By. Smt. Bindu. R, President:
This complaint is filed alleging that the Complainant had insured his Royal Enfield Motorcycle bearing Registration No.KL/12/L/8787 with the Opposite Party for a period from 15.02.2018 to 14.02.2019 with Policy No.71070031170360089732 which is also having PA coverage. On 10.12.2018 at about 4 pm while the Complainant was cleaning the chain of his Motorcycle
in starting position his left index finger, middle and ring finger accidently struck inside the chain cover and sustained grievous injuries. He was taken to Baby Memorial Hospital, Kozhikode and then to ASTER MIMS Hospital, Kozhikode where he was diagnosed total amputation to MF and DIP joint level and partial loss of RF pulp with exposed distal phalanx and accordingly surgery was conducted on 11.12.2018 spending more than Rs.1,00,000/- and has to continue his treatment for long time and suffered permanent disability. The Complainant preferred claim for insurance with Opposite Party and the same has repudiated by letter dated 06.06.2019 on untenable reasons. According to the Complainant, the Complainant had suffered partial loss of 3 fingers and consequent permanent disability which is not appreciated by the Opposite Party while repudiating the claim and hence the Complainant praying for an order directing the Opposite Party to make payment of insurance claim of Rs.2,00,000/- within stipulated time with interest at the rate of 12% along with other reliefs.
2. Upon notice from the Commission the Opposite Parties appeared and filed their version stating that the complaint is not maintainable. There is no deficiency of service on the part of the Opposite Parties as alleged. Policy is admitted by the Opposite Party at the same time if it is contented that the injury was sustained while cleaning the chain of the Motorcycle in starting position and not at the time of travelling or mounting upon or dismounting from the motorcycle and hence they are not liable to pay the claim amount to the Complainant.
3. According to the Opposite Party, the Complainant is not suffering from permanent disablement and as per policy condition for personal accident claim the treatment expenses are not covered, the injuries sustained to the Complainant will not come under the categories mentioned in the policy clause. Hence according to Opposite Party the Complainant is not entitled to get any amount bases on personal accident and prays for dismissal of the complaint.
4. The evidence in this case consists of the oral evidence of PW1 and Ext.A1 to A6 and Ext.X1 series from the side of the Complainant and oral evidence of OPW1 from the side of the Opposite Parties.
5. The following questions are coming up for consideration:-
- Whether the Complainant had sustained to any deficiency of service or unfair trade practice from the Opposite Party?
- Whether the Complainant is entitled to get any compensation from the Opposite Party, if so the quantum of compensation?
- Whether the Complainant is entitled to get cost of the proceedings?.
6. Considered the matter in detail and perused the documents produced and the oral evidence of both the parties. During the examination the Complainant deposed that accident happened while he was cleaning the vehicle on starting mode and not in riding or getting into or getting down from the vehicle. The accident happened not due to the negligence on the part of the Complainant and hence the Opposite Party is liable to pay compensation as per the policy.
7. In evidence of the Opposite Party, as per Ext.X1, the addition payment policy is given to the owner and driver for death and total disability. As per the policy it is specifically stated that “personal accident cover for owner-driver” and Opposite Party admitted that the Complainant is the owner of the vehicle. As per policy condition IMT 15 – Personal accident covered to the insured or any named person other than paid driver or cleaner is there. With respect to Ext.A1 policy the Opposite Party deposed that there is a limit of liability clause saying “limitation as to used” and according to the Opposite party in the box there is no violation that clause by the Complainant. It is deposed by the OPW1 in the box that the term “personal accident” is not defined anywhere in the policy condition.
8. On going through the complaint, version filed by the Opposite Party and also the records produced from either sides the Commission come to the following inferences. The Opposite Party in their version stated that the accident had not happened while the vehicle was plying or running and moreover at the time when the accident happened the driver of the vehicle was not on the vehicle and therefore he is not entitled for any benefit from the Opposite Party. It is a wrong version and the Opposite Party had misinterpreted the term “accident” which need not have happened while on riding or sitting or mounting or dismounting from the vehicle. It can happen at any time. This Commission specifically examined the case of the Complainant and it can be seen that the accident has caused to the Complainant from the vehicle. The vehicle is insured not for a particular type of accident but for all type of accidents and the accident happened to the Complainant is from the vehicle which fact is not denied by the Opposite Party. In the particular case the insurer/the Complainant sustained injury while the chain was cleaning when the engine was in started condition and not due to the carelessness of the Complainant. Since the accident is happened from the vehicle that alone need to be considered at this time. Since the accident is happened from the vehicle and the since the vehicle is insured for the accident this Commission is of the opinion that the Insurance Company is liable to compensate the Complainant.
9. The overall consideration reveals that the Complainant has proved his case and the Complainant is entitled to get the medical expenses incurred to him due to the accident and the Opposite Party cannot repudiate the claim of the Complainant on flimsy grounds. Hence the following orders are issued.
- Directing the Opposite Party to release the claim amount of Rs.2,00,000/- (Rupees Two Lakh Only) to the Complainant within one month from the date of receipt of the Order.
- Opposite Party is directed to pay Rs.25,000/- (Rupees Twenty Five Thousand Only) towards compensation to the Complainant.
- Opposite Party is directed to pay Rs.5,000/- (Rupees Five Thousand Only) as cost of the proceedings.
Needless to say that if the above said amounts are not paid within one month from the date of receipt of the Order, the Opposite Parties have to pay interest @ 8% from the date of order till the date of realization except for the costs ordered.
Hence the Consumer Case is partly allowed.
Dictated to the Confidential Assistant, transcribed by him and corrected by me and pronounced in the Open Commission on this the 19th day of June 2023.
Date of Filing:-20.02.2020.
PRESIDENT :Sd/-
MEMBER :Sd/-
APPENDIX.
Witness for the Complainant:-
PW1. Shibu. K. Driver.
Witness for the Opposite Parties:-
OPW1. Nandakumar. O. Senior Divisional Manager.
Exhibits for the Complainant:
A1. Copy of Motor Two Wheeler Certificate cum policy Schedule Cum
Receipts for the period of 15.02.2018 to 14.02.2019.
A2. Copy of Motor Claim Form.
A3. Copy of Letter. Dt:06.06.2019.
A4. Copy of Registration Certificate.
A5. Copy of Driving License.
A6. Copy of Discharge Summary.
Exhibits for the Opposite Parties:-
X1 (Series). Documents produced by the Opposite Parties (54 Pages).
PRESIDENT :Sd/-
MEMBER :Sd/-
/True Copy/
Sd/-
ASSISTANT REGISTRAR
CDRC, WAYANAD.
Kv/-
