By Sri. P. Raveendran, Member:
The Complainant is the R.C owner of the vehicle No. KL 12D 9645. The vehicle was insured with the Opposite Party under two wheelers package policy as well as personal accident coverage to the owner cum driver for Rs.1,00,000/- from 15.10.2009 to 14.10.2010. The vehicle met with an accident on 02.11.2009 by which the Complainant sustained injury of amputation of right big toe. Complainant has spent Rs.40,000/- towards treatment. The vehicle also damaged and he spent Rs.4,000/-. The matter of accident had intimated to the Opposite Party. But they have not cared. Finally the Complainant send a lawyer notice to issue claim form for which the Opposite Party replied stating false allegations. In the reply Opposite Party stated that they have already processed own damage claim form submitted by the Complainant. The Complainant never filled or submitted any claim form as alleged. The attitude of Opposite Party that to receive the premium on every head and to deny the benefits is gross deficiency of service on the part of the Opposite Party. The Opposite Party has failed to consider that the Complainant is having permanent total disablement. Since he has lost his right big toe out of the accident. Copies of the records of the vehicle as well as treatment records with original submitted to the Opposite party. After verifying the same the Opposite Party has returned the original. The Opposite Party was not sought any further explanation with regard to the nature of the bodily injuries sustained to the Complainant. Hence it is prayed to direct the Opposite Party to pay Rs.50,000/- with 18% interest from 02.11.2009 till the payment as their personal accident coverage and Rs.4,000/- with 18% interest as the repair charge of the vehicle, Rs.10,000/- as compensation and Rs.35,000/- with 18% interest as the treatment expenses and cost.
2. Opposite Party appeared and filed version. In the version it is admitted that the motor cycle No. KL 12D 9645 was insured with this Opposite Party with personal accident benefit coverage, the scale of maximum compensation of Rs.1,00,000/- 100% in case of death, loss of two limbs or sight of two eyes or one limb and sight of one eye and permanent total disablement and 50% in case of loss of one limb or sight of one eye. The Complainant is not entitled to get personal accident benefit as mentioned above. The accident happened on 02.11.2009 was informed on 17.11.2009. The vehicle was garaged at M/S KVR Motors Kalpetta. Opposite Party deputed Mr. K.V. Jeevan the Surveyor to assess the damage of the vehicle and recommended Rs.1,088.70. Hence own damage claim of the Complainant was processed and settled the claim for Rs.1,150/- and cheque No. 469917 dated 02.01.2010 was issued to the Complainant and the Complainant accepted the cheque. While submitting the claim form the Complainant has not given any information regarding the injury to person driving occupant as required in column No.8 of the claim form. The nature of injury will not come under the purview of any one those are enumerated in section III of the policy under the head. The personal accident cover for owner- driver. If the Complainant has not submitted claim form as alleged in the Complaint this Complaint itself is not maintainable as per law. On the basis of above contentions the Forum may dismiss this complaint with compensatory cost.
3. Considering the Complaint and version the following points are to be considered.
Whether there is any deficiency of service on the part of the Opposite Party.
Relief and cost.
4. Point No.1:- To prove Complainants case Complainant has filed his proof affidavit. In the proof affidavit he stated as stated in the Complaint. He has produced Ext.A1 to Ext.A7 series documents Ext.C1 also marked. To prove Opposite Party's case, Opposite Party has produced Exts.B1 to B6 documents. We verified Ext.B1 document, the policy and policy package. As per section III of Ext.B1, the company undertakes to pay compensation as per the following scale for bodily injury death sustained by the owner/driver of the vehicle, in direct connection with vehicle insured whilst mounting into dismounting from or traveling in the insured vehicle as a co-driver caused by violent, accidental, external and insible means which independent of any other cause shall within six calender months of such injury result in (1) death (2) Loss limbs or sight of two eyes or one limb and sight of one eye (3) Loss of one limb or sight of one eye (4) Permanent total disablement from injuries other than named above. We have gone through the Ext.C1. As per Ext.C1 the Complainant is not having any one of the injury noted in item No.1 to 4 mentioned above. Other allegation of the Complainant is that the Opposite Party has not issued the claim form. Ext.B2 is the claim form, alleged by Opposite Party, submitted by the Complainant. We have gone through the signature and name written in Ext.B2 and in the Complaint. The signatures in both documents look alike. No claim has been claimed in column No. 8 of Ext.B2 ie regarding injury to person/driver. We presume that the Ext.B2 is submitted by the Complainant. As per Ext.B2 the vehicle is insured with Opposite Party. At the time of Examination the Complainant admitted that the compensation towards the damages caused to the vehicle is received by him. Hence we come to the conclusion that there is no deficiency of service on the part of Opposite Party. Point No.1 is decided accordingly.
5. Point No.2:- Since the point No.1 is found against the Complainant. We are not discussing point No.2 in detail.
In the above circumstances, the complaint is dismissed. No order as to cost.
Pronounced in open Forum on this the day of 31st December 2010.
Date of filing: 11.02.2010.
PRESIDENT: Sd/-
MEMBER : Sd/-
MEMBER : Sd/-
A P P E N D I XWitness for the Complainant:
PW1. Sujith Babu Complainant.
Witness for the Opposite Party:
Nil.
Exhibits for the Complainant:
A1. Copy of Motor Insurance Certificate cum Policy Schedule. dt:19.10.2009.
A2. Copy of Certificate of Registration.
A3. Copy of Driving Licence.
A4. Copy of Discharge/ Referral Card.
A5 Series. Copy of Lawyer Notice, Postal Receipt and Acknowledgement dt:23.01.2010.
A6. Copy of Lawyer Notice. dt:31.01.2010.
A7series. Bills.
C1. Medical Certificate. dt:11.08.2010.
Exhibits for the Opposite Party:
B1. Motor Insurance Certificate cum Policy Schedule. dt:19.10.2009.
B2. Motor Claim Form.
B3 series. Copy of Motor Survey Report (Final). dt:18.01.2010.
B4. Discharge Voucher. dt:21.01.2010.
B5. Copy of Letter. dt:27.01.2010.
B6. Copy of Letter. dt:16.03.2010
