IN THE CONSUMER DISPUTES REDRESSAL FORUM, PATHANAMTHITTA

Dated this the 23^rd day of June, 2010.

Present : Sri. Jacob Stephen (President):

Smt. C. Lathika Bhai (Member)

                                                                  Sri. N. Premkumar (Member)

C.C.No.150/09 (Filed on 11.11.2009)

Between:

Rahelamma,

W/o. Chandappilla,

Kuttikkattu Padinjarethil,

Parumala.P.O.,

Kadapra, Thiruvalla.

(By Adv. Sunitha.K.K)                                                    …..    Complainant.

And:

1.     Reliance General Insurance Co. Ltd.,

Rep. by Divisional Manager,

Kottayam.

2.     Branch Manager,

Reliance General Insurance Co. Ltd.,

Kannaneth Estate,

Ring Road, Pathanamthitta.

(By Adv. Sailesh Kumar)                                                 ……  Opposite parties.

O R D E R

Smt. C. Lathika Bhai (Member): 

                   The complainant has filed this complaint against the opposite parties for getting a relief from Forum.

         2. The fact of the complaint is as follows:  The complainant is the registered owner of the Honda Active Scooter bearing the Reg.No.KL-277082.  The above said scooter was insured with opposite parties vide policy No.2207172312663728.  As per the policy an amount of Rs.861/- has been paid as the premium of policy and has paid an amount of Rs.50/- as compulsory Personal Accident Cover.  On 7.7.2008 the complainant was driven the vehicle from Thiruvalla to Mavelikkara road while reaching at Kanassa School a driver of the scooter trying to overtake the complainant’s vehicle and hit on the right back side of the scooter and the complainant fell down the road.  Due to the accident the complainant had sustained fracture on right leg and she was admitted in St. Gregorious Hospital, Parumala.  For her treatment the complainant had spent an amount of Rs.40,000/- and she had become 15% permanent disability due to the injuries sustained to her.  The Pulikkeezhu police had registered a Crime as Crime No.182/08 against this accident.  As per the Personal Accident Cover envisaged in the insurance policy taken by the complainant, the complainant is entitled to get Rs. 1 lakh as personal accident cover.  The complainant approached several time before the opposite parties for getting the treatment expenses but they did not pay any amount hence she filed this complaint for getting an order for directing the opposite parties to pay the insured amount with interest and cost of the complainant.  The complainant prays for granting the reliefs.

          3. The opposite parties authorized person has field a version in favour of the opposite parties as follows:  The main contention of the opposite party is that the complaint is not maintainable as the claim of the complainant is belated and the Forum has no jurisdiction to entertain the complaint.  The opposite parties admitted the policy issued to the complainant.  The above said policy purports to cover the requirements of M.V. Act 1988 and the same does not cover the complainant who is the insured.  The Personal Accident Cover envisaged in the policy as personal accident benefit in case of death, loss of two limbs or sight of two eyes or loss of one limb and sight of one eye or total permanent disablement other than the above mentioned injuries an extent of Rs.50,000/- in case of loss of one limb or sight of one eye as per General Regulation 36 of India Motor Tariff and Section III of the terms and conditions in the policy.  The injury sustained to the complainant does not come within the purview of the injuries specified in the policy condition.  As per the policy the person who availed such policy is entitle for the above said amount only on lodging the claim through proper channel within six calendar months from the date on which the injury sustained.  The complainant has not complied with the conditions of policy.  As such the complainant is not entitled for any amount as compensation.

        4. The disability certificate does not disclose the basis on which the percentage of disability was assessed and the criteria by which the same was issued.  The complainant has not sustained any of the injuries as scheduled in the policy hence the complainant is not entitled to get any amount from the opposite parties.  For the above said reasons the opposite parties prayed for the dismissal of the complaint with cost of them.

                   5. The points for consideration in this complaint are:-

(1)  Whether the complaint is maintainable before the Forum?

(2)  Whether the complainant is entitled to get a relief as prayed for in the complaint?

(3)  Reliefs & Costs?

           6. The evidence in this case consists of the proof affidavit and four documents filed by the complainant.  On the basis of proof affidavit Ext.A1 to A4 were marked.  For the opposite parties, the legal authorized person filed proof affidavit and two documents.  On the basis of proof affidavit Ext.B1 and B2 marked.  After closure of the evidence, both sides heard.

          7. The complainant’s case is that her Honda Activa Scooter has been insured with the opposite parties and at the time of taking the policy the opposite parties have received an additional amount of Rs.50/- as compulsory Personal Accident Cover.  As per this policy the complainant is entitled to get an amount of Rs.1 lakh as compensation for the injury sustained to her.  On 7.7.08, while the complainant was driving the vehicle then another scooter trying to overtake her scooter and it hit on the right back side of the complainant’s scooter and the complainant fell down and sustained fracture to the right leg.  For the treatment she had spent an amount of Rs.40,000/- and she approached the opposite parties for getting the amount as per the Personal Accident Cover envisaged in the policy.  But they did not pay the amount and filed this complaint for getting the reliefs as sought for in the complaint.

