IN THE CONSUMER DISUTES REDRESSAL FORUM, PATHANATHITTADated this the 27th day of May, 2010.Present : Sri. Jacob Stephen (President):Smt. C. Lathika Bhai (Member) Sri. N. Premkumar (Member) C.C.No.17/09 (Filed on 05.02.2009) Between: Jacob. K. George, Keeruvallil Veedu, Kallooppara Village, Mallappally Taluk, (By Adv. Sunitha.K.K) ….. Complainant And: The Manager, Reliance General Insurance Co. Ltd., Jackson’s Chellizhukkam Road, Manorama Junction, Kottayam. (By Adv. K. Sailesh Kumar) ….. Opposite party. O R D E R Smt. C. Lathika Bhai (Member): The complainant has filed this complaint against the opposite party for getting a relief from the Forum. 2. The facts of the complaint is as follows: The facts of the complaint is as follows: The complainant is the registered owner of the Hero Honda Motor Cycle bearing Reg.No.KL-28/1303. The vehicle has been insured with the opposite party as per the policy No.2206382312100261. In addition to the premium of the policy the complainant had paid an amount of Rs.50/- as the premium of personal accident cover. The above said vehicle met with an accident on 3.10.08 while he was travelling through Kozhencherry-Thiruvalla road. Due to the accident the complainant sustained type I open fracture both bones (RT) leg, distal third (segmental) fracture of fibula and comminuted fracture D/3rd of tibia. Open deduction and internal fixation was done to the complainant. Tenderness and disfiguration right leg distal half and pain all over the body. After the accident the complainant had a permanent disablement of 25%. For the treatment the complainant had spent an amount of Rs.50,000/-. The opposite party is liable to pay an amount of Rs. 1 lakh as the hospital expenses and his mental agony and sufferings. The complainant had approached several times to the opposite party for getting the insured amount from the opposite party. But they did not take any action for settling the complainant’s grievances. The Thiruvalla police had registered a crime as Crime No.847/08 in respect of the accident of the complainant. The complainant is entitled to get an amount of Rs. 1 lakh from the opposite party as per the personal accident cover envisaged in the policy. Hence he filed this complaint for getting an order for directing the opposite party to pay an amount of Rs. 1 lakh as the compensation for his medical expenses, disability and mental agony and sufferings along with cost. The complainant prays for granting the reliefs. 3. The opposite party has filed a version stating the following contentions: The claim of the complainant is belated and hence the Forum has no jurisdiction to entertain the complaint. The opposite party is admitting the policy issued to the complainant’s vehicle by agreeing the terms and conditions applicable to the two wheelers. The above said policy purports to cover the requirements of M.V.Act 1988 and the same does not cover the insured. The opposite party has admitted the additional premium of Rs.50/- received from the complainant for owner/rider to cover an extent of Rs.1 lakh as personal accident benefit in case of death, loss of two limbs or sight of two eyes or loss of one limb and sight of one eye or total disablement from injuries other than the above mentioned injuries an extent of Rs.50,000/- in case of loss of one limb and one eye. The injury sustained to the complainant is does not come in the purview of the injuries specified in the insurance policy conditions. The said amount paid on the basis of personal contract between the insured and the opposite party and the claimant is entitled for that amount only on lodgi8ng the claim with this opposite party through proper channel within six calendar months of such injury result in, as stipulated by the insurance policy condition. In this case, the complainant has not made any claim before the opposite party, the complainant has not sustained any injuries as stated in the complaint. The complainant has not complied with the conditions of the policy as such he has no right to claim compensation at this belated stage. The complainant is not entitled to get any compensation from the opposite party hence this opposite party prays for the dismissal of the complaint. 4. The point for consideration in this complaint:- Whether the complaint is maintainable before the Forum? 5. The evidence in this case consists of the proof affidavit and 7 documents filed by the complainant. On the basis of the proof affidavit the documents produced by the complainant were marked as Exts.A1 to A7. For the opposite party, the authorized representative of the opposite party filed a proof affidavit and two documents. On the basis of the proof affidavit, the documents produced were marked as Ext.B1 to B2(a). After closure of evidence, both sides heard. 6. The Point: The complainant’s case is that he is the registered owner of the Hero Honda Reg.No.KL-28/1303, which was insured with the opposite party. The opposite party has received an amount of Rs.50/- as additional premium for the personal accident cover. On 03.10.2008, the complainant sustained injuries in a road accident and he was treated in Pushpagiri Hospital. Due to the accident he had sustained 25% disability and have spend an amount of Rs.45.200/- for treatment. According to the complainant as per the personal accident cover envisaged in the policy the complainant is entitled to get an amount of Rs.1 lakh as compensation from the opposite party hence he filed this complaint for getting the reliefs as sought for in the complaint. 