Complainant has filed this complainant against the opposite party for getting a relief from the Forum.

                   2. The facts of the complaint is as follows:  The complainant is the registered owner of the Hero Honda Motor Cycle bearing Reg.No.KL-28/6558.  The above said vehicle is insured with the opposite party vide policy No.570603/31/09/6200006547.  At the time of taking the policy, the complainant had paid additional premium of ` 50 for the compulsory personal accident cover.  On 31.8.09 the complainant was travelling Thiruvalla-Mallappally road when reaching Elias Kavala while giving side to a vehicle coming from opposite side the vehicle turn over and the complainant down and hit on a stone.  He sustained injury on the left rib and head and he was taken the Pushpagiri Hospital.  After giving first aid the complainant was taken to in Medical College Hospital, KOttayam.  For the treatment the complainant had spent an amount of ` 15,000.  The accident was occurred during the coverage period and the complainant had informed the accident to the opposite party and he approached several time for getting the treatment expenses.  But the opposite party has not taken any action.  The accident was entered in the G.D in the Keezhvaipur Police Station.  The non-taking of any action by the opposite party for the claim of the complainant is a deficiency in service hence the complainant filed this complaint for getting the personal accident benefit under the policy with interest along with compensation and cost.  The complainant prays for granting the relieves.

                   3. The opposite party has filed the version stating the following contentions:  The accident happened to the complainant is not reported to them.  No claim is raised with relevant documents by the complainant.  The injury to the complainant and the damage of the vehicle is denied by the opposite party.  The opposite party admitted the policy and its coverage.  The expenses of the complainant is strictly subject to proof.  The lawyers notice sent by the complainant was duly replied by the opposite party stating that the policy does not cover the same.  As per Section III of the policy taken by the complainant compensation is payable only to the Registered Owner-cum-Driver having a valid and effective Driving Licence and for covering death/permanent total disablement from injuries only.  The complainant has no permanent total disablement as per the policy condition.  Hence the opposite party prayed for the dismissal of the complaint with their cost.

         4. On the basis of the above pleadings of the parties, the following points are raised for consideration:

(1) Whether the complaint is maintainable before the Forum?

(2) Whether the complainant is entitled to get a relief as prayed for in the complaint?

(3) Relief and Costs?

          5. The evidence in this case consists of the oral deposition of the complainant as PW1 and Ext.A1 to A7 were marked from his side.  For the opposite parties, Ext.B1, B1(b) were marked through PW1.  After closure of the evidence, both sides heard.

          6. The complainant’s case is that the complainant is the registered owner of the Hero Honda Motorcycle bearing Reg.No.KL-28/6558.  The vehicle is insured with the opposite party and during the coverage period the complainant met with an accident and sustained injuries.  For the treatment he had spent an amount of ` 50,000. As per the personal accident benefit envisaged in the policy the complainant is entitled to get the treatment expenses from the opposite party.  For getting this the complainant approached several time before the opposite party but they declined the complainant’s claim.  Hence he filed this complaint for getting the relieves as prayed for in the complaint.

          7. In order to prove the complainant’s claim, the complainant adduced oral evidence as PW1 and Ext.A1 to A7 were marked.  Ext.A1 is the copy of the insurance policy in the name of the complainant.  Ext.A2 is the copy of G.D entry dated 3.11.09 from Keezhvaipur Police Station.  Ext.A3 is the reply notice sent by the opposite party to the complainant.  Ext.A4 is the Accident-cum wound certificate issued from Pushpagiri Medical College Hospital.  Ext.A5 series are the discharge card and O.P. ticket of the complainant issued from the Medical College Hospital, Kottayam.  Ext.A6 is the Disability Certificate issued by the Medical Board, Pathanamthitta.  Ext.A7 series are the medical bills for the treatment of the complainant. 

