IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA Thursday the 11th day of March, 2016 Filed on 31.01.2011 Present - Smt. Elizabeth George (President)
- Sri. Antony Xavier (Member)
- Smt.Jasmine.D. (Member)
in C.C.No.29/2011 between Complainant:- Opposite Party:- Fr. Stephen. J. Punnackal National Insurance Company Ltd. Vicar, St. Peter’s Church Represented by its Branch Manager Vattayal Ward, Alappuzha – 688 002 Branch Office, Near Iron Bridge (By Adv. James Chacko) Alappuzha (Policy issued from Popular Vehicles & Services Ltd., North Service Centre, Oppo. Lissy Hospital Ernakulam North, Kochi) (By Adv. C. Muraleedharan) O R D E R
SMT. ELIZABETH GEORGE (PRESIDENT) This is a remanded matter. The case was once heard and the President of the then Forum passed an order on 30.01.2012 dismissing the complaint. Since there was no detailed order, Hon’ble State Commission suomoto taken up the matter and remanded the case for hearing for the purpose of passing a speaking order. After remanded, notices were issued to both parties for hearing the matter. 2. The case of the complainant is as follows:- The complainant is the registered owner of the Maruti Alto Car bearing No. KL 04-X-8395. On 27th November, 2009, while the complainant along with other persons was travelling in the said car, the same met with an accident. The car was being driven by one Mr. Antony. In the said accident, one of the co-passengers succumbed to his injuries. The complainant too sustained serious injuries causing permanent disability to him. At the time of the accident, the material car was holding the valid insurance policy. The complainant was also covered by the personal risk policy for an amount of Rs.2 lakhs at the time of the accident. The complainant was paying an additional amount of Rs.100/- as premium for personal accident coverage. The complainant duly intimated the factum of accident to the opposite party. The complainant filed applications for the claim amount and visited the opposite party to disburse the claim amount. The opposite party without any valid reason repudiated the complainant’s claim. Feeling aggrieved on this, the complainant approached this Forum seeking compensation and other relief. 3. The version of the opposite party is as follows:- The policy issued covers personal accident claims for owner driver only. It is an admitted fact that the complainant is not the owner driver of the vehicle, hence complainant is not entitled to get any amount as per the policy. More over the injury alleged to have been sustained to the complainant will not come under the policy coverage. As per the Section 111 of the policy the personal accident cover as per the policy is as follows:- - Death - 100%
- Loss of two limbs or sight of two eyes or one limb and sight of two eyes - 100%
- Loss of one limb or sight of one eye - 50%
- Permanent total disablement from injuries other than named above is - 100%
The amount claimed has no basis at all. The complainant is not entitled to get any of the reliefs prayed for in the complaint. 5 The complainant filed proof affidavit and the documents produced were marked as Exts.A1 to A13. On the side of the opposite party one document produced marked as Ext.B1. 4. The points came up for considerations are:- - Whether there is any deficiency in service on the part of the opposite party?
- Whether the complainant is entitled to get reliefs?
5. It is an admitted fact that complainant is the owner of the vehicle involved in the accident. The vehicle was having a valid policy for the personal accident to the insured of the vehicle. Due to the accident the complainant sustained serious injuries. According to the opposite party as per the conditions of the policy, the injury sustained by the complainant would not entitle him to the benefit of policy. According to the complainant, as per the terms and conditions of the package policy issued by the opposite party, he is entitled to get compensation for his serious injuries sustained in the accident that caused him permanent disability. In order to substantiate his allegations complainant produced Ext.A10 the disability certificate issued by the Dr. Joseph Dixon in favour of the complainant. As per Ext.A10, complainant was having 10% permanent disability due to the alleged accident. According to the opposite party as per Section III of the policy condition, opposite party is liable to pay on four grounds as stated below:- 1) Death - 100% 2) Loss of two limbs or sight of two eyes or one limb and sight of one eye - 100% 3) Lost of one limb or sight of one eye - 50% 4) Permanent total disablement from injuries other than named above - 100% Since the complainant does not sustained any of the injury stated in the injury item No. 1 to 4, he is not entitled to get any benefit as per the personal accident coverage as stated in the policy. In Gulam Vs. Oriental Insurance Company Ltd. rendered in 2014 (4) CPR 553 (National Commission) confirmed the findings of the State Commission and observed that the complainant therein failed to prove that he suffered any injury resulting in disability which is covered by the conditions of the policy. The injuries suffered by the complainant are not fit for payment under policy. The injuries suffered by the complainant not being under the conditions of the policy, the opposite party has not committed any dereliction of services by not making the payment. The same findings are applicable in this case also. “In the disability certificate produced by the complainant, the described injury does not come to be in the ambit of conditions of the insurance policy. From the perusal of conditions of insurance policy, this is clear that in case of death in accident 100% compensation and disability of eye sight in both the eyes or for one limb and one eye, there is provision of providing 100% compensation. Whereas for disability in one limb and one eye, there is provision of giving 50% compensation and for permanent disability, there is mention of giving 100% amount. Whereas, in the above case, the applicant has not submitted any such certificate from which it can be established that he has got any permanent disability of this type.” According to the certificate produced by the complainant, the complainant has suffered 10% permanent disability. According to the complainant he took the policy under the bonafide belief on the basis of the assurance given by the opposite party that he will get personal accident coverage as an owner of the insured vehicle. This Forum has jurisdiction to see only with regard to the defect and deficiency in service from the part of the opposite party. The contention taken by the opposite party is that as per the conditions in the policy, the liability is restricted or limited to the extent of disability given in the slab. The learned counsel of the complainant produced a decision reported in ACJ 2014 page No.721 in Bajaj General Insurance Company Ltd. Vs. C. Ramesh wherein it is held that “under personal accident cover, insured company is liable for injuries sustained by the owner cum driver of the vehicle. There is no negative covenant in the policy that no compensation would be paid in respect of other bodily injuries, but the aggregate of the compensation shall not exceed Rs.1 lakh during anyone period of insurance.” Since this Forum has no jurisdiction to ascertain the damages on the basis of injuries, or disability sustained to the insured like that of Motor Accident Claims Tribunal, this Forum is Constrained to dispose the above complaint without prejudice to the right of the complainant to approach the appropriate Forum to redress his grievance. In the result, complaint is dismissed. Dictated to the Confidential Assistant transcribed by her corrected by me and pronounced in open Forum on this the 11th day of March, 2016. Sd/- Smt.Elizabeth George (President) : Sd/- Sri. Antony Xavier (Member) : Sd/- Smt.Jasmine.D. (Member) : Appendix:- Evidence of the complainant:- Ext.A1 - True copy of the FIR Ext.A2 - True copy of the certificate cum policy schedule Ext.A3 - True copy of the accident register-cum-wound certificate Ext.A4 - True copy of the treatment certificate dated 5.12.2009 Ext.A5 - True copy of the discharge summary Ext.A6 - True copy of the MRI Scanning report Ext.A7 - True copy of the hospital documents dated 21.1.2010 Ext.A8 - True copy of the legal notice and acknowledgement card Ext.A9 series- Bills of Medical Trust Hospital Ext.A10 - Disability certificate dated 14.9.2011 Ext.A11 - Attested copy of the driving license Ext.A12 - Certificate dated 25.11.2011 Ext.A13 - Reply notice dated 19.2.2011 Evidence of the opposite party:- Ext.B1 - Terms and conditions of the two wheeler package policy // True Copy // By Order Senior Superintendent To Complainant/Opposite party/S.F. Typed by:- pr/- Compared by:- | 
