O R D E R<br /> Sri. Santhosh Kesavanath P., President.<br /> Case of the petitioner's is as follows:<br /> The petitioner joined a personal accident insurance policy of respondent Insurance company on 29..12..2005. The period of policy was from 30..12..2005 to 29..12..2006 and a policy certificate was issued to the petitioner for the said period. The capital sum assured by the company is Rs. 3,00,000/-. The petitioner took the policy from1976 onwards and is paying the premium without any break. No claim was preferred by the petitioner till 2005. The petitioner on 6..1..2006 fell down and sustained injuryto the ligament of the right ankle. He was admitted at the I.H.M Hospital, Bharananganam. Dr. M.P Mathew attended and treated the petitioner and he adviced a six weeks complete bed rest for its cure. The petitioner spent huge amount to the treatment and he preferred a claim, to the respondent on 8..3..2006 but no action was taken by the opposite party. Meanwhile the petitioner again involved in an accident on 21..3..2006 and sustained an injury of fracture on the ligament of the left ankle joint. The petitioner was admitted and<br /> <br /> -2-<br /> treated at K.N. J Ayurveda Paramparya Chikilsalayam and Dr. P.P Mathai, treated the petitioner and advised the petitioner to take complete bed rest for further six weeks from 21..3..2006. The petitioner preferred another claim before the opposite party but the same was also not processed till 15..6..2008. On 23..6..2006 petitioner received a letter along with two vouchers for an amount of Rs. 9523/- and 9579/- requesting for the acknowledgement of full and final settlement of both claims. Due to the difference of quantum of the claims the petitioner returned the vouchers to the opposite party. According to the petitioner the act of the opposite party is a clear deficiency of service so, he prays for an amount of Rs. 36,000/- towards claim amount along with costs of the proceedings.<br /> Opposite party filed version contenting that petition is not maintainable either on law or facts and opposite party accepted the issuance of the policy. According to the opposite party the policy is subjected to the terms and condition attached. Since the petitioner has not furnished sufficient treatment records for processing the claim the opposite party assessed the claim for 3 weeks and the medical expenses incurred by the petitioner and thus calculated and a voucher for Rs. 9579/- was sent to the petitioner and same was refused by the opposite party. The opposite party contented that as per condition 2 of the policy the complainant is bound to furnish proof regarding the period of disablement for processing the claim but the petitioner did not furnish the same and it is treated as a supression of material fact. So, no deficiency in service can be attributed against the opposite party. The opposite party also contented that since the dispute is<br /> only with regard to the quantum of compensation offered by the opposite party, it is purely a question to be decided by a Civil Court so the petition is not maintainable <br /> -3-<br /> before this Forum. So, they pray for the dismissal of the petition with their costs.<br /> Points for determination are:<br /> i) Whether there is deficiency in service on the part of the opposite party?<br /> ii) Reliefs and costs.<br /> Evidence in this case consists of affidavit filed by both parties Ext. A1 to A10 documents of the side of the petitioner and Ext. B1 to B3 documents of the side of the opposite party.<br /> The petitioner produced the policy and the policy conditions the said document is marked as Ext. A1. In Ext. A1 clause 1 (f) states that.<br /> If such injury shall be the sole and direct cause of temporary total disablement, then so long as the insured person shall be totally disabled from engaging in any employment or occupation of any description what so ever a sum at the rate of 1% of the capital sum insured stated in the schedule hereto per week is entitled to the insured and but in any case not exceeding Rs. 3000/- per week in all, will be given under all policies.<br /> So, according to the petitioner after the treatment on 6..1..2006 he was advised to take bed rest for 6 weks. Later as a result of the accidental fall on 21..3..2006 the petitioner sustained fracture to the ligament of his left Leg. So, for the said accident by the petitioner had undergone ayurvedic treatment and the doctor who examined the petitioner adviced the petitioner to take bed rest for 6 weeks. So, the petitioner's<br /> argument is that as per clause 1(f ) of A1 the petitioner is entitled for Rs. 3000/- each for 6 weeks together with medical expenses for both claim. The counsel for the opposite party vehemently argued that as per policy condidtions the petitioner has to produce<br /> <br /> -4-<br /> proofs satisfactory to the company regarding the matters in which claim is prefered. Here the petitioner has not produced any treatment records, to substantiate his claim, even after the request of the opposite party. So, the petitioner is not entitled for the claim amounts. The opposite party produced the repudation letter dtd: 5..7..2006 issued by the opposite party to the petitioner the said document is marked as Ext. B2 From Ext. B2 it can be seen that the opposite party has no dispute with regard to prefering the claim their only dispute is with regard to the periods to which claim is to be allowed. The petitioner produced a copy of the medical certificate dtd 10..3..2006 issued from the Immaculate Heart of Mary Hospital, Bharananganam, the copy of the said document is marked as Ext. A3. The petitioner claimed rest of 6 weeks in his 1st claim based on Ext. A3 document. The petitioner produced the copy of certificate issued by Dr. P.P Mathai dtd: 10..5..2006. The copy of said certificate is marked as Ext. A5. From Ext. A5 it can be seen that the doctor adviced the petitioner for taking complete 6 weeks bed rest. We are of the opinion that on rlieying on Ext. A3 and A5 documents the claim amount for 6 weeks in both claims are reasonable and is to be allowed. The act of non processing of both claim of the petitioner, for 6 weeks in 2 claims, is a clear deficiency in service on the side of opposite party. The opposite party has another contention that since the petitioner's dispute is only with regard to the quantum of compensation that has to be<br /> decided by a competent civil court. We disagreee with the said contention of the opposite party because detaining of a portion of the claim amount is a deficiency of service and the forum is comptent to adjudicate that matter also. So, point No. 1 is found accordingly.<br /> <br /> -5-<br /> Point No. 2<br /> In view of the findings in point No. 1, petition is to be allowed and the petitioner is entitled for the reliefs prayed for.<br /> In the result the opposite party is ordered to pay the petitioner an amount of Rs. 36,000/-. The opposite party is also ordered to pay Rs. 2000/- as cost of the proceedings. Since there is no evidence with regard to loss and sufferings no compensation is ordered. The order shall be complied with within 30 days of receipt of the order.<br /> Dictated by me transcribed by the Confidential Assistant corrected by me and pronounced in the Open Forum on this the 23rd day of June, 2008.