By Smt. Beena. M,Member:-
This is a complaint filed under section 35 of the Consumer Protection Act 2019
2. Facts of the case in brief: The Complainant is the registered owner of a scooter bearing Registration No.KL-12-L-8774, which was insured with Opposite Party No.1, covering the period from 08.07.2020 to 07.07.2021. On 17.05.2021 at 10.30 am, while the Complainant was returning to his home, after selling fish, on his Scooter and when he reached at Thattiyapalam, within the Meppadi Police Station Limit, a huge tree from the Forest area fell on the Scooter and as a result of which, the Scooter was damaged and the Complainant sustained very severe injuries like displaced fracture of lateral Tibia (R) and sustained Electric Shock, along with deep abrasion at foot. Immediately after the incident, the Complainant was shifted to DM WIMS Medical College and Hospital, Meppadi, Wayanad and was discharged after conservative treatment. The incident was timely reported to the Police and the accident was entered in the General Diary (GD) dated 18.05.2021 by Meppadi Police. Though the Complainant visited the office of the Opposite Party No.2 many times, the door of the office was seen locked. Later the Complainant informed about the accident to the Agent of the Company named Tony, who was also seen unanswered. The Complainant is still unable to move or to do his fish vending business. The Opposite Party was informed about the accident through phone and also had sent a Lawyer notice on 11.11.2021 demanding to settle the claim. The vehicle was insured under Package Policy which also covers personal accident. There is gross deficiency in the service from the part of the Opposite Parties. The Opposite Parties are liable to compensate the Complainant. The Complainant was unable to do his daily work for a period of 8 months. The Opposite Parties are liable to Indemnify the Complainant for the loss sustained to him personally and occupationally. Hence, this complaint.
3. Notices were served to Opposite Parties and they appeared and filed version.
4. The version filed by the Opposite Parties is as follows:
The Complainant has instituted the above complaint even without knowing the real facts. The Opposite Party stated that they do not have any office at Wayanad District. Except the lawyer notice issued by the Complainant to this Opposite Party they haven’t received any communication from the Complainant. This Opposite Party hasn’t received any claim intimation as prescribed in the policy certificate. The alleged accident was on 17-05-2021 and they issued the lawyer notice on 11-11-2021 then only these opposite parties came to know about this alleged incident. The nature of loss as alleged is not covered under Personal Accident policy. In Sec III of the policy conditions, it is clearly stated the circumstances under which the owner cum driver entitled for compensation. The owner is entitled for compensation only in case of (1) death, (2) in case of loss of two limbs or sight of two eyes or one limb and sight of one eye, (3) loss of one limb or sight of one eye, (4) Permanent total disablement from injuries other than named above. The Complainant has not sustained any of these type injuries and thus it is outside the scope of the coverage of the policy. This Opposite Party is not liable to pay any amount. Hence there is no deficiency in service from this Opposite Party to the Complainant. The Complainant is not entitled for compensation of Rs.3,00,000/-, including the cost from these opposite parties. Therefore, prayed to dismiss the complaint with the compensatory cost of Rs. 5,000/- to the Opposite Parties.
5. On the basis of contention raised by the parties the following points considered:-
- Whether there is any deficiency in service on the part of Opposite Parties?
- Relief and cost.
6. In order to prove the case of the Complainant, the evidence on affidavit of the Complainant has been filed and the documents marked as Ext A1 to A7 and C1. No proof affidavit filed by the Opposite Parties. There is no document marked on the side of the Opposite Parties.
7. It is not denied and disputed that the Complainant is the owner of two wheeler bearing registration no. KL-12-L-8774 and said scooter was insured with the Opposite Party under a two wheeler package policy covering the period from 08.07.2020 to 07.07.2021 and the sum insured for personal accident coverage of Rs.15,00,000/-. According to the Complainant, during the said policy period he met with an accident on 17.05.2021, while he was returning to his home and due to such accident the Complainant sustained injuries. The main contention of the Opposite Party is that as per section III of policy conditions the owner is entitled for compensation only in case of death, loss of limbs, loss of sight, permanent disablement from injuries. One of the main condition of policy is that the Complainant shall be given notice in writing to the Opposite Party immediately upon the occurrence of any accidental loss or damage and in the event of any claim and thereafter the insured shall given all such information and assistance as the company shall required. But on perusal of the document relied by the Complainant there is no proof as that the Complainant has given information to the Opposite Party in writing immediately upon the accident. But the Complainant stated that he has visited the office of the 2nd Opposite Party many times, which cannot be taken into consideration. Due to the accident, he may be failed to intimate the same to the Opposite Party immediately in writing. It is only a curable defect. The counsel for the Complainant argued that since he is doing sale of fish and unable to stand he will come under the clause stated in the policy and in that extent he has permanent total disability and he is entitled for the sum assured. Here nothing is produced to show that he is unable stand for doing sale of fish.
8. The medical board report which is marked as Ext C1 shows that the Complainant has 13% permanent disability. The accident occurred on 17.05.2021 and the lawyer notice sent on 11.11.2021, the report of doctor is on 16.05.2023. So it can be taken that the disability at present as 13%. Here we have to decide whether the assured had suffered total permanent disablement in this case. As per Ext C1, the Complainant had suffered only 13% permanent disability and not total permanent disability. Hence, we have to hold that the assured is not eligible to get any amount under the said policy of insurance. There is no deficiency in service on the part of Opposite Party, thus the Complainant is not entitled for the relief as claimed.
In the result the complaint stands dismissed.
Dictated to the Confidential Assistant, transcribed by him and corrected by me and pronounced in the Open Commission on this the 24th day of June 2024.
Date of Filing:-25.01.2022.
PRESIDENT : Sd/-
MEMBER : Sd/-
APPENDIX.
Witness for the Complainant:-
PW1. Rasheed. A. V. Nil.
Witness for the Opposite Parties:-
Nil.
Exhibits for the Complainant:-
A1(Series). Medical Certificate ( 2 Numbers).
A2. Copy of Motor Two-Wheelers Package Policy Schedule cum
Certificate of Insurance for the period of 08.07.2020 to 07.07.2021.
A3. General Diary Abstract.
A4. Copy of Lawyer Notice. Dt:11.11.2021.
A5. Acknowledgment Card.
A6. Copy of Registration Certificate.
A7. Copy of Emergence Department Discharge Summary.
C1. Medical Certificate issued by District Medical Board, Wayanad. Dt:16.05.2023.
Exhibits for the Opposite Parties:-
Nil.
PRESIDENT :Sd/-
MEMBER :Sd/-
/True Copy/
Sd/-
ASSISTANT REGISTRAR
CDRC, WAYANAD.
Kv/-
