IN THE CONSUMER DISPUTES REDRESSAL FORUM, PATHANAMTHITTA, Dated this the 28th day of September, 2010. Present : Sri. Jacob Stephen (President). Smt. C. Lathika Bhai (Member) N. Premkumar (Member) C.C.No.120/09 (Filed on 05.09.2009)Between: Thomas. A.T., S/o. Chacko, Areekkara House, Vallamkulam (W) P.O., Eraviperoor, Thiruvalla. (By Adv. Sunitha. K.K) ..... Complainant. And: The Oriental Insurance Co. Ltd., Rep. by the Branch Manager, Oriental Insurance Co. Ltd., Thiruvalla. (By Adv. P.D. Varghese) ..... Opposite party. O R D E R Smt. C. Lathika Bhai (Member): The complainant has filed this complaint against the opposite party for getting a relief from the Forum. 2. The facts of the complaint is as follows:- The complainant is the registered owner of the KL.03/E-3068 Bajaj Chethak Scooter. It was insured with the opposite party’s vide policy No.441900/31/08/2404 and the complainant had paid an additional amount of ` 50 as premium for the compulsory personal accident cover. On 5.9.07 the complainant and his wife proceeding from West to East through Thiruvalla-Kozhencherry road reaching at Manakkachira while taking a deviation the scooter was hit by another motorcycle. Due to the accident small finger of the complainant became fracture and sustained 12% disability. For the treatment the complainant spent an amount of ` 25,000. The medical bill for the treatment has lost from the complainant. The accident occurred during the coverage period of the policy hence the complainant approached the opposite parties for getting the treatment expenses from them. But they did not give any compensation to the complainant. Thiruvalla police had registered a Crime as Crime No.584/07 against the accident occurred to the complainant. In the circumstances, the complainant filed this complaint for getting an order for directing the opposite parties to pay the insured amount to the complainant. The complainant prays for granting the relief. 3. The opposite parties have filed a version stating the following contentions: The complaint is not maintainable either in law or on facts. The accident and injuries narrated in the complainant has not been intimated to the opposite party. It is mandatory as per the policy that notice shall be given in writing to the opposite party in the event of any claim and thereafter the insured shall give all such information and assistance as the company shall require. In this case, the complainant had directly approached this Forum without giving any intimation to the opposite party or submitting a claim as required by the policy. This complaint is filed without complying the statutory formalities hence the complaint is premature and the complainant is liable to be dismissed, as there is no cause of action for filing this complaint. The opposite parties have admitted the policy issued to the complainant and the additional premium collected from the complainant to cover personal accident benefit to owner-driver. The policy covers only death or permanent total disablement. The complainant has not sustained any injuries, which will entitle the benefits under personal accident cover. The opposite parties are not liable to pay any medical expenses incurred by the complainant as per the personal accident cover envisaged in the policy without complying the policy conditions. The complainant never approached the opposite parties for compensation for the injuries sustained in accident as alleged in the complaint. The complainant is not entitled to get any relief as claimed in the complaint. Hence the opposite parties prayed for the dismissal of the complaint with their cost. 4. On the basis of the pleadings of the parties, the point to be considered is whether the complainant is entitled to get the relief as sought for in the complaint? 5. Evidence in this case consists of the proof affidavit and Ext.A1 to A4 marked from the side of the complainant and for the opposite party proof affidavit filed by the opposite party and Ext.B1 and B2. After closure of the evidence, both sides heard. 6. The complainant’s case is that he is the registered owner of the scooter bearing Reg.No.KL-3/E 3068, which has been insured with the opposite party from 14.7.07 to 13.7.08. There is a personal accident cover envisaged in the policy and premium for that was paid by the complainant. On 5.9.07 the complainant and his wife proceeding from Thiruvalla-Kozhencherry road while taking a deviation the scooter hit by another motorcycle and he had sustained injuries and had became 12% disability. Hence he claims the relief as sought for in the complaint. 7. In order to prove his case, the complainant has filed a proof affidavit and Ext.A1 to A4. Ext.A1 is the Insurance Policy Certificate of the vehicle. Ext.A2 is the disability certificate issued by the Medical Board, General Hospital, Pathanamthitta. Ext.A3 is the Accident Register-cum Wound Certificate issued by the Pushpagiri Medical College Hospital. Ext.A4 is the copy of the driving licence of the complainant. 8. According to the opposite parties, they have contended that the accident was not intimated them. It is mandatory as per the policy that notice shall be given in writing to the opposite party immediately upon the occurrence of any accidental loss or damage in the event of any claim and thereafter the insured shall give all such information and assistance as the company shall require. The complainant has not made any claim before them by complying statutory formalities hence the complaint is premature. As there is no cause of action for filing this complaint, the complaint is liable to be dismissed. 9. In order to prove the contentions of opposite party, opposite party has filed a proof affidavit and Ext.B1 and B2. Ext.B1 is the copy of the insurance policy certificate of the complainant’s vehicle. Ext.B2 is the terms and conditions of the policy. 10. On going through the evidences in this case, it can see that the accident was occurred during the coverage period. The opposite parties have admitted the policy and the acceptance of the personal accident cover premium from the complainant. Ext.A3 shows that the complainant had sustained injuries due to the accident. Ext.A2 shows that the complainant has 12% disability. 11. According to the complainant, he is entitled to get compensation for the treatment expenses incurred during the coverage period as per the personal accident cover envisaged in the policy. 12. The opposite parties main contention is that the complainant has not informed the accident or injuries sustained to him to the opposite party. It is mandatory as per the policy condition that notice shall be given in writing to the company immediately upon the occurrence in the event of any claim and thereafter the insured shall give all such information and assistance as the company shall required There is no evidence from the complainant to show that he had made a proper claim before the opposite party along with relevant documents and it was repudiated by them. The material on records does not show that the complainant had lodged a claim before the opposite parties for getting compensation from them. Without repudiating the complainant’s claim by opposite parties there is no valid cause of action for filing this complaint. The complainant failed to act up on the terms and conditions of the policy. In the circumstances, the alleged deficiency in service, is not find against the opposite parties. Hence the complaint is liable to be dismissed. 13. In the result, the complaint is dismissed. No cost. Declared in the Open Forum on this the 28th day of September, 2010. (Sd/-) C. Lathika Bhai, (Member) Sri. Jacob Stephen (President) : (Sd/-) Sri. N. Premkumar (Member) : (Sd/-) Appendix: Witness examined on the side of the complainant: Nil. Exhibits marked on the side of the complainant: A1 : Insurance Policy Certificate of the vehicle issued by the opposite party to the complainant. A2 : Photocopy of the Disability Certificate dated 25.8.09 issued by the Medical Board, General Hospital, Pathanamthitta to the complainant. A3 : Photocopy of the Accident Register-cum Wound Certificate dated 6.9.07 issued by the Pushpagiri Medical College Hospital. A4 : Photocopy of the driving licence of the complainant. Witness examined on the side of the opposite parties: Nil. Exhibits marked on the side of the opposite parties: B1 : Copy of the insurance policy certificate of the complainant’s vehicle. B2 : Terms and conditions of the policy. (By Order) Senior Superintendent. Copy to:- (1) Thomas. A.T., Areekkara House, Vallamkulam (W) P.O., Eraviperoor, Thiruvalla. (2) The Branch Manager, Oriental Insurance Co. Ltd., Thiruvalla. (3) The Stock File.
| | HONORABLE LathikaBhai, Member | HONORABLE Jacob Stephen, PRESIDENT | HONORABLE N.PremKumar, Member | | 
