Date of Filing : 23.11.2010
Date of Order : 27.07.2011
BEFORE THE II ADDITIONAL DISTRICT CONSUMER
DISPUTES REDRESSAL FORUM,
SESHADRIPURAM, BANGALORE – 560 020
Dated 27th JULY 2011
PRESENT
Sri. S.S. NAGARALE, B.A., LL.B. (SPL) …. President
Smt. D. LEELAVATHI, M.A., LL.B. …. Member
Sri. BALAKRISHNA V. MASALI, B.A., LL.B.(SPL) …. Member
COMPLAINT NO. 2631/2010
Sri. Kempegowda,
S/o. K. Nagaraju,
No. 11, 2nd Cross, 4th Main,
Tilaknagara, Jayanagara,
Bangalore – 560 041. ……. Complainant
V/s.
General Manager / Claims Manager,
M/s. Shriram General Insurance Co. Ltd.,
S.5, 2nd Floor, White House,
St. Mark’s Road,
Bangalore – 560 001. …… Opposite Party
ORDER
(By the President Sri. S.S. Nagarale)
This Complaint is filed by the Complainant u/s. 12 of the Consumer Protection Act, 1986.
Brief facts of the case are that Complainant had insured his Bajaj Auto Rickshaw with OP for the period from 30.09.2008 to 29.09.2009 and the personal accident cover under the Policy is Rs.2,00,000/-. On 14.11.2008 due to accident his Auto Rickshaw turtled upside down and Complainant seriously injured in the said accident. He was admitted to Hospital and he has incurred medical expenses of more than Rs.2.00 Lakhs. Therefore, Complainant has claimed Rs.2.00 Lakhs from the OP.
2. OP filed defence version admitting the Policy. The defence of the OP is that it is the duty of the Complainant to submit all the Hospital records along with FIR of the police complaint, but in this case Complainant has not submitted necessary documents to the OP. Therefore, Complaint is premature. OP has not rejected / repudiated the claim of the Complainant. Therefore, requested to dismiss the Complaint on the ground it is premature one.
3. Arguments are heard.
4. Point now for consideration is whether the Complaint is premature.
5. I have gone through the pleadings of the parties and the documents produced. As regards taking of the Policy is concerned, there is no dispute. Admittedly, Complainant has taken Policy from the OP. On the documents produced by the Complainant, he has not produced repudiation letter of the OP. Even it is not made clear whether the Complainant has submitted claim form along with necessary documents to the OP for settlement of the claim. OP has taken specific defence that Complainant has to submit Hospital records, FIR and other documents for settling the claim and Complainant has not at all submitted the documents along with claim form. Therefore, it is the case of the OP that Complaint is premature.
6. The Learned Counsel for the OP submitted that Complainant shall be directed to submit the claim form along with documents and OP will consider the documents under terms & conditions of the Policy and settle the claim as per Law. He has further submitted that OP has not at all rejected / repudiated the claim. Therefore, there is no question of deficiency of service on the part of OP. This submission of the Learned Counsel for the OP is quite correct and fair. In view of these submissions, it is just, fair & reasonable to direct the Complainant to submit his claim form along with necessary documents to the OP. Thereafter, OP shall consider the claim of the Complainant in accordance with Law as per the terms & conditions of the Policy and settle the claim of the Complainant within 30 days and make payment. In case Complainant is not satisfied with the settlement of the claim, he will be at liberty to file fresh Complaint before the Consumer Fora for getting justice. With these observations, I proceed to pass the following:
ORDER
Complaint is allowed. Complainant is directed to submit the claim form along with other necessary documents to the OP. On submission of the claim form, OP shall settle the claim of the Complainant within 30 days as per the policy terms & conditions as per Law.
Complainant will be having liberty to accept the claim settled by the OP or will be at liberty to file fresh Complaint if he is dissatisfied with the settlement of the claim.
Complaint is disposed off accordingly.
Send copy of this Order to both the parties free of cost immediately.
Pronounced in the Open Forum on this 27th day of July 2011.
Order accordingly
PRESIDENT
We concur the above findings
MEMBER MEMBER
SSS