          8. The opposite party’s counsel has cross-examined PW1.

          9. The opposite party contended that the complaint is false and hence denied.  The accident that happened to the complaint is not reported to the opposite party and not filed relevant document for processing the complainant’s claim.  As per Sec.III of the policy taken by the complainant, compensation is payable only to the registered owner-cum-driver having a valid and effective driving licence and for covering death/permanent total disablement from injuries only.  The complainant has no permanent total disablement to claim under the policy.

          10. In order to prove the contentions of the opposite party there is no oral evidence from the part of opposite party.  At the time of cross-examination of PW1, Ext.B1 to B1(b) marked.  Ext.B1 is the policy certificate of the complainant’s vehicle.  Ext.B1(a) is the terms and conditions of the policy and Ext.B1(b) is the Section 3 of the Ext.B1 policy.

          11. On going through the evidences in this case as per Ext.A1 policy, the policy was issued in the name of the complainant.  Ext.A2, A4 and A5 shows that the complainant had sustained injury due to a road accident and he was treated in Pushpagiri Medical College Hospital and after admitted in Kottayam Medical College Hospital.  Ext.A7 series shows that the complainant had spent some amount for treatment.  Ext.A6 shows that the complainant had 16% disability due to the accident.  According to the opposite parties, they contended that the complainant has not filed a claim form with relevant documents before them.  Without relevant documents they could not process the claim.  The complainant had sent only a lawyers notice which was duly replied them.  Moreover, the complainant has no permanent total disablement to claim under this policy.

          12. It is pertinent to note that there is no evidence from the part of the complainant that he had filed a proper claim with relevant documents before the opposite party.  The complainant had sent only a lawyers notice.  The copy of the notice has not been produced by the complainant.  The documents produced before the Forum such as Ext.A7 series and other documents are to be produced before the opposite party for processing the claim.  Without claim form and documents the opposite party could not process the claim.  IN the circumstances, we could not find any deficiency in service from the part of opposite party.  Hence the complaint is liable to be dismissed.  However, the complainant has the liberty to lodge a proper claim with relevant documents before the opposite party within one week from the date of receipt of this order.  The opposite party is directed to accept the claim form of the complainant without considering the delay caused for the same.

          13. In the result, the complaint is dismissed with the above direction.  No cost.

          Declared in the Open Forum on this the 7^th day of January, 2011.

                                                                                                    (Sd/-)

                                                                                      C. Lathika Bhai,

                                                                                            (Member)

Sri. Jacob Stephen (President)                  :         (Sd/-)

Sri. N. Premkumar (Member)                 :         (Sd/-) 

Appendix:

Witness examined on the side of the complainant:

PW1  :  K.P. Dileepkumar.

Exhibits marked on the side of the complainant:

A1     :  Photocopy of the insurance policy. 

A2     :  G.D entry dated 3.11.09 issued by Keezhvaipur Police Station. 

A3     :  Photocopy of advocate notice sent by the opposite party to the 

             complainant. 

A4     : Accident Register-cum wound certificate dated 31.8.09 issued by 

             Pushpagiri Medical College Hospital to the complainant. 

A5     :  Discharge card

A5(a) & A5(b) :  O.P. tickets issued by the Medical College Hospital,

                             Kottayam. 

A6     :  Disability Certificate issued by the Medical Board, Pathanamthitta.  A7 & A7 series (A7(a) to A7(w) : Medical bills for the treatment of the 

                                                          complainant.

Witness examined on the side of the opposite party:  Nil.

Exhibits marked on the side of the opposite party:

B1     :  Policy certificate of the complainant’s vehicle. 

B1(a)          :  Terms and conditions of the policy

B1(b) :   Section 3 of the Ext.B1 policy.

                                                                                                (By Order)

                                                                                     Senior Superintendent.

Copy to:- (1) K.P. Dileep Kumar, Puthusserimuriyil,

                       Kallooppara Village, Mallappally Taluk.

       (2) Manager, National Insurance Co. Ltd., Thiruvalla Branch,

                       Ennikkattil Estate, M.C. Road, Thiruvalla.

                 (3)  The Stock File.