Delhi

West Delhi

CC/15/373

ROHTASH SINGH - Complainant(s)

Versus

Manager the Oriental Insurance Company Limited - Opp.Party(s)

04 Feb 2017

ORDER

CONSUMER DISPUTES REDRESSAL FORUM (WEST)

GOVERNMENT OF NCT OF DELHI

150-151, Community Centre, C-Block, JanakPuri, New Delhi – 110058

 

                                                                                                       Date of institution: 13.06.2015  

Complaint Case. No.373/15                                                                                     Date of order: 04.02.2017                    

IN  MATTER OF

Rohtash Singh S/o Dharambir Singh, R/o house no. 44, Gali no.3, Dichaun Enclave, Najafgarh, New Delhi-64                                                                                             Complainant

VERSUS

Manager the Oriental Insurance Company Limited, Branch 9, Community Centre Phase-1, Mayapuri New Delhi-64                                                                                             Opposite party-1

 

Divisional Manager the Oriental Insurance Company Limited, D.O. 18, Janakpuri New Delhi-58,                                                                                                                               Opposite party -2

 

ORDER

R.S. BAGRI,PRESIDENT

Present complaint is brought by Rohtash Singh named above herein after referred as the complainant U/S-12 of the Consumer Protectin Act for directions to the opposite parties to pay medical claim of the complainant on account of injuries suffered by him in an accident and compensation for mental and physical agony suffered by him due to negligence and unfair trade practices adopted by the opposite parties.

            The brief relevant facts for disposal of the present complaint as stated are that the complainant was insured with opposite parties from 03.09.2008 to 02.09.2009 through policy no. 215502/48/2009/960 for sum of Rs. 2,00,000/-. The complainant was a Driver.  On 05.03.2009 he had gone to village Aanma, Tehsil Tamnar, District Raigarh, State of Chhattisgarh. When he was standing on road side, all of a sudden one scorpio driven rashly and negligently in a very high speed came and hit in the complainant. He suffered multiple injuries. He was shifted to Government hospital Gharghora District Raigarh, State of Chhattisgarh. When he gained consciousness he narrated the accident to the attending doctor and Police. After discharge from Government Hospital Gharghora he took treatment from various Hospitals. The complainant informed the opposite parties of the accident and requested them for his treatment. The complainant received a letter dated 23.03.2009 from

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the opposite parties. Thereupon the complainant deposited some treatment record and medicine bills with the opposite parties. The opposite parties did not reimburse the bills. They asked for disability certificate. The complainant after one or two years obtained disability certificate. The complainant has suffered 90% permanent disability of right hand and left leg. Thereafter the complainant deposited all treatment record with disability certificate with the opposite parties. The opposite parties did not pay any claim. The complainant has become 90% disabled. He is unable to perform his daily pursuits and earn lively hood. Hence the present complaint for directions to the opposite parties to pay amount of the claim with interest @24% per annum from the accident till actual realization and pay compensation for mental and physical pain, agony and sufferings on account of deficiency in services and unfair trade practice on the part of opposite parties.

            Notice of the complaint was sent to the opposite parties. They appeared and filed reply while contesting the complaint and raising preliminary objections of maintainability,  limitation, misuse of process of law, concealment of true and material facts,  non-production of medico-legal report and reporting the matter to the opposite parties after long delay  and registration of FIR after seven months of the accident.

            However, on merits the opposite parties asserted that according to the complainant the accident took place on 05.03.2009 and the present complaint is filed on 13.06.2015 after lapse of period of about six years. The matter was reported to the Police on 30.10.2009 after lapse of period of seven months from the accident.  The Police filed report U/S-173 Cr.P.C before the Illaqa Magistrate U/S 279/337 IPC only and there is no medico legal report to show injuries on the person of complainant. The insurance amount is not Rs.2 lakhs as claimed by the complainant whereas the same is Rs. one lakh only in case of permanent disability on the person of the complainant. The complainant was required to inform the opposite parties of the accident with full particular immediately after the accident. The opposite parties rightly declined claim of the complainant. The complainant is not entitled for any compensation and prayed for dismissal of the complaint.

