BEFORE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION
AT HYDERABAD
F.A.No. 348 OF 2013 AGAINST C.C.NO. 49/2012 DISTRICT FORUM,
ADILABAD
Between:
Ramavathar Agarwal, S/o Gujarimal Agarwal,
Age 52 years, Occ: Agriculture
H. No.3-3-202/18, Chincharwada,
Adilabad -504 001 .. Appellant/complainant
And
Manager
Bajaj Allianz General Insurance Co.Limited
8-6-126, 1st floor, Near Koti Bomma Circle
Kothirampur, Karimnagar – 505 001 .. Respondent/opposite party
Counsel for the Appellant : Mr. V. Narayana Swamy
Counsel for the Respondent : Mr. N. Mohan Krishna
QUORUM :
SRI JUSTICE GOPALAKRISHNA TAMADA… HON’BLE PRESIDENT
AND
SRI R. Lakshminarasimha Rao ….. HON’BLE MEMBER
Tuesday, the Twenty Second Day of April
TWO THOUSAND FOURTEEN
Order (As per Sri R. Lakshminarsimha Rao.. Hon’ble Member )
****
01 The unsuccessful complainant is the appellant. He filed the appeal assailing the order of the District Forum which dismissed the complaint holding that in absence of documents showing occurrence of accident within limits of its jurisdiction, it has no jurisdiction to try the matter.
02 The brief facts of the case as seen from the averments of the complaint are that the appellant insured his motor cycle bearing registration number A P-01-H-7625 with the respondent-insurance company and he met with an accident on 25.09.2010 while returning from his fields at Nirala village when his motor cycle slipped off and he fell down and sustained fracture to his right hand. The appellant was shifted to the hospital of Dr.Tippe Swamy where he was given first aid and from there the appellant was shifted to the hospital of Dr.Ajitpahadke where he had undergone surgery and a steel rod was inserted in his right hand. The appellant claimed that he incurred an amount of Rs.80,000/- for his medical expenses and he would need a sum of Rs.20,000/- for removal of the steel plate from his hand.
03 The respondent-insurance company admitted issuance of the insurance policy bearing no. OG-11-1810-1802-00003546 in respect of the motor cycle bearing registration number for the period commencing from 16.06.2010 to 15.06.2011. The respondent contended that the appellant had not intimated it about the accident and he did not produce any documents to prove that the accident at all occurred and even if it is presumed that the accident occurred on the said day, the appellant is not entitled to any claim as he did not receive any permanent total disability or loss of limb or loss of sight of one eye. The claim is subject to other terms of the insurance policy such as the appellant possessing valid and effective driving licence at the time of the accident.
04 The appellant filed his affidavit and the documents, Ex.A-1 to A37 and on behalf of the respondent-insurance company filed memo to treat the counter as proof affidavit and no documents were filed on their behalf.
05 Feeling aggrieved by the order of the District Forum dismissing his complaint, the complainant has filed appeal contending that the District Forum has not considered the evidence in proper perspective and dismissed the complaint. The appellant contended that he sought for compensation of Rs.1,00,000/- and on account of the deficiency in service on the part of the respondent-insurance company he suffered loss.
06 The learned counsel for the appellant has filed written arguments.
07 The point for consideration is whether the order of the District Forum is vitiated by misappreciation of facts or law?
08 The appellant’s ownership of the motor cycle bearing registration number AP-01-H-7625 and the insurance policy bearing number OG-11-1810-1802-00003546 issued by the respondent in respect of the motor cycle are not disputed. The appellant’s case is that on 25.09.2010 while he was returning on his motor cycle from his fields to his home, the motor cycle could skid as a result of which he fell down and sustained fracture to his right hand. The learned counsel for the respondent has contended that the appellant has not produced any evidence to the effect that he met with the accident and sustained the injury in the accident.
09 Admittedly, the appellant had not lodged any report or complaint with the police. The copy of prescription issued by Dr.Tippe Swamy of ‘Nikhil Orthopedic Hospital’, Adilabad does not reflect any inference of injury on account of an accident. There is an unauthorized correction of date in the prescription and the prescription indicates the appellant feeling pain at his forearm and the doctor after going through X-ray, opined that the appellant suffered from fracture and he prescribed tablets with an advice for review after five days.
