Punjab

StateCommission

FA/12/259

Neelam Sood - Complainant(s)

Versus

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

Raman Mohinder Sharma

22 Jan 2015

ORDER

2^nd Additional Bench

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB

DAKSHIN MARG, SECTOR 37-A, CHANDIGARH

 

First Appeal No.   259 of 2012

                                                           

                                     Date of institution: 2.3.2012  

                             Date of Decision:22.1.2015

 

Neelam Sood W/o Sh. Ramesh Chander, R/o 6-B, Sarabjit Singh, Near Bhatia Hospital, Kapurthala.

…..Appellant/Complainant

                                      Versus

1. Bajaj Allianz General Insurance Company, G.E. Plaza Airport, Yerwada, Pune – 411 006.
2. Bajaj Allianz General Insurance Company, 2^nd Floor, Satnam Complex, BMC Chowk, G.T. Road, Jalandhar.
3. Ramesh Chander S/o Sh. Piara Lal R/o 6-B, Sarabjit Nagar, Near Bhatia Hospital, Kapurthala.

…..Respondents/Opposite Parties

 

First Appeal against the order dated 8.12.2011 passed by the District Consumer Disputes Redressal Forum, Jalandhar.

 

Quorum:-

 

              Shri Gurcharan Singh Saran, Presiding Judicial Member

              Shri Jasbir Singh Gill, Member

 

Present:-

 

          For the appellant             :         Sh. R.M. Sharma, Advocate

          For respondent Nos.1&2  :         Sh. Vishal Aggarwal, Advocate

          For respondent No.3        :         Sh. Hitesh Sood, Advocate

 

 

Gurcharan Singh Saran, Presiding Judicial Member

ORDER

The appellant/complainant (hereinafter referred as “the complainant”) has filed the present appeal against the order dated 8.12.2011 passed by the District Consumer Disputes Redressal Forum, Jalandhar(hereinafter referred as “the District Forum”) in consumer complaint No. 515 dated 17.8.2010 vide which the complaint filed by the complainant was dismissed.  

2.                The complaint was filed by the complainant under the Consumer Protection Act, 1986 (in short ‘the Act’) against the respondents/opposite parties(hereinafter referred as ‘Ops’) on the allegations that the complainant purchased Honda City Car from Jalandhar having its Registration No. PB-09-J-1221 and purchased its insurance policy from Op Nos. 1 & 2 vide policy No. OG-10-1202-1801-00004948 for the period 31.10.2009 or 30.10.2010 on 1.12.2009 having cover note No. BZ0802654072 after paying the requisite premium. On 30.11.2009, the complainant alongwith Sahil Sood, Samriti Khanna & Navpreet Kaur were coming from Malout to Kapurthala. The car was driven by Ramesh Chander OP No. 3. The complainant was sitting adjoining to the driver seat whereas other persons were sitting on the back seat of the car. At about 7.30 a.m. when they reached near Dharamkot, stray cow came running on the road. The driver in order to save the car from the cow took sharp turn towards his left side and he lost its control, which hit the tree and the car was overturned. The matter was reported to P.S. Dharam Kot and DDR No. 27 dated 2.12.2009 was recorded in which the complainant alongwith the other occupants Sahil Sood, Samriti Khanna and Navpreet Kaur received multiple injuries. The complainant was admitted in Joshi Hospital, Jalandhar and was operated upon by the Doctors and she paid a sum of Rs. 83,941/-. The complainant became disabled to the extent of 20%. The complainant was earning Rs. 1,20,000/- p.a. from her boutique and now she cannot do the household work and on account of these injuries she had engaged the services of helper for which she is paying Rs. 2,000/- per month. A demand was raised to pay Rs. 83,941/- the medical expenses as well as Rs. 1 lac on account of mental and physical agony. OP Nos. 1 & 2 instead of admitting the claim sent letter dated 9.4.2010 and 28.4.2010 to the complainant demanding the documents from the complainant and she submitted the documents vide letter dated 7.5.2010. After receiving those documents the amount was not remitted but the claim was closed as ‘no claim’ vide letter dated 21.5.2010, which amounts to contravention of the terms and conditions of the policy. In this complaint, she has demanded medical expenses of Rs. 83,941/-, damages due to mental agony, torture and harassment Rs. 25,000/-, legal expenses Rs. 11,000/-, loss in business Rs. 1 lac, cost of litigation/complaint Rs. 10,000/- in all Rs. 2,29,941/-.

3.                The complaint was contested by the Ops, who filed written reply taking preliminary objections that the complaint was not maintainable because as per the terms and conditions of the Private Car Package Policy, Personal Accident Cover is granted to the insured/owner/driver of the car under Section-III of the policy terms and conditions and nature of the injury and compensation has been referred as under:-

Nature of Injury		Scale of compensation
(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 of sight of one eye	50%
(iv)	Permanent total disablement from injuries other than named above	100%

4.                Since the injury of the complainant was not of the nature mentioned in Clause III of the policy and disability of the complainant is also of temporary nature, therefore the claim did not fall under the scope of personal accident cover of the policy, therefore, the claim was closed as ‘no claim’ vide letter dated 21.5.2010. There was no mal practice, unfair trade practice or deficiency in services on the part of these Ops. On merits also, insurance policy was admitted but the claim was maintainable only in terms of disability referred above in the preliminary objections. The claim of the complainant was not covered under the terms and conditions of the policy. Therefore, it was closed as ‘No claim”. No merit in the complaint. It be dismissed.

