KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
VAZHUTHACAUD, THIRUVANANTHAPURAM
APPEAL No. 687/2018
JUDGMENT DATED: 19.04.2023
(Against the Order in C.C. 234/2017 of CDRF, Malappuram)
PRESENT:
HON’BLE JUSTICE SRI. K. SURENDRA MOHAN : PRESIDENT
SMT. BEENA KUMARY. A : MEMBER
APPELLANT:
New India Assurance Co. Ltd., Manjeri, 1st Floor, M.C. Mall, Rajiv Gandhi Bypass Road, Melakkam, Manjeri represented by its Manager, Regional Office, Kochi-682 011.
(By Adv. Rajan P. Kaliyath)
Vs.
RESPONDENT:
Haridasan V., S/o Raman, Valapramban House, Panayi Post, Anakayam, Manjeri, Pin-676 509.
(By Adv. Deepesh A.S.)
JUDGMENT
SMT. BEENAKUMARY A. : MEMBER
The opposite party in C.C. No. 234/2017 on the file of the Consumer Disputes Redressal Forum, Malappuram (District Forum for short) is the appellant. The complainant is the respondent.
2. The facts of the case in brief are that the complainant is the Owner-cum-driver of lorry bearing Reg. No. KL-10-AE-9082. The above vehicle had been insured with the opposite party and the owner as well as driver of the vehicle are covered by the policy. For availing this coverage additional premium was also paid by the complainant. On 21.04.2017 at the time of unloading wheat sacks from the lorry, the complainant sustained fracture on his left hand and he was admitted in Malabar hospital at Manjeri. For the treatment of the complainant he had spent Rs. 80,000/-. When the complainant approached opposite party with the hospital bills, he was told that the R.C owner was not entitled to get any insurance amount. The denial of the insurance amount to complainant manifests the deficiency in service and unfair trade practice of the opposite party. Therefore complainant approached the District Forum for redressal of his grievances.
3. The opposite party filed version with the following contentions. It is true that the opposite party had issued a commercial vehicle package policy in respect of vehicle No. KL-10- AE-9082 for the period from 11.06.2016 till 10.06.2017. By virtue of the policy the insurance amount is available for own damage, legal liability to third party, legal liability to paid driver, conductor, cleaner employed for operation . If the owner and the driver is one and the same person, he will be entitled to personal accident coverage subject to the terms and conditions of the policy. As per the policy the owner-cum- driver is entitled to 100 % compensation in case of death, 100% compensation in case of loss of two limbs or sight of two eyes or loss one limb and sight of one eye, 50% for the loss of one limb or sight of one eye and 100% for permanent total disability. The compensation will be paid under only one of the above items and total liability of the insurer shall not exceed Rs. 2,00,000/- during any one period of insurance. In the present case the complainant has not sustained injury as per the above policy clauses. Hence the complainant is not eligible for medical expenses and treatment expenses and compensation for the loss of earning capacity etc as claimed. Hence the opposite party prayed for dismissal of the complaint.
4. In this case the complainant and opposite party filed affidavits and Exts. A1 to A7 and Exts. B1 & B2 were marked. The complainant has produced the policy copy as Ext. P6 and the opposite party has produced the same as Ext. B1. As per this document the complainant had paid Rs. 1,105/- as own damage premium and Rs. 18,050/- as total premium. In the policy copy it is clearly stated that “this policy is subject to the terms, conditions and exceptions applicable to package/liability policy attached/available on the website http://newindia.co.in. IMT Endorsement Number(s) printed herewith attached 40”.
5. The District Forum allowed the complaint on the ground that the opposite party did not issue policy conditions to the complainant. Ext. B2 is the commercial vehicle package policy containing the terms and conditions of contract of policy.
6. Sec. IV of Personal Accident cover for owner-driver states that subject otherwise to the terms, exceptions, conditions and limitation of this policy, the company undertakes to pay compensation as per the following scale for bodily injury/death sustained by the owner-driver of the vehicle in direct connection with the vehicle insured or whilst mounting /dismounting from or travelling in the insured vehicle as a co-driver, caused by violent, accidental external and visible means which independently of any other cause shall within six calendar months of such injury result in death, loss of two limbs or sight of two eyes or one limb and sight of one eye, loss of one limb or sight of one eye or permanent total disablement from injuries other than named above. In the present case the complainant sustained injury on his left hand alone and thus that injury will not come within the above categories of injuries mentioned in the policy.
7. The District Forum found that the categories of the injuries mentioned in the version are not seen in the policy. The above classification is seen only in an additional sheet produced by the opposite party. On that ground the District Forum allowed the complaint. But the complainant has the commercial vehicle policy. The general rule applicable is on the basis of Ext. B2 commercial vehicle package policy conditions. Ext. B2 document is the part and parcel of the policy certificate. As per this document the complainant is not entitled to get any benefit under the policy due to the accident.
8. The learned counsel for the appellant vehemently argued the matter before us and placed two decisions in favour of the appellant. The respondent has not appeared before this Commission.
9. Insurance policy is a contract of agreement. Both parties are bound to comply with the terms and conditions of the contract. We cannot move beyond the terms and conditions of the policy. In United India Insurance Co. Ltd. v. Vijayarajan 2009 (3)KLT 269 (M.A.C.A. No. 1794 of 2008) the Apex Court held that compensation is payable subject to fulfillment of certain conditions. In National Insurance Co. Ltd. Vs. Ashalata Bhownik 2018(4) KLT 3032(SC) C.A. No. 9100/2018 the High Court was not justified in directing the appellant/insurer to pay the compensation determined by the Tribunal. Since the indemnification extended to personal accident of the deceased is limited to Rs. 2,00,000/- under the contract of insurance.
10. From the above mentioned discussion, we find that the order passed by the District Forum is against the policy of insurance. The complainant is not entitled to get any benefit under the Personal Accident Cover policy. The injury sustained to him by the accident is not covered under the policy conditions. Hence the order passed by the District Forum, Malappuram in C.C. No. 234/2017 is set aside.
In the result, the appeal is allowed and the complaint, C.C. No. 234/2017 stands dismissed. No order of costs. The appellant has the right to withdraw the amounts deposited before this Commission and the District Forum, on proper application.
Sd/-
JUSTICE K. SURENDRA MOHAN : PRESIDENT
Sd/-
BEENA KUMARY. A : MEMBER
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