DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BARNALA, CAMP COURT AT AMRITSAR, PUNJAB.

Complaint Case No : RBT/CC/2018/368

Date of Institution : 23.05.2018/29.11.2021

Date of Decision : 22.06.2022

Gurdeep Singh s/o Gurdeep Singh r/o Village Kot Dharam Chand Kalan, Tehsil Tarn Taran.  …Complainant

Versus

1. HDFC ERGO General Insurance Company Limited, 3rd Floor, Nagpal Tower-1, SCO-128, Ranjit Avenue, Amritsar, Punjab through its Authorized Representative/Signatory.

2. HDFC ERGO General Insurance Company Limited, 1st Floor 165-166, Backbay Reclamation, HT Parekh Marg, Church Gate, Mumbai through its Authorized representative/signatory.

…Opposite Parties

Complaint U/S 11, 12 and 13 of The Consumer Protection Act

Present: Sh. Rabbi Kalia Adv counsel for complainant.

Sh. RP Singh Adv counsel for the opposite parties.

Quorum.-

1. Sh. Ashish Kumar Grover : President

2. Smt. Urmila Kumari : Member

(ORDER BY ASHISH KUMAR GROVER PRESIDENT):

    The present complaint has been received by transfer from District Consumer Commission, Amritsar in compliance of the order dated 26.11.2021 of the Hon'ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh. The complainant filed the present complaint under Sections 11, 12 and 13 of the Consumer Protection Act against HDFC Ergo General Insurance Company Limited, Amritsar and another. (in short the opposite parties). 

2. The facts leading to the present complaint as stated by the complainant are that the complainant had purchased motor insurance Goods Carrying Comprehensive Policy for the truck make Bharat Benz from the opposite party No. 1 bearing No. 2315201921448700000 for 31.8.2017 to 30.8.2018 for sum assured of Rs. 7,50,000/- and also include cover the for the owner/driver for the sum of Rs. 2,00,000/-. 

3. It is further alleged that on 30.12.2017 the complainant was driving his truck No. PB-02-DF-3321 from Nimach to Jammu and Kashmir. At around 10 or 11 PM when the complainant reached near Sanodhiya flyover all of a sudden a cow came in front of the truck due to which the truck stuck into the trees. The complainant got badly injured . The whole of the incidence recorded in the daily dairy register at PS Gulabpura. Then the complainant was admitted to Ananta Institute of Medical Science and research centre situated at Village Kaliwas District Rajsamand. The expenses for the treatment was paid by the complainant to the tune of Rs. 75,083/-. On 4.1.2018 the complainant got discharged from the said hospital after depositing whole of the amount. After that complainant on 31.1.2018 admitted in Smt Paarvati Devi Hospital for further treatment and discharged from the said hospital on 1.2.2018. The complainant here also spent Rs. 27,219/- for his treatment. After the treatment the complainant contacted the opposite party No. 1 for the claim under his insurance policy plan but they denied the claim of the complainant on the ground that the complainant is not entitled for any kind of claim which amounts to deficiency in service and unfair trade practice. Hence, the present complaint is filed seeking the following reliefs.-

1) The opposite parties may be directed to give claim for the total expenses of Rs. 1,02,302/- with interest at the rate of 18% per annum.  

2) To pay Rs. 10,000/- as compensation, Rs. 10,000/- for deficiency in service and unfair trade practice, Rs. 10,000/- for mental agony and harassment and Rs. 20,000/- as litigation expenses.

3) Any other relief to which the complainant is found entitled. 

4. Upon notice of this complaint, the opposite parties filed written statement taking preliminary objections that the present complaint is not maintainable as the complainant claimed medical expenditure incurred on the treatment whereas the policy issued to the complainant is a Motor Insurance Goods Carrying Comprehensive Policy covering the vehicle bearing No. PB-02-DF-3321. The said policy is not a health policy and no medical expenses are covered under the policy. It is submitted that Personal Accident Cover has been give to the complainant under provisions of General Rules 36 of the India Motor Tariff which is adopted in all the motor policies issued by all the insurers in India. The Personal Accident cover only death and permanent disability of owner driver who is registered owner of the vehicle. The medical expenditure incurred by the complainant are not covered under any provision. The benefits payable under the category of Personal Accident has been well defined under Section IV of the policy terms and conditions and it does not provide for reimbursement of medical expenses instead it provides fixed compensation in case of 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 and permanent total disablement from injuries other than name above. So, complainant has not come to this Commission with clean hands and concealed the true facts. The complainant has no locus standi to file the present complaint. 

5. On merits, it is submitted that the complainant had lodged the claim for the damaged caused to the vehicle which is under process. No claim for medical expenditure cover under the PA cover given in the motor policy so the complainant is not entitled for any claim. There is no deficiency in service and unfair trade practice on the part of the opposite parties. Lastly, the opposite party prayed for the dismissal of the present complaint with costs.   

6. We have heard the learned counsel for the parties and gone through the record on the file. 

7. It is admitted fact between the parties that the complainant purchased Motor Insurance Goods Carrying Comprehensive Policy for the truck from the opposite party No. 1 for the period from 31.8.2017 to 30.8.2018 for sum insured of Rs. 7,50,000/-. It is also admitted that the said policy also covered the personal accident of owner/driver in case of death or permanent disability for a sum of Rs. 2,00,000/-. 

8. Learned counsel for the complainant argued that the complainant met with an accident on 30.12.2017 in which complainant was badly injured and admitted in Ananta Institute of medical Sciences and Research Centre District Rajsamand where he paid Rs. 75,083/- for his treatment and thereafter he admitted in Smt. Paarvati Devi Hospital on 31.1.2018 and discharged from the said hospital on 1.2.2018. In this hospital also complainant incurred Rs. 27,219/- on his treatment. In this way, the complainant is entitled for the claim of Rs. 1,02,302/- towards expenses of his treatment but opposite party denied the claim of the complainant. 

9. The learned counsel for the opposite parties argued that the complainant purchased Motor Insurance Policy not health insurance policy which covered personal accident of owner/driver also but not covered any medical expenses incurred by owner/driver on his treatment in case of injury in an accident. 

10. We have perused the copy of policy Ex.OP-1.2/1 which is in favour of the complainant. In this policy it is clearly mentioned that it covered Damage to third Party property of Rs. 7,50,000/- and personal accident cover for owner/driver of Rs. 2,00,000/-. We have also perused terms and conditions of policy Ex.OP-1.2/2 in which it is clearly mentioned that Personal Accident Cover for owner/driver is in case of 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 and permanent total disablement from injuries other than name above. But in the policy and terms and conditions it is nowhere mentioned that the medical expenses in case of injury in accident, incurred by the complainant on his treatment is also covered under this policy. The complainant also not filed any document in evidence to prove that there is any policy of the opposite parties regarding the coverage of treatment expenses in case of injury in an accident. As the opposite parties only covered the vehicle, third party liability and personal accident cover of owner/driver so by not paying the claim of the complainant regarding treatment expenses is not at all any deficiency in service and unfair trade practice on their part. 

11. In view of the above discussion, as there is no merit in the present complaint and the same is dismissed. However, no order as to costs or compensation. Copy of the order will be supplied to the parties by the District Consumer Commission, Amritsar as per rules. File be sent back to the District Consumer Disputes Redressal Commission, Amritsar. 

ANNOUNCED IN THE OPEN COMMISSION:

        22nd Day of June 2022

 

 

            (Ashish Kumar Grover)

            President

              

(Urmila Kumari)

Member