10 Dr.Phadke addressed letter under ExA19 which contains an unauthorized correction as to the date and month and the doctor sought for opinion of Dr.Shah regarding the surgery to be performed upon the appellant. The discharge summary of Pahadke Hospital, no doubt would establish the surgery undergone for fracture of the appellant’s forearm. The appellant was admitted to Pahadke Hospital on 04.10.2010, he had undergone surgery on 04.10.2010 and was discharged from the hospital on 05.10.2010. The discharge summary does not speak of the appellant sustaining injury in any accident and even it does not indicate any injury the appellant claimed to have suffered as a result of the accident. There is no other evidence placed on record to establish the factum of accident.
11 The terms of the insurance policy have binding effect on the appellant and the respondent. As per the terms of the insurance policy, the appellant is entitled to an personal accident sum assured of Rs.1,00,000/- provided he sustained permanent disability as a result of the injury he suffered in the accident involving the motor cycle. The appellant failed to establish his case that he met with the accident involving the motor cycle. Even if it is presumed that the appellant sustained the injury while riding on his motor cycle, yet his claim is subject to Clause 8 of the insurance policy which is extracted in paragraph 7 of the written version which is reproduced below:
“ As per the Section III of the policy the personal accident cover of the owner driver is “ subject otherwise to the terms and exceptions conditions and limitations 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, indirect connection with the vehicle insured whilst mounting into/dismounting from or travelling in the insured vehicle as a co-driver, caused by violent accidental external and visible means which independent of any other cause shall with six months of such injury result in :
Nature of injury scale of compensation
01.Death 100%
02.Loss of two limbs or sight of two eyes
or One limb and sight of one eye 100%
03.Loss of one limb or sight of one eye 50%
04.Permanent total disability from injuries
Other than named above 100%
But as per the averments of the complaint the complainant did not receive any sort of such injuries as such this opposite party is not liable to pay any compensation to the complainant. Hence the complaint is liable to be dismissed on this sole ground only.
12 The appellant has not suffered loss of limb or loss of sight in one eye nor did he suffer permanent total disability. Viewed from any angle, the appellant failed to establish that he met with an accident and sustained injury as a result of the accident as also he failed to satisfy the requirement of the terms of the insurance policy. The District Forum erred in holding that in absence of FIR it was difficult for it to decide whether is has jurisdiction to decide the lis. The District Forum interestingly opined that the appellant’s failure to file any documents indicates occurecne of the accident outside the limits of its jurisdiction. Infact, the appellant has brought on record copy of letter dated 20.10.2010 , ExA3 which reads as under:
To
The Manager,
Bajaj Allianz General Insurance Co. Ltd
8-6-126, 1st floor, Near Koti Bomma Circle
Kothirampur, Karimnagar 505001
I, Sri Ramavathar Agarwal, S/o Gujarimal Agarwal, age :51 years, Occ :Agriculture, R/o Adilabad, I am to address you as under
That, I purchased a TVS Star City Motorcycle bearing AP-01-H-7625 through Karur Vysya Bank, Adilabad Ltd and the Bank got insured the aforesaid Motorcycle through your branch vide policy No.)G-11-1810-1802-00003546 valid from 16 Jun 2010 to15 JUN 2011.That the aforesaid policy covered PA cover for Owner-Driver of Rs.1,00,000/-
That on 25.9.2010 while I was returning from my Agriculture Land situated at Nirala Village, my motorcycle slipped and I fell down from my motorcycle and received fracture injured to my left hand, immediately, my servant took me to Adilabad at Dr. Tippa Swamy whre in I was given the First Aid and subsequently I was shifted to dr. Ajit Phadke Hospital, there after I was operated and Steel Rod were inserted. That, of the aforesaid accident I have incurred an expenditure of Rs.75,000/-so far.
That at the time of accident, the policy was in existence, hence I call upon your to indemnity the loss of Rs.75,000/- to at the earliest.
Thanking you
Yours Faithfully,
Sri Ramavthar Agarwal, S/o Gujarimal Agarwal
H.No.3-3-202/18,
Chincharwada, Adilabad 504 001.
13 The letter does not come to the rescue of the appellant’s case as it was sent a month after the alleged accident occurred. There is no denying of the respondent’s plea that the appellant is obligated by the terms of the insurance policy to pass on intimation immediately after the accident occurred. The District Forum observed that the appellant failed to prove that he met with an accident and in the same breath it recorded finding that the accident occurred outside the limits of its jurisdiction. The District Forum ultimately dismissed the complaint. We also conclude the complaint should end in dismissal, however for the reasons other than those assigned by the District Forum.
14 In the result, the appeal is dismissed confirming the order of the District Forum. In the circumstances of the case, the parties shall bear their own costs.
PRESIDENT MEMBER
DATED : 22.04.2014
