DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, NORTH-WEST
GOVT. OF NCT OF DELHI
CSC-BLOCK-C, POCKET-C, SHALIMAR BAGH, DELHI-110088.
CC No: 659/2017
D.No.____________________ Dated: ___________________
IN THE MATTER OF:
GYANENDER,
S/o SH. YOGENDER KUMAR,
R/o 1/2614, RAM NAGAR,
LONI ROAD, GALI No.5,
NEAR RADHA KRISHAN TEMPLE,
SHAHDARA, NEW DELHI-110032.… COMPLAINANT
Versus
ICICI LOMBARD GENE. INS. Co. LTD.,
ICICI LOMBARD HOME,
414, VEER SAVARKAR MARG,
NEAR SIDDHI VINAYAK TEMPLE,
PRABHA DEVI, MUMBAI-400025.
ALSO AT: SPACE No.315,
3rd FLOOR, AGGARWAL CITY MALL,
PLOT No.04, ROAD No.44,
PITAM PURA, NEW DELHI-110034.… OPPOSITE PARTY
CORAM:SH. M.K. GUPTA, PRESIDENT
SH. BARIQ AHMED, MEMBER
MS. USHA KHANNA, MEMBER
Date of Institution: 11.08.2017
Date of decision:28.05.2020
SH. M.K. GUPTA, PRESIDENT
ORDER
1. The complainant has filed the present complaint against OP under section 12 of the Consumer Protection Act, 1986 thereby alleging
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that the complainant has taken insurance policy bearing no.3005/ 25120701/10375/000 for the period from 01.11.2014 to 31.10.2015 (mid-night) from OP with compulsory PA cover. On 25.04.2015, the complainant was going from Ramesh Nagar to Connaught Place on his Motor-Cycle bearing no. DL-14-SD-5061 at around 1:30 a.m. when the complainant was on Patel Road, Near Metro Pillar No.174 an unknown vehicle hit his vehicle and the complainant fell down and sustained serious injuries. Thereafter, the complainant was taken to Lady Harding Hospital by CATS ambulance and the doctors referred him to Ram Manohar Lohia Hospital, New Delhi on the same day and the complainant suffered serious spinal injuries and remained hospitalized for 24 days and was discharged on 17.05.2015. The complainant further alleged that he suffered serious Spine injury and X-Ray & MRI reports suggest D7 Vertebra Wedge compression and the complainant become paraplegic and is not able to stand on his legs and is using wheel chair for his movement. The complainant further alleged that the complainant was driving the Motor-Cycle in his lane with normal speed and the accident was caused due to sole negligent act of unknown vehicle and the complainant has taken the above said insurance policy from OP with compulsory PA cover and OP is liable to pay the compensation to the owner/insured being the insurance company of the vehicle involved in the accident and the vehicle involved in the said accident was insured with OP on the date of
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accident for all such risks and OP is liable to pay the compensation to the owner/insured. The complainant further alleged that the complainant is of just 31 years of age and is unmarried and the mother of the complainant is dependent on the income of the complainant and the entire life of the complainant ruined due to said accident. Thereafter, the complainant through his Counsel informed OP vide letter dated 11.09.2015 sent via speed post on 12.09.2015 for the benefit of Personal insurance Cover under the said policy and OP did not pay any heed to the letter of the complainant and the complainant bore all the hospitalization charges out of his own pocket. The complainant further alleged that the complainant was shocked when OP did not consider the claim of the complainant even after many days from the date of discharge of the complainant and in the month of December-2015, the complainant filed a Petition u/s 166 & 140 of the Motor Vehicle Act, 1988 for grant of compensation before the Motor Accident Claim Tribunal Delhi, Tis Hazari Court, Delhi and OP appeared before the MACT and filed its written statement and an application Under Order VII Rule 11 read with Section 151 CPC stating that the MACT did not requisite jurisdiction to entertain the petition as the Tribunal has no power to grant claim to owner and driver of vehicleand on the same day, the complainant withdrew the said claim petition u/s 166 & 140 of Motor Vehicle Act, 1988 with the liberty to approach the appropriate Forum/Court of Law in respect of the
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claim petition. The complainant further alleged that OP has illegally refused to consider the claim of the complainant without any justified reason and there was no delay on part of the complainant to inform OP regarding the hospitalization under the same policy from OP and the complainant paid premium for purchasing personal accident cover despite receiving the premium, OP refused to entertain the claim of the complainant and the complainant accordingly allegedthat repudiation of the rightful claim by the OP amounts to deficiency in service.
