Sri.Siddegowda, President 1. This complaint is filed under section 12 of the Consumer Protection Act 1986, claiming insurance of Rs.1,00,000/- with compensation of Rs.1,00,000/- with interest. 2. The facts of the complaint are as follows; The guardian of the complainant has filed this complaint pleading that the complainant while riding K.A.05-HB-2146 Motor Cycle met with an accident on 07.10.2006 at 8.00 p.m. on Malavally - Mandya Road, Near Gattikoppalu and fell down by the motor bike and sustained head injury and other injuries. The complainant had obtained comprehensive policy no.71701180201013901 from the Opposite party from 03.10.2006 to 02.10.2007 and as per the policy terms, in case of personal accident he is entitled to compensation of Rs.1,00,000/-. After the accident, the complainant was shifted to Malavally Government Hospital and then to J.S.S. Hospital, Mysore, where he took treatment from 08.10.2006 to 18.10.2006, but he could not get conscious and therefore he was discharged and shifted to Udhbhava Hospital, Bangalore on 19.10.2006 and treated up to 02.11.2006 and the treatment was not fruitful. Thereafter he was admitted to Sanjo Hospital, Mandya, but the complainant could not get consciousness and as per the advice of the doctor he was discharged and the complainant is under treatment as per the advice and the complainant has sustained permanent disability and the parents of the complainant are looking after him. On 05.01.2007, the Opposite party was informed with claim form about the accident along with documents and claimed the insurance amount. Again legal notice dated 26.03.2007 was sent, but Opposite party has sent reply dated 30.03.2007 and as per that reply, necessary documents were furnished to the Opposite party through legal notice dated 23.04.2007, but the Opposite party has not settled the claim intentionally and not informed the result. Therefore, the Opposite party has committed deficiency in service. 3. 1st Opposite party has filed version and 2nd Opposite party is the Branch of 1st Opposite party. Admitting the insurance policy issued to the complainant, it is contended that the complainant was not in possession of valid driving license at the time of accident, but he had only learner license and there was none accompanying him holding a valid license to fulfill Rule 3 of the Central Rules. As per the hospital records, alleged accident was due to skidding of the vehicle and self fall. The complainant did not suffer from permanent disability as per law. None of the discharge cards has certified the patient suffering from permanent disability. The complainant has not furnished the documents of permanent disability. There is no intentional repudiation or service failure. Even now, the Opposite party is ready and willing to settle the claim in terms of the policy if necessary documents are produced. Therefore, the Opposite party has not committed deficiency in service and complaint is liable to be dismissed. 4. The mother of the complainant has filed affidavit and she was examined and Dr.V.Shivananda is examined as CW.2 and Ex.C.1 to C.19 are marked. On behalf of the Opposite party, one witness is examined and Ex.R.1 to R.3 are marked. 5. We have heard both sides. 6. Now the points that arise for our considerations are:- 1) Whether the Opposite party has committed deficiency in service? 2) Whether the complainant is entitled to the relief sought for? 7. Our findings and reasons are as here under:- 8. POINTS No.1 & 2:- From the evidence of the mother of the complainant and the documents Ex.C.6 FIR, mahazar and Ex.C.7 intimation from the hospital to the Police, Ex.C.8 MV report it is clearly established that the complainant met with an accident on the night of 07.10.2006 while riding motor cycle and sustained head injury and other injuries and shifted to Government Hospital, Malavalli and then he was treated in J.S.S.Hospital, Mysore as per the documents Ex.C.12 and C.13 and at Victory Hospital as per Ex.C.14, then at Udhbhava Hospital, Bangalore as per Ex.C.15 & C.16 and then at Sanjo Hospital, Mandya as per Ex.C.17, Ex.C.18 is the wound certificate, Ex.C.9 is the insurance policy. As per the terms of the policy as mentioned Ex.R.3, in case of comprehensive policy, compensation is provided for the injury or death sustained by the owner/driver of the vehicle and in case of death 100%, II) Loss of two limbs or sight of two eyes or one limb and sight of one eye 100%. III) Loss of one limb or sight of one eye 50%. IV) Permanent total disablement from injuries other than named above 100%. Admittedly, the insurance is claimed for permanent disability at Rs.1,00,000/-. 9. It is undisputed that the complainant submitted claim form as per Ex.C.2 and in this claim form the column Are you totally disabled from working it is not answered at all and there is no mention of permanent disability. 10. The complainant has pleaded that he has suffered permanent disability, Opposite party has denied the same. Of course, the complainant has sent the treatment records to the Opposite party, but he has not at all furnished the permanent disability certificate to the Opposite party to consider the insurance claim. In fact, there is no repudiation claim by the Opposite party at all, because admittedly as per Ex.C.4 the Opposite party has sought for the production of necessary documents to claim the insurance. But again the complainant through his advocate sent the treatment records, but without any certificate that the nature of injury to the head is a permanent one and there is permanent disability to the complainant. So, without certificate of permanent disability, the Opposite party is not in a position to consider the claim and to allow or disallow the claim. Therefore, there is failure on the part of the complainant to comply with the information sought by the Opposite party to consider the claim. Therefore, at this stage, we cannot attribute any negligence or deficiency in service on the part of the Opposite party. 11. Therefore, at this stage, we are not in a position to consider the claim of the insurance sought for by the complainant. Therefore, in the result, we proceed to pass the following order; ORDER The complaint is disposed off directing the complainant to submit the claim form with permanent disability certificate to the Opposite party within one month and then Opposite party shall consider the claim and intimate the result of the claim to the complainant within two month. However, there is no order as to cost. (Dictated to the Stenographer, transcribed, corrected and then pronounced in the open Forum this the 19th day of September 2008). (PRESIDENT) (MEMBER) (MEMBER)