7. In order to prove the complainant’s case, the complainant has filed a proof affidavit and Exts.A1 to A7. Ext.A1 is the accident cum wound certificate issued from the Pushpagiri Hospital. Ext.A2 is the discharge summary from Pushpagiri Hospital. Ext.A3 is the Disability Certificate issued by the Medical Board, Pathanamthitta General Hospital. Ext.A4 is the FIR prepared by the Thiruvalla police for the accident occurred by the complainant. Ext.A5 is the scene mahazar prepared by the Thiruvalla police. Ext.A6 is the medical bills issued from the Pushpagiri Hospital to the complainant. Ext.A7 is the copy of the insurance policy issued by the opposite party to the complainant’s vehicle. 8. The opposite party’s main contention is that the complaint is belated and the complainant has not made any claim before the opposite party as per the policy terms and conditions for getting the compensation. Further, injuries sustained to the complainant does not come under the purview of the injuries specified in the insurance policy condition. Hence the complainant is not entitled to get any compensationfrom the opposite party. 9. In order to prove the contentions of opposite party, the authorised representative filed a proof affidavit and Exts.B1 to B2(a). Ext.B1 is the attested copy of the General Regulation 36 of Indian Motor Tariff. Ext.B2 and B2(a) are the attested copies of the insurance policy with terms and conditions issued to the complainant’s vehicle. 10. On going through the evidences in this case, the materials on record shows that the opposite party had issued an insurance policy to the complainant’s vehicle with personal accident coverage. During the coverage period, the complainant had sustained serious injuries and he was treated in Pushpagiri Hospital and spent an amount of Rs.45,200/- for the treatment expenses. After the accident, he became 25% disabled. According to the complainant, he has entitled to get compensation as per the conditions of the policy issued to him. 11. The opposite party’s main contention is that the complaint is belated and the complainant has not filed any claim before the opposite prty as required by the terms and conditions of the policy. It is the main point to be considered in this complaint. The complainant has not produced any evidence to show that he had approached the opposite party and informed the accident to them or lodged a proper claim before them and that was repudiated by the opposite party. The materials on record also does not shows that the complainant had filed a proper claim before the opposite party. The cause of action of this complaint is arising out only after repudiating the claim of the complainant by opposite party. Without repudiating the claim by the opposite party before filing this complaint, this complaint is not maintainable before the Forum. Hence the complainant’s prayer cannot allowable. 12. Considering the facts and circumstances and quantum of expenses and disability of the complainant, the complainant is allowed to file a fresh claim before the opposite party with sufficient documents as required by the policy conditions within two weeks from the date of receipt of this order. The opposite party is directed to accept the claim form from the complainant, without considering the delay in filing the claim, for taking necessary steps as per the policy condition. 13. In the result, this complaint is dismissed with the above said directions. No cost. Pronounced in the Open Forum on this the 27th day of May, 2010. (Sd/-) C. Lathika Bhai, (Member) Sri. Jacob Stephen (President) : (Sd/-) Sri. N. Premkumar (Member) : (Sd/-) Appendix: Witness examined on the side of the complainant : Nil. Exhibits marked on the side of the complainant. A1 : Photocopy of the accident register-cum-wound certificate dated 03.10.2008. A2 : Photocopy of the discharge summary issued by Pushpagiri Medical College Hospital, Thiruvalla. A3 : Attested true copy of the standing disability assessment Board Certificate dated 29.09.2009 issued by General Hospital, Pathanamthitta. A4 : Photocopy of the Final Report dated 30.11.2008 submitted by K.R. Anil Kumar, Sub Inspector of Police, Thiruvalla before the Judicial First Class Magistrate’s Court, Thiruvalla. A5 : Photocopy of the scene mahazar dated 12.11.2008 prepared by the Sub Inspector of Police, Police Station, Thiruvalla. A6 : Medicals bills from Pushpagiri Medical College Hospital, Thiruvalla. A7 : Photocopy of the insurance policy certificate issued by the opposite party to the complainant. Witness examined on the side of the opposite party : Nil. Exhibits marked on the side of the opposite party: B1 : Photocopy of the General Regulation 36 of India Motor Tariff. B2 : Photocopy of the insurance policy. B2(a) : Terms and conditions of Ext.B2 policy. (By Order) Senior Superintendent. Copy to:- (1) Jacob. K. George, Keeruvallil Veedu, Kallooppara Village, Mallappally Taluk. (2) The Manager, Reliance General Insurance Co. Ltd., Jackson’s Chellizhukkam Road, Manorama Junction, Kottayam. (3) Stock File.
| | HONORABLE LathikaBhai, Member | HONORABLE Jacob Stephen, PRESIDENT | HONORABLE N.PremKumar, Member | | 
