The case of complainant is that the complainant is a conductor working under the management of M/s. Karippal Motors. On 26.12.03 at 9 p.m. while he was riding his motor cycle with a pillion rider it was skipped and the complainant and pillion rider fell in the gutter and sustained serious bodily injuries. Immediately complainant was taken to Aswini Hospital at Ottappalam and admitted there. The complainant has taken a Personal Accident Policy from the respondent and the policy number was 100606/42/03/00257. The policy is valid for the period from 9.7.2003 to 8.7.2004. The complainant was drawing Rs.3480/- as salary from M/s. Karippal Motors per month. Due to the injuries sustained the complainant could not do his duty as conductor from 26.12.2003 to 30.11.2004. The complainant furnished the details of injury and other details in the office of respondent. But it was not settled. Hence this complaint.

 

            2. The counter in brief is that this respondent admits that the complainant had met with an accident and was admitted in Aswini Hospital as inpatient. But the respondent disputes the gravity of the injury as alleged by the complainant and the averment in the complaint that due to the accident he was not able to do the work is false and denied. After discharge from hospital the complainant was on rest for a few days and thereafter he is going for duty. The complainant was working in Karippal bus running from Thrissur-Palakkad route as ticket checker. The complainant was not bedridden after three months from the date of injury and now he is working as a conductor. It is not correct that the complainant is on loss of pay leave from 26.12.03 to 31.7.04 and the averment in the complaint that he was on leave from 26.12.03 to 31.7.04. As per the policy the sum insured is for Rs.50,000/- for the period of insurance. As per the claim complainant is entitled to receive a sum of Rs.9000/- as compensation for 12 weeks. The amount was determined on the basis of medical bill, medical report dated 15.1.04 and loss of his earning. According to the medical report the confinement period to bed was three months as the direct and sole consequences of the injuries sustained. The complainant visited the office of the respondent 3 times from the date of injury. He was found in good healthy condition and was not at all bed ridden after three months from the date of injury. The contention of the complainant that he has temporary total disablement from 26.12.03 to 15.11.04 is false.   There is no deficiency in service. The complainant is only entitled for compensation for 12 weeks i.e. 1% of the sum insured of Rs.50,000/- and that will come to Rs.6000/-. The medical expenses as per the eligibility will come to Rs.3000/-. So in total this respondent has offered Rs.9000/- to the complainant and it was sent to the complainant but it was returned. Hence dismiss.

 

            3. The respondent filed additional counter to the effect that the complainant is not entitled for any interest as claimed in the complaint. The interest rate claimed in the complaint is too excessive and without any basis. Prevailing rate of interest is only 6%. 

 

            4. The points for consideration are:

(1)   Is there any deficiency in service?

(2)   If so, reliefs and costs.

 

            5. The evidence consists of Exts. P1 to P10, Ext. R1 to R9 and the depositions of RWs-1 to 3. No oral evidence adduced by complainant.

            6. Points: According to the complainant, he has taken a Personal Accident Policy from the respondent and the policy number was 100606/42/03/00257. The policy was valid for the period from 9.7.2003 to 8.7.2004. On 26.12.03 at 9 p.m. while he was riding his motorcycle, the motorcycle skipped and he got serious bodily injuries. Immediately he was taken to Aswini Hospital at Ottappalam and admitted there. After that he had applied for the insurance claim on 15.1.04. But the respondent offered Rs.9000/- to the complainant and a voucher of Rs.9000/- was sent. But it was returned by the complainant.

 

            7. According to the complainant, this amount is not at all sufficient and as per the benefit of the policy the complainant is entitled to get 12% of the capital sum insured upto 100 weeks. He further states he had temporary total disablement from 26.12.03 to 30.11.04. There are 45 weeks and for that he is entitled to get Rs.45,000/-. 