2. On these allegations the complainant has filed the complaint praying for direction to OP to declare OP guilty of deficiency in service and for illegally rejecting genuine claim of the complainant under a valid personal accidental policy and direct OP to pay a sum of Rs.1,00,000/- to the complainant towards the personal accidental cover, to pay a sum of Rs.50,000/- towards compensation for causing mental damages, loss, harassment as well as to pay a sum of Rs.25,000/- alongwith interest @ 18% per annum from the date of the filing of the claim by the complainant till the realization.
3. OP has been contesting the complaint and has filed written statement wherein OP submitted that there is no deficiency in service on the part of OP and the complaint is not maintainable and there is no merit in the complaint. OP further submitted that as per terms & conditions of the policy IMT 15 “personal accident cover to
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the insured or any named person other than paid driver or cleaner (applicable to private cars including three wheelers rated as private cars and motorized two wheelers with or without side car) and in the consideration of the payment of an additional premium it is hereby agreed and understood that the company undertakes to pay compensation on the scale provided below for bodily injury as hereinafter defined sustained by the insured person in direct connection with the vehicle insured or whilst mounting and dismounting from or travelling in vehicle insured and caused shall within 6 months of the occurrence of such inquiry. OP further submitted that the complainant had not intimated the incident to the company within reasonable period of time and PA cover of the policy is granted only in case of disability or death of the owner driver.
4. The complainant filed rejoinder and denied the contentions of OP.
5. In order to prove his case, the complainant filed his affidavit in evidence and has also filed written arguments. The complainant also placed on record copy of Two Wheeler Certificate-Cum-Insurance policy Schedule issued by OP, copy of DD No.6-A, P.S. Ranjit Nagar, Delhi, copy of his driving license, copy of R.C., copy of discharge report dated 17.05.2015 issued by Dr. Ram Manohar Lohia Hospital, New Delhi, copy of Legal Notice dated 11.09.2015 sent by the complainant through his Counsel to OP by Regd.
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Post/Speed Post/Courier and copy of order dated 18.04.2017 of Sh. Dinesh Bhatt, Judge, MACT-I, Central Tis Hazari Court, Delhi. The complainant also filed copy of IRDA rules & regulations.
6. On the other hand, Sh. Krashanu Pundir, Manager Legal of OP filed his affidavit in evidence which is as per the written statement. OP also filed Two-Wheeler Package Policy Wording. OP has also filed written arguments.
7. This forum has considered the case of the complainant as well as OP in the light of evidence and documents placed on record. The documents and evidence of the parties shows that the vehicle of the complainant i.e. Two-Wheeler bearing registration no-DL-14-SD-5061 was insured with OP vide a policy of OP for the period from 01.11.2014 to 31.10.2015 (mid-night) and the complainant met with an accident and suffered injuries.
8. The discharge report given by Dr. Ram Manohar Lohia Hospital, New Delhi to the complainant shows that the complainant was hospitalized on 25.04.2015 and was discharged on 17.05.2015. But the said report does not suggest that the complainant suffered any injury relating to loss of limb or eye or both. The discharge report even does not suggest that the complainant has suffered any disability to his body due to injury received in the accident. The complainant has also failed to place on record any document to show that he paid/incurred expenditure on the treatment of his injuries.
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9. Thus, there is no merits in the case of the complainant and the complaint is dismissed being devoid of merits.
10. Let a copy of this order be sent to each party free of cost as per regulation 21 of the Consumer Protection Regulations, 2005. Thereafter file be consigned to record room.
Announced on this 28th day of May, 2020.
BARIQ AHMED USHA KHANNA M.K. GUPTA
(MEMBER) (MEMBER) (PRESIDENT)
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UPLOADED BY:SATYENDRA JEET
