IN THE CONSUMER DISPUTES REDRESSAL FORUM, PATHANAMTHITTA, Dated this the 22nd day of July, 2010. Present : Sri. Jacob Stephen (President). Smt. C. Lathika Bhai (Member) N. Premkumar (Member) C.C. No.85/09 (Filed on 17.06.2009) Between: Eapen Varghese, S/o. Varghese Eapen, Kachiramangalathu Veedu, Kaviyoor Muri, Kaviyoor Village, Thiruvalla. .... Complainant. And: The Divisional Manager, Oriental Insurance Co. Ltd., Marthoma Building, T.K. Road, Thiruvalla. .... Opposite party. ORDER Sri. N. Premkumar (Member): Complainant filed this complaint against the opposite parties for getting a relief from the Forum. 2. Fact of the case in brief is as follows: Complainant is the owner and possessor of a Bajaj CT 100 motor cycle bearing registration No.KL-03K-5943. While the complainant was driving the said vehicle from Koodal to Konni, a motor cycle from the opposite direction dashed his vehicle at Murinjakal Junction on 13.11.2008. He fell down and sustained injuries. His vehicle was insured with opposite party’s insurance company and a policy has also issued to him. As per policy package, he paid Rs.50/- as premium for personal accident cover. 3. As a result of the accident, complainant incurred an amount of Rs.5,000/- as treatment expenses. He approached the opposite party for getting the assured amount. But opposite party has not taken any step. Hence this complaint for getting the insured amount with interest, compensation and cost. 4. Opposite party entered appearance and filed version stating that the complaint is not maintainable either in law or on facts. According to opposite party, as per complaint itself, complainant’s vehicle collided with another vehicle. The complainant had not lodged any claim form as required by the terms of the policy. As per the terms kof the policy, there is a personal accident cover. The nature of injury and scale of compensation is as follows: Details of injury | Scale compensation | 1. Death | 100% | 2. Loss of two lips or sight or two eyes or one limb and sight of one eye. | 100% | 3. Loss of one limb or sight of one eye | 50% | 4. Permanent total disablement from injuries other than named above | 100% |
5. The injury of the complainant does not fall under any of the above category. As per clause IV of the above table, permanent total disablement means 100% physical disability. Therefore, complainant is not entitled to get personal accident claim benefit under the policy. The complainant is not entitled to get reimbursed the medical expenses since there is no undertaking for the same. Hence, opposite party canvassed for the dismissal of the complaint. 6. From the above pleadings, following points are raised for consideration: (1) Whether the complaint is maintainable before this Forum? (2) Whether the reliefs sought for in the complaint are allowable? (3) Reliefs and Costs? 7. Evidence of the complainant consists of the proof affidavit filed by the complainant along with certain documents. The documents produced were marked as Exts.A1 to A4. Evidence of opposite party consists of the proof affidavit filed by the opposite party along with one document. The document produced was marked as Ext.B1. After close of the evidence, both sides were heard. 8. Points 1 to 3: In order to prove the complainant’s case, the complainant filed proof affidavit along with certain documents. The documents produced were marked as Exts.A1 to A4. Ext.A1 is the discharge summary of complainant issued from Pushpagiri Medical College Hospital. Ext.A2 is the copy of insurance policy certificate issued by the opposite party. Ext.A3 is the copy of final report in connection with the accident issued by the Koodal Police Station. Ext.A4 is the Medical bill for Rs.3,851/- issued by the Pushpagiri Medical College Hospital. 9. In order to prove opposite party’s contention, opposite party filed proof affidavit along with one document. The document produced was marked as Ext.B1. Ext.B1 is the terms and condition of two wheeler package policy. 10. On the basis of the contentions and averments of the parties, we have perused the entire materials on record. It is seen that there is no dispute regarding the issuance of policy and the accident. The only dispute is that the injury of the complainant does not fall under any of the clauses of the policy. 11. On a perusal of Ext.A1, it is seen that due to the accident, complainant sustained a lacerated wound over anterior aspect (Rt) leg. Ext.A4 shows that he incurred treatment expenses of Rs.3,851/-. He has not made a case that he had sustained permanent total disability from the accident or to produce disability certificate to that effect. As per Ext.B1, complainant’s injury does not come within clause I to IV of Ext.B1. There is no provision in Ext.B1 for reimbursement of treatment expenses. Therefore, in this circumstance, we find no deficiency from opposite party’s part. Hence complaint is not allowable. 12. In the result, complaint dismissed. No cost. Pronounced in the Open Forum on this the 22nd day of July, 2010. (Sd/-) N. Premkumar, (Member) Sri. Jacob Stephen (President) : (Sd/-) Smt. C. Lathika Bhai (Member) : (Sd/-) Appendix: Witness examined on the side of the complainant : Nil. Exhibits marked on the side of the complainant: A1 : Discharge summary dated 19.11.2008 of complainant issued from Pushpagiri Medical College Hospital, Thiruvalla. A2 : Copy of insurance policy certificate issued by the opposite party to the complainant. A3 : Copy of final report dated 29.11.2008 submitted by the Asst. Police Sub Inspection, Koodal before the Judicial First Class Magistrate Court I, in connection with the accident. A4 : Medical bill for Rs.3,851/- issued by the Pushpagiri Medical College Hospital, Thiruvalla. Witness examined on the side of the opposite party : Nil. Exhibits marked on the side of the opposite party: B1 : Terms and conditions of Two Wheeler Package Policy. (By Order) Senior Superintendent. Copy to: (1) Eapen Varghese, Kachiramangalathu Veedu, Kaviyoor Muri, Kaviyoor Village, Thiruvalla. (2) The Divisional Manager, Oriental Insurance Co. Ltd., Marthoma Building, T.K. Road, Thiruvalla. (3) The stock file.
| | HONORABLE LathikaBhai, Member | HONORABLE Jacob Stephen, PRESIDENT | HONORABLE N.PremKumar, Member | | 