 

            8. According to the respondent as per the records the complainant is only entitled for compensation for 12 weeks. As per the policy 1% of the sum insured of Rs.50,000/- is entitled by the complainant. They further states that the medical expenses as per the eligibility will come to Rs.3000/-. So they offered Rs.9000/-. 

 

            9. Ext. R1 is the certified copy of the policy with terms and conditions. As per Clause (1)(f) of the policy, the policyholder will be entitled for 1% of the capital sum insured only if injury shall be sole and direct cause of temporary total disablement. Ext. P5 is the certificate issued by Dr. Sathyapal to the insured. It would show that the complainant was reviewed in 24.7.04 and his right ankle has improved satisfactorily and has minimal residal stiffness. Again he was advised to continue physiotherapy and start light physical activity. Dr. M.B. Sathyapal is examined as RW1. RW1 deposed that as per Ext. R7 the patient will be able to attend to a portion of normal duties after 3 months from the date of injury. During cross examination he stated that “I have advised rest of 6 months from the said date. Ext. R8 is the claim form attached with medical report by RW1 in which the Doctor certified that the injured person to be confined to bed for four months. The probable date of being able to attend any portion of his normal duties was 24.7.04. The resumption of his normal duties fully is to be reviewed after four months. So as per Ext. R8 by 24.7.04 the complainant will be able to attend any portion of his normal duties. The resumption of normal duties not noted and depends on review. As per Ext. R5 it was issued by RW1 and the complainant was advised rest for 6 months. So according to the treated doctor the probable date of being able to attend to any portion of normal duties was on 24.7.04. It was after 7 months of accident. As per Ext. R5 he was advised for 6 months rest. There is no other document produced to show that the complainant is needed rest in addition to that period. There is no document to show that review was done after 24.7.04. The complainant produced a letter from Karippal Travels and it is marked as Ext. P6. It shows that after the accident he has joined in the bus service again on 1.11.2004 and continued till 23.3.2005. It is also stated in the letter that he has not recovered fully and due to illness he could not continue his job as conductor in the bus service. So he has resigned and left the service on 24.3.2005. Even if the document is marked it cannot be taken as a conclusive proof. The only reliable record is the evidence of RW1. According to him, for 6 months he was unable to attend his normal duties. So it can be considered that the complainant is entitled for 6 months compensation. 

 

            10. The investigator who has appointed by the company filed a report and is marked as Ext. R6. He was examined as RW3 and deposed that when he had visited the house of complainant on 30.6.04 the wife of complainant told that he has gone to job. There is no cross examination on this point and it can be treated that on 30.6.04 he was doing his job. So the complainant is entitled for 6 months compensation for the temporary total disablement caused to him. In the present case 1% of the capital sum insured will come to Rs.500/- and he is entitled for 24 weeks compensation at the rate of Rs.500/-.

 

            11. The complainant claims medical expenses as per bill and it will come Rs.17,384/-. But the respondents stated that he is entitled only for Rs.3000/- as per the eligibility. But the respondent produced medical bills entrusted by the complainant and it will come to Rs.17,362.17. The respondent was examined as RW2 and deposed that there is no irregularity in Ext. R12 medical bills. But they offered only Rs.3000/- on the basis of eligibility. There is no evidence to show that how they fixed the eligibility. As per the policy premium was computed for medical expenses and it was accepted from the complainant also. So the complainant is entitled for the medical expenses incurred as evidenced by Ext. R12. There is serious deficiency in service on the part of respondents in disallowing the medical expenses and also in computing the weeks for compensation. So the complainant is entitled for compensation for the mental agony suffered by him.

 

            12. In the result, complaint is allowed and the respondent is directed to pay 6 months compensation at the rate of 1% of the capital sum insured; Rs.17,362.17/- (Rupees seventeen thousand three hundred and sixty two and paise seventeen only) as medical expenses and Rs.5000/- (Rupees five thousand only) as compensation for the mental agony suffered with costs Rs.500/- (Rupees five hundred only) within two months.