, hence prays for dismissal of the complaint.
9.    The averments made and documents produced by complainant, proves that the injuries suffered and the treatment taken at the Hospital as in patient.  Since the injuries suffered does not fall under any of the categories detailed in the Indian Motor Tariff Regulations for the payment of compensation, under personal accident insurance over the opposite party has refused to pay the benefits.  This defence is supported by the decision of National Commission in case of National Insurance Co., -Vs- Ramesh Kumar Gupta reported in 2015 (2) CPR 290 (NC). Therefore, the repudiation of the personal accident benefits by opposite party is justified and thereby the complainant is not entitled for any of the reliefs sought.  Accordingly, point No.1 is answered in the Negative.

10. Point No.2:- In view of the above discussion, we pass the following

:: O R D E R ::

1. The complaint is hereby dismissed.
2. Give the copies of this order to the parties, as per Rules.