            When the complainant was asked to lead evidence by way of affidavit in support of his complaint he filed his affidavit dated 24.11.2015. Wherein he once again narrated facts of the complaint. The complainant in support of his case also relied upon policy no. 215502/48/2009/960 issued by the opposite parties, order of mediation and conciliation centre dated 24.11.2014, copy of report U/S-173 Cr.P.C dated 27.11.2009, copy of discharge ticket dated 9.03.2009 from Government Hospital Gharghora District Raigarh State of Chhattisgarh, discharge summary from Goel Nursing Home, OPD tickets of Janaki Das Kapoor memorial Hospital, PGIMS Rohtak, medical bills, disability certificate dated

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29.09.2010, letter dated 23.03.2009 written by the opposite parties to the complainant, representations dated 27.02.2012, 09.04.2014 and 05.05.2014 made by the complainant to opposite parties.

The opposite parties in support of their case have filed affidavit of Smt. Meena Kalra dated 14.12.2015. She has supported the version of the opposite parties. The opposite parties have relied upon letter dated 23.03.2009 and repudiation letter dated 31.03.2014.

We have heard the complainant and counsel for opposite party and have gone through material on record carefully and thoroughly.

From the complaint and documents relied upon by the complainant it reveals that the accident took place on 05.03.2009. The complainant informed the opposite parties of the accident on 17.03.2009 and reported the matter to the police on 30.10.2009. There is no medico legal report showing any injury in the accident. The complainant himself refused for medico legal report. The opposite parties asked the complainant to submit his claim with documents vide letter dated 23.03.2009. He submitted claim on 02.12.2013 after lapse of a period of 4 years and 9 months. Whereas according of para no. 1 of the terms and conditions of the insurance policy the complainant was required to inform the opposite parties of the accident immediately. Which reads as under

“ Upon the happening of any event which may give rise to claim under the policy, written notice with full particulars must be given to company immediately, in case of death written notice also of death must unless reasonable cause is shown, be so given before internment cremation and in case, within one calendar months after the death, in the event of loss of sight or amputation of limbs written notice thereof must also be given within one calander month after such loss of sight or amputation.”

The complainant informed the opposite parties on 17.03.2009 after lapse of period of 12 days. Hence the case of the complainant falls under exclusion clause of para no. 1 of the term and conditions of the insurance policy as the complainant failed to give notice to the opposite parties with full particulars immediately after the accident.

There is also no medico legal report to show that the complainant suffered any injury  in the accident on 05.03.2009.  The complainant reported the matter to the police on 30.10.2009 after a lapse of  a period more than 7 months. Hence there is inordinate and unexplained delay of more than 7 months in reporting the matter to the Police. Which is after thought and does not inspire confidence in the version of the complainant. The complainant also did not submit claim within reasonable time from obtaining disability certificate. The disability certificate was issued on 29.09.2010. The complainant filed claim

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with the opposite parties on 02.12.2013 after a lapse of a period of more than two years from issuances of disability certificate.

In view of above facts and observations the complaint falls under the exclusive clause as the complainant did not sent notice to the opposite parties with full particulars immediately after the accident. The delay of more than 7 months in reporting the matter to the police, obsence of medico-legal report and filing claim after more than two years from issuances of disability certificate also create dent in version of the complainant. The complainant has failed to show any deficiency in services and negligence on the part of opposite parties. Therefore, there is no merit in the complaint. The complaint falls and deserve by dismissal. Resultantly dismissed.  

Order pronounced on :

• Copy of order be sent to the concerned parties free of cost.
• Thereafter, file be  consigned to record.

 

 

 

(PUNEET LAMBA)                                    (URMILA GUPTA)                                        (R.S.  BAGRI)

   MEMBER                                                       MEMBER                                                  PRESIDENT