Haryana

Yamunanagar

CC/912/2012

Harpreet S/o.Angrej Singh - Complainant(s)

Versus

Bajaj Allianz General Insurance Co.Ltd - Opp.Party(s)

Karam Singh

25 May 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

                                                                                                Complaint No. 912  of 2012.

                                                                                                Date of institution: 28.08.2012

                                                                                                Date of decision:  25.05.2017

Harpreet Singh aged about 22 years son of Shri Angrej Singh, resident of village Kapuri Khurd, Tehsil Bilaspur, District Yamuna Nagar.                                                                                                                                                                                      

                                                                                                     …Complainant.

                                                Versus

1. The Bajaj Allianz General Insurance Company Ltd. having office at 116, Model Colony, Opposite Nirankari Bhavan, Yamuna Nagar, through its authorized officer.
2. The Bajaj Allianz General Insurance Company ltd. having its Regional and Head office at GE Plaza, Airport Road, Yerwada, Pune-411006 through its Managing Director/Chairman.                                                                                                                                                                                                                                                                                                                                                                                                                                         …Respondents

BEFORE: SH. ASHOK KUMAR GARG…………………… PRESIDENT

                  SH. S.C.SHARMA……………………………….. MEMBER

                  SMT. VEENA RANI SHEOKAND……………….MEMBER 

 

Present: Sh. Karam Singh, Advocate, counsel for complainant.   

               Sh. Rajiv Gupta, Advocate, counsel for respondents.

           

ORDER   (ASHOK KUMAR GARG, PRESIDENT)

1.                     The present complaint has been filed under section 12 of the Consumer Protection Act 1986 with the averments that complainant was owner of motorcycle bearing registration No. HR-71A-9190 Marka Hero Honda Splendor which was insured with the respondents (hereinafter respondents will be referred as OPs Insurance Company) vide cover note No. MC1002051638 valid from 19.10.2011 to 18.10.2012 and when the complainant was coming from his village Kapuri Khurd District Yamuna Nagar to village Bilaspur on his motorcycle in question on 24.05.2012 and he was crossing the village Chanda Kheri, meanwhile a stray cow came running from the side of village and complainant tried his best to save her but the motorcycle in question skipped and complainant could not control the same due to which he met with an accident and received injuries on left leg which was fractured and also received the injuries on the other parts of the body. After that, complainant was shifted to Civil Hospital, Yamuna Nagar and thereafter, he was taken to Kohli Hospital, Jagadhri. It has been further mentioned that due to the injures, the complainant become permanent disabled and he could not attend his classes for diploma courses of JBT. After that, complainant gave intimation to the OPs Insurance Company and officials of the OPs assured the complainant that they will release the payment to the complainant very shortly. However, later on the official of the Ops prolonged the matter on one pretext or the other. So, there is a deficiency in service and unfair trade practice on the part of the OPs and lastly prayed for directing the Ops to pay the claim amount of Rs. 5,00,000/- as compensation on account of permanent disablement, shortened of life, expenses of treatment etc. and also to pay compensation for mental agony, harassment as well as litigation expenses.

2.                     Upon notice, OPs Insurance Company appeared and filed its written statement by taking some preliminary objections such as complaint is not maintainable; there is no negligence or deficiency in service on the part of the OPs; this forum has no jurisdiction to decide the present complaint. The cases relating to the Motor Vehicle Accident Claim of injuries/death are dealt under Motor Vehicle Act for which legislature has specifically constituted Motor Accident Claim Tribunals to entertain and try such type of cases. The present case is relating to accidental injury suffered by the claimant in the alleged Motor Vehicular Act, which is not subject matter of this Forum. As per terms and conditions of the insurance policy in question, no notice as per condition no.1 of the insurance policy was given immediately to the insurance company, even till date neither the insurance company was intimated nor any claim was lodged with it. Had the complainant lodged any claim with the insurance company, a specific claim number would have been assigned to the same and the company would have sought the desired documents including copy of FIR/DDR, Copy of DL, Copy of RC of the insured vehicles and other related documents including medical treatment record and permanent disability certificate etc. to substantiate the accident and accidental injuries/ disability if any but the complainant did not inform the insurance company in this case. It has been further mentioned that even as per terms and conditions of the insurance policy, a personal accident cover for owner-driver of the vehicle is payable only if the named insured, holding a valid and effective driving license, while himself driving the insured vehicle, suffers loss of two limbs or sight of two eyes, or one limb and sight of one eye or loss of one limb or sight of one eye, or permanent disablement from injuries, however, in this case, the complainant has not suffered any such injuries or disability entitling him to claim personal accident claim under the category of owner-driver under the policy in question and on merit contents of the complaint were controverted and reiterated the stand taken in the preliminary objections and lastly prayed for dismissal of complaint.

