IN THE CONSUMER DISPUTES REDRESSAL COMMISSION, KOTTAYAM
Dated this the 30th day of August, 2022
Present: Sri. Manulal V.S. President
Smt. Bindhu R. Member
Sri. K.M. Anto, Member
C C No. 120/2021 (filed on 22-07-2021)
Petitioner : Royes Joseph,
Kadanthottu House,
Manimala, P.O.
Kanjirappally,
Kottayam – 686 543
(Adv. G. Jayasankar)
Vs.
Opposite Party : (1) HDFC ERGO General Insurance
Co. Ltd. Regd. Office, 1st Floor,
HDFC House 165/166,
Back bay Reclamation
H.T. Parekh Marg,
Mumbai – 400020
Rep. by its Chief Executive Officer.
(2) HDFC ERGO General Insurance
Co. Ltd. Branch, 2nd Floor,
Chicago Plaza, Rajaji Road,
Near KSRTC Bus Stand,
Ernakulam – 682 035
Rep. by its Branch Manager.
(For Op1 and 2, Adv. Nithin Sunny Alex)
O R D E R
Smt. Bindhu R. Member
The petitioner is the owner of the tipper lorry bearing registration no. KL- 34/1607, which was duly insured with the opposite parties as policy no. 231720268349 1000000 for a period from 6.3.19 to 5.3.20 with consumer ID 101778391740 .
On 26.7.2019 the said vehicle met with an accident at Manimala and the
complainant was immediately admitted at Carithas Hospital, Thellakom and treated there as IP till 29.07.2019 and continued treatment till 19.09.2019 as OP. The complainant was bed ridden for 56 days due to the said accident and still continuing further treatment. The accident was duly informed to Manimala police station and a GD entry was prepared dated 22.9.2019. The complainant submitted a claim before the respondents for an amount of Rs.78,764/- as treatment expenses along with all the documents. In spite of submission of claim, the opposite parties did not settle the claim. The complainant later sent a legal notice but even after receiving the notice also the opposite parties did not respond. Being the owner and driver of the vehicle the complainant is very well entitled for the claim amount and the non-response of the opposite parties is a clear deficiency in service. Hence the case is filed for payment of the claim amount and compensation.
The opposite parties were duly summoned and they appeared and filed version jointly.
The opposite parties allege that the complaint is false and vexascious. It is admitted that the complainant has taken a Good Carrying Liability Policy based on the contract between the parties and both the insured and the insurer are bound by the same. All the facts stated about the accident should be subjected to strict proof of the same. Regarding the personal accident claim, the complainant ought to have made a claim as per the terms and conditions of the contract. Condition no 1 of the policy conditions itself is that the insured has to make a claim and intimate the loss to the insurer. “Notice shall be given in writing to the Company immediately upon the occurrence of any accidental loss or damage and in the event of any claim and thereafter the insured shall give all such information and assistance as the Company shall require. Every letter claim writ summons and / or process or copy thereof shall be forwarded to the Company immediately on receipt by the insured. Notice shall also be given in writing to the Company immediately the insured shall have knowledge of any impending prosecution Inquest or Fatal Inquiry in respect of any occurrence which may be give rise to a claim under this policy”
The complainant had not make a claim under the personal accident policy and if there is a registered claim, there would definitely be a registered number. The complaint is premature and the insured was not given an opportunity to assess the loss or the same intimated. The complaint is premature, time barred and beyond the jurisdiction of this Commission. There is no deficiency of service on the part of the opposite parties. Hence the complaint is liable to be dismissed.
Complainant filed proof affidavit along with documents marked as Exhibit A1 to A6.Opposite party also filed proof affidavit along with one document which was marked as Exhibit B1.
On a detailed perusal of the pleadings and evidence, we would like to frame the following points:
1)Whether there is any deficiency in service on the part of the opposite parties?
2. If so what are the reliefs?
The complainant’s case is that he had taken insurance for his vehicle and the vehicle met with an accident under the policy period. He had duly submitted proper claim but the opposite parties neither settled nor rejected the claim. Whereas the opposite parties resisted the allegations that the complainant has not submitted a claim to the opposite parties and without getting information of the accident and subsequent treatment, they were unable to settle the amount. The opposite parties have raised a contention that the complainant is not a consumer which is not sustainable as From Exhibits A2, A3 and B1 it is clear that the complainant is a consumer of the opposite parties. Regarding the contention of the jurisdiction, the complainant being the resident in Kottayam district and the claim is below 50,00,000/- this Commission has ample jurisdiction to try this complaint.
The main contention of the opposite parties is that the complainant did not act according to the terms and conditions of the policy. The policy condition stipulates that the insured shall send a notice to the opposite parties at the occurrence of an accident and on requirement of documents from the company the insured shall submit them. Here the complainant neither sent a notice to them nor submitted a claim. Without following the terms of the policy conditions, the opposite parties are unable to process the claim. Exhibit A3 is the photocopy of the claim form duly filled by the complainant which is not objected by the opposite parties. The opposite parties’ contention is that no notice also was given to the opposite parties regarding the accident or claim as per the policy conditions.
Notice shall be given in writing to the company immediately upon the occurrence of any accident and in the event of any claim; Every letter claim write summons and /or process shall be forwarded to the Company immediately on receipt of the insured. Notice shall also be given in writing to the company immediately the insured shall have knowledge of any impending prosecution inquest of Fatal inquiry in respect of any accident which may give rise to a claim under the policy.
The complainant has produced Exhibit A3 nil dated as the claim form which he claims to have been sent to the opposite party and the postal receipts are produced as Exhibit A4. But on a keen perusal we find that the A4 receipts dated 28.6.21 is the receipts of the legal notice Exhibit A6 sent by the counsel for the complainant dated 28.6.21. Any endorsement of receipt also is not there in A3. No cogent evidence has been adduced by the complainant to prove that he had submitted the claim before the opposite parties. So it is found that the complainant has not made any claim or intimation of the accident to the opposite party. Without receiving a claim the opposite party could not process the claim. Hence in the absence of a claim before the opposite parties, we find that the complainant has failed to establish his case of non-payment of insurance policy claim by the opposite parties. No deficiency of service is seen on the part of the opposite parties. Thus the complaint is dismissed.
Pronounced in the Open Commission on this the 30th day of August, 2022
Smt. Bindhu R. Member Sd/-
Sri. Manulal V.S. President Sd/-
Sri. K.M. Anto, Member Sd/-
Appendix
Exhibits marked from the side of complainant
A1 – Photocopy of discharge summary
A2 – Copy of insurance policy
A3 – Photocopy of motor insurance claim form
A4 – Postal AD card
A5 – Copy of general diary abstract dtd.22-09-2019 from Manimala Police station
A6- Copy of legal notice dtd.28-06-2021
Exhibits marked from the side of opposite party
B1 – Copy of policy along with terms and conditions
By Order
Assistant Registrar
