Kerala

Idukki

CC/40/2018

Mathew Ouseph - Complainant(s)

Versus

Manager National Insurance Company Ltd - Opp.Party(s)

Adv.K M Sanu

26 Jul 2019

ORDER

 

DATE OF FILING :01/03/18

IN THE CONSUMER DISPUTES REDRESSAL FORUM, IDUKKI

Dated this the 26^th day of July 2019

Present :

SRI. S. GOPAKUMAR PRESIDENT

SMT.ASAMOL P. MEMBER

CC NO. 40/2018

Between

Complainant : Mathew Ouseph,

Kunnathel House,

Purappuzha P.O., Thodupuzha.

(By Adv: K.M.Sanu)

And

Opposite Party : The Manager,

National Insurance Co.Ltd.,

Muvattupuzha Road,

Thodupuzha P.O., Thodupuzha.

(By Adv: Berg George)

 

O R D E R

SRI. S. GOPAKUMAR (PRESIDENT)

 

The case of the complainant is that,

 

Complainant took a Motor Vehicle Policy from the opposite party company for the period from 08/02/17 to 07/02/18 for his motor vehicle having Reg. No.KL/43/1838. This policy is a Traffic Accident Policy. As per the terms of the policy, the policy covers the treatment expenses of the policy holder up to Rs.1 Lakh rupees for any motor vehicle accident. While so, the complainant met with an accident on 10/08/2017, while he riding in the above said vehicle by colluding with a motor bike and sustained serious injuries. Due to that accident he sustained fracture and wound in his right hand elbow. The complainant admitted and treated in Chazhikkattu Hospital from 10/08/17 to 18/08/17, and spent Rs.31,650/- for treatment alone and another Rs.40,000/- had occurred as additional expenses. The matter of accident was duly informed to Karimkunnam police and police registered a case as Crime No.558/17.

 

(Cont....2)

 

-2-

 

Immediately after the discharge from the hospital complainant lodged an accident claim before the opposite party company with relevant documents. But the opposite party company not considered the claim till. Hence alleging deficiency in service complainant approached this Forum against opposite party, for getting relief such as to direct the opposite party to pay the claim amount along with compensation and cost.

 

Upon notice opposite party entered appearance and filed detailed reply version admitting the issuance of the policy discussed in the complaint. Opposite party further contented that they received the claim application, but they cannot allow the claim on the reason that no medical bills are produced by the complainant as stated in the complaint. Opposite party further contented that along with the claim application complainant produced a bill for an amount of Rs.1725/-. That is why they delayed the matters. Opposite party admitted that they are ready to pay the medical expenses if the complainant produce sufficient documents. Hence no deficiency in service can be happened on the part of the opposite party in this matter.

 

Evidence adduced by the complainant by way of documents and it is marked as Ext.P1 to Ext.P5. Ext.P1 is the policy certificate, Ext.P2 is the copy of FIR in Crime No.558/17 of Karimkunnam Police, Ext.P3 is the copy of bills and receipt stated (10/08/17 to 18/08/17), Ext.P4 is the copy of discharge summary, Ext.P5 is the copy of medical certificate.

 

From the defence side copy of policy certificate produced and marked as Ext.R1.

 

Heard both sides,

 

The point for consideration is whether there was any deficiency in service from the part of the opposite party, and if so, for what relief the complainant is entitled to?

 

The Point:- We have heard the counsel for both sides and had gone through the documents.

 

(Cont....3)

 

-3-

 

It is an admitted fact that complainant took a motor vehicle policy from the opposite party company for his two wheeler valid from 08/02/17 to 07/02/18. The policy is a traffic accident coverage policy. As per this policy it covers the accidental claim up to one lakh rupees. This policy certificate having No.57080148162100001230. He is also admitted that this vehicle which covers this policy met with an accident with one Motor Bike, and the complainant who rides the vehicle at the time of accident suffered serious injuries such a fracture and wound right hand. He was treated as in patient in Chazhikkattu Hospital and spent Rs.31,650/- towards medical treatment. To substantiate this matter the complainant produced Ext.P1 to Ext.P5 documents. On perusing the documents such as medical bills, discharge summary and treatment record, the Forum convinced that the averments in the complaint are believable and sustainable. This matter is admitted by the opposite party in their version and opposite party defended the case that, the delay caused in allowing the claim is not wilful, opposite party further stated that along with the claim application complainant filed a medical bill having Rs.1725/-. That is why the opposite party failed to allow the claim.

 

On perusing the documents the Forum is in a considered view that, the defence taken by the opposite party cannot be believable. It is quite natural that, if the complainant put a mediclaim to them, that will be along with sufficient documents. Hence the version of the opposite party in non considering on non- payment of the claim amount till date cannot be sustainable. More over it is very pertinent to note that why the opposite party not send a letter to the complainant stating the fact of non considering the claim or what prevented the opposite party to further direct the complainant to produce the whole medical bills as per the claim application. It is seen that, opposite party has not took any effort to allow this claim or opposite party neglected the claim application of the complainant. This act of the opposite party is a serious deficiency in their service and the opposite party is liable to compensate the complainant adequately.

 

On the basis of above discussion the claim allowed. Opposite party is directed to pay the claim amount of Rs.31,650/- as per Ext.P3 medical bill along with 12% interest from 18/08/17 till the payment. Opposite party is

(Cont....4)

 

-4-

further directed to pay Rs.5000/- as compensation and Rs.2000/- as litigation cost to the complainant, failing which the amount of compensation shall carry 12% interest from the date of receipt of this order till its realisation.

 

Pronounced in the Open Forum on this the 26^th day of July, 2019.

 

Sd/-

SRI. S. GOPAKUMAR (PRESIDENT)

Sd/-

SMT. ASAMOL P. (MEMBER)

 

APPENDIX

 

Depositions :

On the side of the Complainant :

Nil

On the side of the Opposite Party :

Nil

Exhibits :

On the side of the Complainant :

Ext.P1 - The policy certificate

Ext.P2 - The copy of FIR in Crime No.558/17 of Karimkunnam Police

Ext.P3 - The copy of bills and receipt stated (10/08/17 to 18/08/17)

Ext.P4 - The copy of discharge summary

Ext.P5 - The copy of medical certificate.

On the side of the Opposite Party :

Ext.R1 - The copy of policy certificate.

 

 

Forwarded by Order,

 

 

SENIOR SUPERINTENDENT