3.                     To prove the case, counsel for the complainant tendered into evidence short affidavit of complainant as Annexure CW/A and documents such as photo copy of bill of chemist as Annexure C-1 to C-5, photo copy of bill of  Kohli Hospital as Annexure C-6, Photo copy of bill of Narwal Viklang Kendra as Annexure C-7,  Photo copy of X-ray report as Annexure C-8, Photo copy of insurance policy as Annexure C-9, Photo copy of pollution certificate as Annexure C-10 and photo copy of RC of Motorcycle bearing registration No. HR-71A-9190 as Annexure C-11 and closed the evidence on behalf of complainant.

4.                     On the other hand, counsel for the Ops tendered into evidence affidavit of Sachin Ohri, Assistant Manager as Annexure RA and documents such as attested duplicate copy of insurance policy as Annexure R-1 and closed the evidence on behalf of OPs.

5.                     We have heard the learned counsel for both the parties and have gone through the pleadings as well as documents placed on file very minutely and carefully.

6.                     The only grievances of the complainant is that he met with a road side accident on 24.05.2012 when he was driving the motorcycle in question and received multiple injuries including fracture of leg and remained admitted firstly in the Civil Hospital and after that in Kohli Hospital, Yamuna Nagar and spent huge amount on treatment and lodged the claim with the OPs Insurance Company but the Ops Insurance Company did not bother to release the claim amount. Learned counsel for the complainant draw our attention towards the bill of expenses Annexure C-1 to c-7 and X-ray report Annexure C-8 but the Ops failed to release the claim amount which constitute the deficiency in service on the part of OPs Insurance Company.

7.                     On the other hand, learned counsel for the OPs argued at length that till date neither any intimation nor any claim was lodged with the Ops Insurance Company. Had the complainant lodged any claim with the Ops Insurance Company, specific claim number would have been assigned to the same and company would have sought the desired documents including copy of FIR/DDR, copy of DL, copy of RC of the insured vehicle, permanent disability certificate etc. Learned counsel for the Ops further argued that even as per terms and conditions of the insurance policy, the personal accident cover for owner-driver of the insured vehicle is payable only if the named insured having valid and effective driving license while driving the insured vehicle, suffers loss of two limbs or sight of two eyes, or one limb and sight of one eye or loss of one limb or sight of one eye, or permanent disablement from injuries and draw our attention towards the terms and conditions of the insurance policy as Annexure R-1.            Learned counsel for the OPs further argued that as the complainant has totally failed to place on file any disability certificate showing such disability to that extent as mentioned in the policy in question. So, claim is not payable under the policy in question under the head of personal accident. Learned counsel for the OPs further argued that even for such type of cases, a special court i.e. Motor Vehicle Accident Claims Tribunals has been constituted by the Legislature and this Forum has no jurisdiction to entertain and try the present complaint. Lastly, prayed for dismissal of complaint.

8.                     After hearing both the parties, we are of the considered view that there is no deficiency in service or unfair trade practice on the part of the Ops. We have perused the terms and conditions of the policy  in question and as per these terms and conditions of the insurance policy the claim of the complainant is not maintainable as neither the complainant has placed on file any disability certificate showing the disabilities to that extent as mentioned in the terms and conditions of the insurance policy nor has placed on file any document vide which he ever lodged the claim with the Ops Insurance Company. It is pertinent to mention here that the complainant wants to get reimbursement of the medical expenses under the coverage of PA under the Motor Vehicle Act Insurance Policy, not under the medical insurance policy. As per coverage of PA under Motor Vehicle Act insurance policy only following nature of injuries are covered:

(i) 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 ……………….100%

(iv) Permanent total disablement from injuries other than named above…..100%

            But in the present case the complainant does not fall in the above noted any category and in the absence of any cogent evidence that the complainant has suffered any permanent disability to that extent as mentioned above. We are unable to hold that the complainant is entitled to get any claim. On the other hand also, we have also gone through the contents of the complaint but not a single iota of word has been disclosed in the complaint that on what date and month and vide which document, the claim was lodged with the Ops Insurance Company. Even, the complainant has not disclosed the amount spent on treatment in the complaint. 

9.                     Resultantly, in the circumstances noted above, the complainant has failed to prove any deficiency in service and unfair trade practice on the part of OPs. Hence, we find no merit in the present complaint and the same is hereby dismissed with no order as to costs. Copies of this order be sent to the parties concerned as per rules. File be consigned to the record room after due compliance.

Announced: 25.05.2017.

                                                                                          (ASHOK KUMAR GARG)

                                                                                           PRESIDENT

 

 

                              (VEENA RANI SHEOKAND)         (S.C.SHARMA)

                                MEMBER                                          MEMBER