BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MYSORE-570023

CONSUMER COMPLAINT NO.315/2017

DATED ON THIS THE 10^th May 2018

      Present:  1) Sri. H.M.Shivakumara Swamy

B.A., LLB., - PRESIDENT  

                     2) Sri. Devakumar.M.C.                  

                                                B.E., LLB., PGDCLP   - MEMBER

Sri. Devakumar,M.C.

Member

1.     The complainant filed the complaint under section 12 of the C.P.Act 1986, against opposite party, alleging deficiency in service and seeking a direction to pay Rs.2,00,000/- being the risk covered, Rs.1,00,000/- for the mental agony, Rs.2,000/- towards notice charges, Rs.20,000/- towards litigation expenses in all a total sum of Rs.3,22,000/- with interest at the rate of 24% from the date of claim till the date of realization with such other reliefs.
2.     The complainant submits that, his vehicle bearing No.KA-09-MA-3385, insured with opposite party, met with an accident near Jalor, Rajastan State on 20.04.2017.  His left upper limb was amputed at Shalby Hospital, and got discharged on 26.04.2017 and returned to Mysuru.  The jurisdictional police registered the complaint.  Later, intimation was delivered to opposite party vide letter dated 26.07.2017, by enclosing necessary documents and made the claim for payment of Rs.2,00,000/- under the insurance policy.  The opposite party not settled the claim amount.  Hence, the aggrieved complainant filed the complaint seeking reliefs.
3.     The opposite party filed their version and admits the insurance policy and its validity in respect of the vehicle involved in the accident.  The opposite party admits the receipt of certain documents, but without duly filled in claim form, to enable them to process the claim in accordance with the policy terms and conditions.  The legal notice caused by complainant was admitted.  Due to non-compliance of demand by the opposite party, the claim was not settled.  Hence, denied the allegations of deficiency in service and prays for dismissal of the complaint with costs.
4.     Both parties led evidence by filing affidavit and relied on certain documents.  Written arguments filed.  Heard the respective counsels.  Perused the material on record and posted the matter for orders.     
5.     The points arose for our consideration are:-

1. Whether the complainant establishes the deficiency in service by opposite party, for not settling the claim amount under the insurance policy in respect of his vehicle and thereby he is entitled for the reliefs sought?
2. What Order?

6.    Our findings on the aforesaid points are as follows:

Point No.1 :-  In the negative

Point No.2:- As per final order

:: R E A S O N S ::

7.    Point No.1:- The complainant was the owner of the vehicle bearing No.KA-09-MA-3385, got insured his vehicle with opposite party, on payment of premium of Rs.23,286/- and the insurance policy was valid between 20.04.2017 to 19.04.2018.
8.    The vehicle met with an accident at 12.30 AM on 20.04.2017, while proceeding to his place, near Jalor, Rajastan State.  Due to the said accident, the complainant suffered serious injuries and his left upper limb was amputed at Hospital and later got discharged from hospital on 26.04.2017.
9.    The accident was registered at Sayal Police Station, Jalor District, Rajastan State.  Accident information was communicated to opposite party vide letter dated 26.07.2017, by enclosing certain documetns.  The complainant made the personal accident claim amount of Rs.2,00,000/- under the insurance policy.  In spite of submission of claim form with relevant documents on 26.07.2017, the opposite party failed to settle the claim.  Hence, the complaint, alleging deficiency in service for non-settlement of the claims under the policy.
10. The opposite party contended that, the complainant intimated the occurrence of accident at Rajastan State with certain documents.  However, they called upon the complainant to submit the duly filled in “claim form” along with all the records, such as, hospital records, discharge summary bills, lab reports, etc., vehicle documents, KYC documents, bank particulars to consider the claims under the policy, but the complainant failed to furnish the same, as such, they were unable to process the settlement of claim.  In view of the same, the allegation of deficiency in service is denied as false and contended that the complaint is not maintainable and liable to be dismissed with costs.
11. On perusal of the pleadings, evidence and the documents place on record, it is true that, the complainant’s vehicle insured with opposite party, met with an accident at Jolar District of Rajastan State.  The complainant intimated the opposite party about the accident and furnished few documents along with the letter dated 26.07.2017.  It is true that, the complainant made the claim under the policy, but without submission of requisite claim form, as per the policy terms and conditions to settle the claim.  The opposite party on receipt of the legal notice, replied the same, calling upon the complainant to submit various documents, to proceed further to settle the claims.  The complainant instead of furnishing the relevant documents sought by opposite party resorted to file this complaint by alleging deficiency in service and seeking reliefs, which is not justified.  However, the complainant is at liberty to seek claims under the policy, by submitting the necessary documents to the opposite party, to process the claim settlement at the earliest.  Therefore, it is correct to direct the complainant to submit all the relevant documents along with the duly filled in claim form to the opposite party in order to process and settle the claims.  Further, the opposite party has to settle the claim amount, on receipt of the necessary documents with claim form.  In view of the same, the opposite party is not liable to pay any compensation to the complainant.  Accordingly, the point No.1 is answered in the negative.

12. Point No.2:- With the above observations in point No.1, we proceed to pass the following order:-

:: O R D E R ::

1. The complaint is hereby dismissed with the following directions:-
   1. The complainant is hereby directed to submit the duly filled in claim form along with all the relevant documents sought by the opposite party, in order to process and settle the claims in accordance with the policy terms and conditions to the opposite party, within 30 days of this order.
   2. Further, the opposite party is hereby directed to settle the admissible claims in accordance with the provisions of the policy, in favour of the complainant, within 30 days, after receipts of all the necessary documents from the complainant.
2. Give the copies of this order to the parties, as per Rules.

(Dictated to the Stenographer transcribed, typed by her, transcript corrected by us and then pronounced in open court on this the 10^th May 2018)