5.                The parties were allowed by the learned District Forum to lead their evidence.

6.                In support of his allegations, the complainant had tendered into evidence her affidavit Ex. C-A, copy of RC Ex. C-1, cover note Ex. C-2, DDR Ex. C-3, details of Bills with bills Exs. C-4 to C-35. On the other hand, the opposite party had tendered into evidence affidavit of Sunil Koul, Asstt. Manager Ex. O-A, affidavit of Suvir Vig, Branch Manager Ex. O-B, Policy schedule with policy terms and conditions Ex.O-1, letter dt. 21.5.10 with postal receipt Ex. O-2 & 3.

7.                After going through the allegations in the complaint, written statement filed by the OP, evidence and documents brought on the record, it was observed that the injury of the complainant was not of the nature as mentioned under Section-III of the policy and disability of the complainant was of temporary nature, therefore, the claim does not fall under the scope of personal accident cover and accordingly, the complaint was dismissed.

8.                In the grounds of appeal, it has been stated that the claim was wrongly dismissed by the learned District Forum. The certificate-cum-policy schedule supplied by the Company provide the liability of the Company to cover of death or bodily injury. The Booklet showing the terms and conditions was not shown to the complainant. The claim of the complainant is duly covered under the terms and conditions of the policy, therefore, impugned order be set-aside and appeal be accepted.

9.                The taking of the private car package policy no. OG-10-1202-1801-00004948 for the period 30.10.2010 to 1.12.2009 was purchased by the complainant is not denied. It has been alleged that while coming from Malout to Kapurthala Near Dharamkot, the car met with an accident in which she received injuries and admitted in Joshi Hospital in Jalandhar and a sum of Rs. 83,941/- was spent by him. With regard to the accident, DDR No. 27 dated 2.12.2009 Ex. C-3 was allowed. These bills have been proved on the record from Exs. C-5 to C-22. However, the main point for determination is whether the injuries received by the complainant are duly covered under the terms and conditions of the policy. In the written statement, the Ops have stated that the Company undertakes to pay compensation in case bodily injury/death sustained by the owner driver of the vehicle whilst driving or, mounting into/dismounting from the vehicle insured or whilst travelling in it as a co-driver, caused by violent accidental external and visible means which independent or any other cause shall within six months of such injury results in as under:-

Nature of Injury		Scale of compensation
(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 of sight of one eye	50%
(iv)	Permanent total disablement from injuries other than named above	100%

 

10.              Counsel for the complainant has referred to the cover note Ex. C-2 in which PA cover for four passengers to Rs. 1 lac each for which the premium of Rs. 200/- was paid. Therefore, apart from driver/owner there is coverage of personal accident cover for four passengers and that the complainant was travelling as a passenger in the said vehicle with the Ops. However, the terms and conditions have been referred in the Booklet Ex. O-1 and Section-III deals with Personal Accident Cover for owner/driver as referred above. The case of this complainant is not covered under first three clauses and he has referred to permanent total disability to Clause 4 under which total disablement from injuries other than named above. However, before the District Forum the disability certificate was furnished by the complainant Ex. C-24 in which disability of 20% of temporary nature has been referred on 29.4.2010. Therefore, the disability suffered by the complainant was of temporary nature, therefore, the claim was rightly declined by the District Forum.

11.              During the appeal, the complainant has placed on the record one certificate dated 12.3.2012. Even this certificate shows the disability 15% and in the certificate it has not been referred whether it is of temporary or permanent nature and till the complainant proves that the injury is of permanent nature then the complainant’s case will not be covered under the terms and conditions of the policy. Therefore, even this certificate does not cover the case of the complainant. It has been referred in the grounds of appeal that this booklet containing the terms and conditions of the policy were not given to him. This has been stated so for the first time in the appeal. There is no reference that he was not given the copy of the terms and conditions of the policy. Moreover, no person, who are taking the additional coverage for the passengers will not go through the terms and conditions of the policy. Therefore, we are of the opinion that the findings so recorded by the District Forum are correct findings and the same are hereby affirmed.

12.              In view of the above discussion, we do not find any merit in the appeal and the same is dismissed with no order as to costs.

13.              The arguments in this appeal were heard on 20.1.2015 and the order was reserved. Now the order be communicated to the parties as per rules.

14.              The appeal could not be decided within the statutory period due to heavy pendency of Court cases.

 

 (Gurcharan Singh Saran)

Presiding Judicial Member

 

January 22, 2015.                                                                                                                                                        (Jasbir Singh Gill)

as                                                                                                                                                                                               Member