By Sri. MOHANDASAN.K, PRESIDENT
The case of complainant is as follows: -
1. The complainant is the owner of Autorickshaw, which is insured with the opposite party. The complainant purchased the vehicle for self employment purpose and the number of the vehicle is KL 53A 3081 and it is insured vide policy No. is 442790/31/2019/188. The complainant submit that the opposite party had assured that they will provide all the benefits including compensation for the personal injuries.
2. On 09/07/2018 while the vehicle was driving by his relative one Mr. Muhammadali, met with an accident at Tiruvegapuram and the vehicle was overturned and the complainant was thrown out from the vehicle. The complainant sustained grievous injures and the vehicle totally damaged. The police recorded the statement of the complainant.
3. Subsequently the complainant informed the accident and injuries to the agent of the opposite party and he assured that the opposite party will provide the benefits and instructed to repair the vehicle and to pay the medical bills. The documents including photographs and others related to the accident was taken by the opposite party men. The complainant undergone treatment at KIMS Alshifa Hospital Perinthalmanna and he incurred Rs.48, 736/-for treatment. The documents of the treatment also furnished to the opposite party.
4. The complainant spent Rs.20, 950/- to repair the vehicle and in addition to that he was incurred Rs.5, 000/- towards other expenses. While the complainant was taken to the hospital at Valanchery at first instance, he spent Rs.907/- for the medicine itself. Thereafter the complainant was laid up due to the injuries. Meanwhile, all the records were furnished to the opposite party. Thereafter the opposite party men had obtained certain blank papers signed from the complainant and it was informed that those papers were required for sanctioning the claim amount. The said documents furnished during 2019 June. It was assured his claim amount will be credited to the bank account but the complainant submit that so far no amount has been allowed in his favor.
5. The complainant approached the opposite party directly and then informed that the complainant is not entitled for the claim since the vehicle was in the name of complainant. The submission of the complainant is that the opposite party had assured that all the risks will be covered by the insurance and thus collected Rs. 8,000/- towards insurance premium. The opposite party had assured to cover treatment expenses up to 2 lakh rupees. The submission of the complainant is that the premium amount Rs.8, 000/- is an exorbitant amount to cover the liability of the Autorickshaw. It was under the impression that the personal injuries also will cover, and that is why the complainant remitted Rs.8, 000/- towards the insurance. The complainant submit that he incurred an amount of Rs.60, 000/- for treatment and an amount of Rs.26, 000/- for the repair work of the autorickshaw. The complainant prays for Rs.86, 000/- from the opposite party towards the insurance amount along with 9% interest.
6. On admission of the complaint notice was issued to the opposite party and the opposite parties one and two entered appearance and filed version. The opposite parties denied the allegations and averments in the complaint and contended that the complaint is not maintainable, devoid of merits and is liable to be dismissed with cost.
7. The opposite parties submitted that the complainant had approached the first opposite party and requested to issue policy of an autorickshaw bearing registration No. KL 51A 3081 and the opposite party had issued policy conditions and subsequently the complainant had accepted the policy conditions and had remitted the policy premium. The first opposite party had issued policy No. 442790/31/2019 /188 with policy conditions in favor of the complainant for the period commencing from 26/04/2018 to 25/04/2019.
8. The opposite party denied that the bearing registration number KL 53A 3081 autorickshaw had met with an accident on 09/07/2018. The opposite party submitted that the complainant approached with motor claim form before the second opposite party on 04/09/2019 and based on the above motor claim the second opposite party had deputed Mr. Ranjith O T, an independent surveyor and loss assessor, holding IRDA license on the very same day itself. The policy condition stipulate that the accident has to be reported to the company within 15 days of the accident and the complainant had not complied the policy condition and not reported the alleged accident in time. The above said surveyor reported to the second opposite party that he visited friends auto garage Kolamangalam, Valanchery to assess the alleged damages of the above autorickshaw but the vehicle was not in the garage. The surveyor contacted the complainant using the contact number given in the claim form and requested to produce the alleged damaged vehicle for inspection as part of the procedure to assess the alleged damages of the autorickshaw and the complainant was not willing for the same and the surveyor was unable to assess the alleged damages of the autorickshaw and so the opposite parties disputed the alleged accident and the complainant has to prove the alleged accident with reliable documents.
9. The opposite parties denied the allegation that the photographs and other records in connection with accident and treatment had collected by the agents of the opposite parties. The opposite parties submitted that the policy issued in favor of the complainant covering the liability of the above autorickshaw but not covered other claims under the policy. The claim of the complainant that he had spent Rs.86, 000/- for the repair and other expenses are false and baseless. The opposite party further denied that the surveyor had collected the blank signed papers, forms etc for the claim purpose which the complainant must prove beyond reasonable doubt. The opposite party submitted that there is no deficiency in service and the complaint is liable to be dismissed with cost.
