By Sri. K. Gheevarghese, President:
The complaint filed against the Opposite Parties to compensate the Complainant for the sum insured for the bodily injuries and treatment expenditure.
2. The complaint in brief is as follows:- The Complainant is the R.C Owner of a car numbered KL 10 S/7115. The vehicle was insured by the 1st Opposite Party through the 2nd Opposite Party covering the risk of personal accident for a sum of Rs.2,00,000/- during the period of 22.04.2009 to 21.04.2010. The accident took place on 16.08.2009 and the Complainant sustained fracture injuries and dislocation of right hip, posterior acetabular fracture and the right femoral head fracture.
3. The Complainant was given first aid treatment at Kalpetta and was taken to Thejasvini Hospital Mangalore for expert treatment. The 1st Opposite Party had given only Rs.30,000/- to the loss of the vehicle as salvage value and the expenditure for the treatment of the Complainant was not considered in the mean time. Later the Complainant was informed by the 1st Opposite Parties that the personal accident coverage extents only to the cases (1) death in case of injuries such as (2) loss of two limbs on sight of two eyes on one limb on sight of one eye. (3) loss of one limb or one eye (4) permanent total disablement from injuries other than the above.
4. The Complainant has given the copies of document of all the treatment expenses to the 1st Opposite Party to consider the claim. The denial of claim by the Opposite Parties is a deficiency in service.
5. There may be an order directing the Opposite Parties:-
To compensate the Complainant with Rs.50,000/- to the injuries sustained along with interest at the rate of 18%
To pay Rs.10,000/- towards compensation and Rs.1,00,000/- towards the treatment expenses along with cost.
6. The Opposite Parties filed version in short it is as follows. The Complaint is not maintainable and it is to be dismissed in limine. The insurance of the Car No. KL10S/7116 during the period 22.04.2009 to 21.04.2010 is admitted by the 1st Opposite Party. The accident of the car and the expenses if any to the persons are to be proved by the Complainant. The allegation of the Complainant that the expenses that are to be subsequently compensated are false.
7. The Complainants claim of Rs.10,000/- for treatment expenditure is false and denied by the 1st Opposite Party. The Complainant had no personal injuries that to be compensated abide by the policy conditions. The terms of policy extents to the total permanent disablement as avered in the policy conditions. The injuries that cover the risk includes under section IV of the policy is death, loss of limbs, on sight of eyes on permanent total disablement from injuries. The injures alleged as sustained are not under risk coverage as per the terms of policy. This Opposite Party is not liable to pay any compensation to the Complainant and it is to be dismissed with cost to the Opposite Party.
8. The sum up of the version filed by the 2nd Opposite Party is as follows:- The Car numbered KL 10S/7116 was insured by the 1st Opposite Party through the 2nd Opposite Party. The damages to the car out of the accident and personal injuries to the Complainant are not known to the 2nd Opposite Party. The compensation of Rs.30,000/- to the Complainant for the damages of car resulted in the accident intimated from any source. The personal accident covers only the risk of injuries termed in the policy conditions. There is no deficiency in service on the part of the Opposite Parties the complaint is to be dismissed with cost to this Opposite Party.
9. Points in consideration are:-
Is there any deficiency in service on the part of the Opposite Parties?
Relief and cost.
10. Points No. 1 and 2:- The evidence in this case consist of the proof affidavit of Complainant and Opposite Party Ext.A1 to A7, B1 and X1 are the documents. The oral testimony of the Complainant and 1st Opposite Party is also considered in this case.
11. The Complainant is the driver cum R.C owner who met with accident while driving his car. The documents produced evidenced the injury sustained by the Complainant and the expenses for treatments. Ext.X1 is the Medical Certificate issued by the District Medical Board Mananthavady there in the Complainant has the partial ankylosis right hip with terminal restriction of flexion and rotations. No limb length disparity and there is glutial muscle wasting. The disability is 10% permanent assessed by the board. The damages of the vehicle was compensated by 1st Opposite Party and there is no pleading for the Complainant to get damages from the 2nd Opposite Party who stood as a link of the insurer and the insured PW1. The Complainant, on examination deposed that he is in continuity of the work which he had been doing before the accident. Ext.B1 series is the certificate of insurance and policy conditions. The clause IMT.15 of the policy conditions details on personal accident cover. The scale of compensation for personal accident (1) Death, compensation 100% (2) Loss of two limps, on two eyes or one limb and sight of one eye 100% (3) Loss of one limb on sight of one eye 50% and (4) Permanent total disablement from injuries other than the named above 100%. The sub clause IV of the clause 15 terms 100% Compensation for permanent total disablement from injuries other than named above. The contention of the 1st Opposite Party is that the injuries sustained by the Complainant is not sufficient enough to compensate as per the terms of policy. The Complainant has no total permanent disablement to be compensated with. More over the Complainant has not filed any claim before the 1st Opposite Party. The claim of the Complainant to get compensation for the personal accident sustaining of the injuries does not cover the risk as per the policy conditions and the points are found accordingly.
In the result the complaint is dismissed no order as to cost.
Pronounced in open Forum on this the day of 26th March 2011.
Date of filing:23.02.2010.
PRESIDENT: Sd/-
MEMBER : Sd/-
MEMBER : Sd/-
A P P E N D I X
Witness for the Complainant:
PW1. Dr. T.A. Abdul Majeed. Complainant.
Witness for the Opposite Parties:
OPW1. Mathew Paul. Branch Manager National Insurance Company, Kalpetta Branch.
Exhibits for the Complainant:
A1. Copy of the Certificate of Insurance.
A2. Copy of the Certificate of Registration.
A3. Copy of the Driving Licence.
A4. Copy of the Discharge Summary.
A5 series. Bill.
A6. Letter. dt:10.12.2009.
A7. Certificate. dt:28.01.2011.
X1. Medical Certificate.
Exhibit for the Opposite Parties:
B1. Copy of the Certificate of Insurance.