          8. In order to prove the complainant’s case, the complainant filed a proof affidavit and Exts.A1 to A4.  Ext.A1 is the copy of the insurance policy issued by the opposite parties to the complainant’s vehicle.  Ext.A2 is the Accident Register-Cum-Wound Certificate dated 7.7.08 issued by Medical Officer St. Gregorious Medical Mission Hospital, Parumala.  Ext.A3 is the disability Certificate issued by the Medical Board, Pathanamthitta.  Ext.A4 is the copy of legal notice issued by the complainant to the 2^nd opposite party.

          9. The opposite parties contended that the complaint is not maintainable, as the complainant has not filed any claim before them as per the terms and conditions.  Further the injury sustained to the complainant is not come within the purview of the injuries specified in the policy conditions.  Hence the complainant is not entitled to get any benefit as per the Personal Accident Cover envisaged in the policy.

          10. In order to prove the contentions of opposite parties, the legal representative of opposite parties filed proof affidavit and Exts.B1 and B2.  Ext.B1 is the attested copy of the insurance policy taken by the complainant.  Ext.B1(a) is the copy of the terms and condition ns of the policy.  Ext.B2 is the copy of General Regulation 36 of India Motor Tariff.

          11. On going through the evidences in this case the materials on records shows that the opposite party had issued an insurance policy to the complainant’s vehicle with Personal Accident Cover.  During the coverage period the complainant had sustained serious injuries and he was treated in St. Gregorious Hospital and spent an amount of Rs.40,000/- for the treatment expenses.  After the accident she became 15% disabled.  According to the complainant he has entitled to get compensation as per the conditions of the policy issued to him.

          12. The opposite party’s main contention is that the complaint is belated and that the complaint has not filed any claim before the opposite parties as required by the terms and conditions of the policy.  The main point to be considered in this case is that whether the complainant had made a proper claim before the opposite parties for getting compensation from them?  The complainant has not produced any evidence to show that she had approached the opposite parties and informed the accident to them or lodged a proper claim before them as per the policy condition and that was repudiated by the opposite parties.  Ext.A4 legal notice was issued by the complainant to the 2^nd opposite party only on 9.9.09.  The material on records does not show that the complainant had filed a proper claim before the opposite parties.  The cause of action arises only after repudiating the claim of the complainant by opposite parties.  In the absence of a repudiation, the complainant has no cause of action and hence this complaint is not maintainable before the Forum.  Hence the complainant’s prayer is not allowable.

          13. However on considering the facts and circumstances and quantum of expenses and disability of the complaint, the complainant is allowed to file a fresh claim before opposite party with sufficient documents as required by policy terms and conditions before the opposite party within two weeks from the date of receipt of this order.  The opposite party is directed to accept the claim form from the complainant, without considering the delay caused in filing the claim, for taking necessary steps as per the policy condition.

          14. In the result, this complaint is dismissed with above direction.  No cost.

          Declared in the Open Forum on this the 23^rd day of June, 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 o the side of the complainant:

A1     :  Photocopy of the Reliance General Insurance policy issued by the 2^nd 

               opposite party to the complainant’s vehicle. 

A2     :  Photocopy of the Accident Register-Cum-Wound Certificate dated 7.7.08 

               issued by Medical Officer St. Gregorious Medical Mission Hospital, 

               Parumala to the complainant. 

A3     :  Photocopy of the Disability Certificate issued by the Medical Board, 

               Pathanamthitta to the complainant. 

A4     :  Copy of advocate notice issued by the complainant to the

               2^nd opposite party.

Witness examined on the side of the opposite parties:  Nil.

Exhibits marked on the side of the opposite parties:

B1     :  Photocopy of the insurance policy. 

B1(a) :  Photocopy of the terms and conditions of the policy. 

B2     :  Photocopy of General Regulation 36 of India Motor Tariff.

                                                                                                                        (By Order)

                                                                                   Senior Superintendent.

Copy to:- (1) Rahelamma, W/o. Chandappilla, Kuttikkattu Padinjarethil,

                     Parumala.P.O., Kadapra, Thiruvalla.

      (2) The Divisional Manager, Reliance General Insurance Co. Ltd.,

            Kottayam.

      (3) The Branch Manager, Reliance General Insurance Co. Ltd.,

            Kannaneth Estate, Ring Road, Pathanamthitta.

      (4)  The Stock File.