9. The complainant and opposite parties filed affidavit and documents. The documents on the side of complainant marked as Ext. A1 to A9. Ext. A1 is copy of driving license No. 52/2113/2006 dated 14/01/2016. Ext A2 series are medical bills. Ext A3 are three photographs. Ext. A4 is copy of certificate of registration of vehicle No. KL 53A 3081. Ext. A5 is copy of driving license No 55/2649/2012 dated 18/03/2015 of the complainant. Ext. A6 is copy of insurance policy No.442790/31/2019/188 for the period 26/04/2018 to 25/04/2019. Ext. A7 series of medical bills worth Rs.48, 736/-. Ext. A8 is motor claim form nil dated. Ext. A9 is copy of repair bill issued from friends’ auto garage for Rs.20, 950/- dated 20/08/2018. The opposite parties’ documents marked as Ext B1 to B3. Ext. B1 is motor insurance certificate cum policy schedule. Ext. B 2 is copy of motor claim form. Ext. B3 is insurance surveyors report.
10. Heard complainant and opposite parties, perused affidavit, and documents. The following points arise for consideration: -
- Whether there is deficiency in service on the part of the opposite parties?
- Relief and cost?
11. Point No.1 &2
The case of the complainant is that he is the registered owner of Vehicle No. KL 53 A 3081 which is insured with the opposite parties. The vehicle met with an accident and sustained damages to the vehicle and injuries to the complainant. The complainant submitted his claim form through the agent of the opposite party. But the opposite party did not sanction the claim amount. The complainant submitted documents A1 to A10 to establish the case of the complainant. Ext. A1 is the copy of driving license, who drove the vehicle at the relevant time. Ex. A2 series and A 7series are medical bills for the treatment expenses incurred by the complainant. Ext. A9 is the copy of clam form.
12. The opposite party submitted that the complainant submitted a claim form on 04/09/2018 contenting that his vehicle was met with an accident on 09/07/2018. The opposite party duly deputed independent surveyor and loss assessor Mr. Ranjith to inspect the vehicle and to prepare the survey report. The opposite party produced Ext. A3 report which says that the vehicle not produced for the survey, and not inspected the damages and so it is not possible to assess the claim. It is further reported that chassis number and engine number not verified physically and reported driving license not submitted. The opposite party specifically contended in the version that the complainant did not produce the vehicle for survey and also contended that the insurance policy does not cover except the liability of the autorickshaw, the other claims are not covered under the policy. The opposite parties produced Ext. B1 the policy copy and the complainant produced Ext. A6 the relevant insurance certificate cum policy schedule. The perusal of documents produced by the complainant shows that there was a vehicle in the name of the complainant and he was holding driving license also. Ext A3 Fotos shows that the said vehicle met with an accident. But the complainant did not produce any document regarding the accident from the police station either GD entry or FIR and even not produced accident register cum wound certificate. There is no document to show that the vehicle was inspected by the motor vehicles inspector to see the damages and cause for the accident. The complainant did not state the reason for not producing the vehicle before the surveyor for the assessment of damages. The opposite party specifically contented that the vehicle was not produced before the surveyor for the assessment of damages. So it can be seen that except the photographs the complainant failed to establish the exact extent of damages sustained to the vehicle and thereby he spent the amount for repairing the vehicle. The insurer was not given opportunity to verify the condition of the vehicle after the accident. Though the complainant contended the documents were given to the opposite party’s agent, but there is no due document to establish the same before the Commission.
13. The complainant also claimed that he is entitled treatment expenses for the injuries sustained in the accident. Though the policy reveals that the opposite party realized 100/- rupees for personal accident for owner-driver but the conditions for the entitlement not revealed either through Ext. B1 or through the Ext. A6. Moreover, the documents regarding the medical bills does not reveal the nature of injuries sustained to the complainant and the complications thereon. The complainant failed to establish that there was an accident as alleged in the complaint and thereby he met an expense as claimed in the complaint. The complainant also fails to establish the insurance policy covers the injury sustained in the accident and entitled for the medical expenses met by him. In the absence satisfactory evidence from the side of complainant, the Commission cannot conclude that there was an accident as claimed by the complainant and he duly approached the opposite parties with documents and he is entitled for the medical expenses as per the policy. Hence, we dismiss this complaint due to want of material evidences from the side of complainant.
Dated this 3rd day of July, 2023.
Mohandasan . K, President
Preethi Sivaraman.C, Member
Mohamed Ismayil.C.V, Member
APPENDIX
Witness examined on the side of the complainant: Nil
Documents marked on the side of the complainant: Ext. A1 to A10
Ext.A1: Copy of driving license No. 52/2113/2006 dated 14/01/2016
Ext.A2: (series) are medical bills.
Ext A3: Three photographs.
Ext A4: Copy of certificate of registration of vehicle No. KL 53A 3081.
Ext A5: Copy of driving license No 55/2649/2012 dated 18/03/2015 of the
complainant.
Ext.A6: Copy of insurance policy No.442790/31/2019/188 for the period 26/04/2018
to 25/04/2019.
Ext A7: (series) is medical bills worth Rs.48,736/-.
Ext A8: Motor claim form nil dated.
Ext A9: Copy of repair bill issued form friends auto garage for Rs.20,950/- dated
20/08/2018.
Witness examined on the side of the opposite party: Nil
Documents marked on the side of the opposite party: Nil
Ext.B1: Motor insurance certificate cum policy schedule.
Ext.B2: Copy of motor claim form.
Ext.B3: Insurance surveyors report.
Mohandasan . K, President
Preethi Sivaraman.C, Member
Mohamed Ismayil.C.V, Member
