By Sri. MOHAMED ISMAYIL.C.V, MEMBER
The grievance of the complainant is as follows:-
1. It is stated by the complainant that he had purchased a Bajaj Re 445Autorickshaw bearing No. KL-16 H-9321 from one Mr.Abdul Nasar for his livelihood.It is further stated that an insurance policy coverage was availed to the vehicle from the opposite parties and Rs.8,210/- was remitted as premium of the insurance scheme. The insurance coverage was valid from 22/03/2021 to 21/03/2022. The opposite parties have calculated IDV value of the vehicle as Rs. 54,000/-(Rupees Fifty four thousand only). It is also stated that insurance coverage was duly transferred in favour of the complainant after making change in the registration certificate of the vehicle.
2. But on 03/05/2022, the vehicle was overturned while attempting to save stray dogs. Due to the accident, the complainant has sustained serious injury and hospitalised for treatment. The vehicle was also damaged. It is averred that police has registered the accident in General Diary of Police Station, Valanchery. It is stated that the complainant had spent Rs.77,204/- (Rupees Seventy seven thousand two hundred and four only) for his treatment in EMS Hospital, Perinthalmanna and also spent Rs. 44,020/- (Rupees Forty four thousand and twenty only) for treatment in Shafi Ayurvedic Nursing Home. The incident was reported before the opposite parties and vehicle was entrusted with Pang Auto Garage for repair work. It is submitted that quotation bill was handed over to the opposite parties and later on the basis of direction given by the opposite parties, repairment work was started. The complainant has contacted with the opposite parties with required documents for reimbursement of expenses incurred for repair work and treatment. But the complainant was compelled to contact the opposite parties repeatedly for proper action. Later the opposite parties paid Rs.15,000/- (Rupees Fifteen thousand only) as the amount of reimbursement of expenses incurred for repair work of the vehicle. It is averred that the complainant has incurred a total of Rs. 30,253/- for repair work. But the opposite parties have reimbursed only Rs. 15,000/-. It is alleged by the complainant that the opposite parties have also rejected claim for reimbursement of medical expenses of Rs. 1,21,224/- incurred for his treatment. It is alleged that the opposite parties have negligently treated claim application of the complainant. It is stated that the complainant has incurred a total amount of Rs. 1,51,477/- for his treatment and repair work of vehicle. But the opposite parties refunded only Rs. 15,000/-. The act of the opposite parties are amounted to deficiency in service as well as unfair trade practices. So the complainant has prayed for a direction to the opposite parties to reimburse Rs. 1,36,477/- as the balance amount of the expenses incurred for his treatment and repair work of vehicle with interest under the insurance coverage. The complainant also prayed for a direction to the opposite parties to pay Rs. 3,00,000/-(Rupees Three lakh only) as compensation for the sufferings of mental agony and hardship due to the acts of the opposite parties. The complainant also claimed Rs.50,000/- (Rupees Fifty thousand only) from the opposite parties as cost of the proceedings.
3. The complaint is admitted and issued notices to the opposite parties. The opposite parties have entered appearance and filed version jointly.
4. The version was filed by the authorised officer of the opposite parties. The opposite parties denied allegation made in the complaint. The opposite parties have admitted issuance of insurance policy to the complainant. It is also admitted that they had received a claim in connection with damages of vehicle. But it is contended by the opposite parties that they did not receive any claim application with respect of personal accident cover for owner/driver. So the opposite parties are not answerable to the complainant in that regard. It is contended that damage of the vehicle was assessed by a competent surveyor and on the basis of assessment Rs. 15,138/- has been paid to the complainant. It is contended that assessment was done in accordance with terms and conditions of the policy. According to the opposite parties, the complainant does not sustained any injuries or disability as required by terms of the policy for insurance benefits. The opposite parties did not commit any kind of deficiency in service towards the complainant, hence prayed for dismissal of the complaint.
5. The complainant and the opposite parties have filed affidavits in lieu of evidence. The documents of the complainant is marked as Ext.A1 to Ext.A7 documents. Ext.A1 document is the copy of insurance certificate issued by the opposite parties in favour of former owner of the vehicle showing its validity from 22/03/2021 to 21/03/2022. Ext.A2 document is the copy of certificate of registration of the vehicle showing the ownership of the vehicle in favour of the complainant. Ext. A3 document is the copy of Commercial Motor Passenger Carrying Endorsement issued by the opposite parties showing transfer of insurance coverage in favour of the complainant. Ext. A4 document is the copy of relevant portion of General Diary of Valancheri Police Station showing the details of accident occurred to the vehicle of complainant as averred in the complaint. Ext. A5 document is the copy of work bill dated 23/05/2022 issued by Pang Auto Garage showing the expenses of repair work of the vehicle. Ext. A6 document is the copy of discharge bill dated 23/03/2022 issued by EMS Memorial Co-operative Hospital in favour of the complainant. Ext. A7 document is the copy of discharge bill dated 21/05/2022 issued by Shafi Ayurvedic Nursing Home in favour of the complainant. The documents of the opposite parties are marked as Ext.B1 and Ext B2 documents. Ext.B1 document is the copy of certificate of Policy and its conditions issued in favour of the former owner of the vehicle. Ext.B2 document is the copy of survey report in connection in the damage of vehicle of the complainant.
6. Heard both sides in detail. Perused affidavit and documents carefully. The following points are arise for consideration:-
- Whether the act of the opposite parties are amounted to deficiency in service?
- Cost and relief?
7. Point No.(i) & (ii):-
The Commission is considering the above points together as those are interrelated. The argument of the complainant is that claim application submitted for reimbursement of expenses incurred for his treatment and repair work of vehicle are negligently treated and arbitrarily rejected by the opposite parties. It is argued by the complainant that he got every right to get reimbursement of total expenses incurred for his treatment and repair work of vehicle in the strength of insurance policy coverage issued by the opposite parties as per Ext.A1 document. The opposite parties have reimbursed only Rs.15,000/- to the expenses incurred for repair work instead of Rs. 30,253/-and the opposite parties are not cared to reimburse Rs.1,21,224/-, the expenses incurred for his treatment. It is pleaded in the complaint that the complainant had purchased KL-16 H-9321 autorickshaw for his livelihood from one Mr. Abdul Nasar and produced copy of registration certificate as Ext.A2 document. Ext.A3 document produced by the complainant would show that the insurance policy has been duly changed in favour of the complainant from former owner of the vehicle. The vehicle was met with an accident and he had sustained injuries and treated in two hospitals and produced discharge bills. The discharge bills are marked as Ext.A6 and Ext.A7 documents respectively. Ext.A6 document would show that the complainant had spent Rs.77,204/- for treatment in EMS Memorial Hospital & Research Centre Ltd, Perinthalmanna between 16/3/2022 and 23/3/2022. Ext.A7 document would show that the complainant had spent Rs. 44,020/- for his treatment in Shafi Ayurvedic Nursing Home, Kuttippuram. Ext. A5 document would show that Rs. 30,253/- was spent for repair work of vehicle. Ext. A4 document would show that Police has investigated the accident occurred to his vehicle.
8. On the contrary, the opposite parties argued that they have treated claim application for reimbursement of repair work of vehicle properly with due diligence and contended that no application was received with respect to reimbursement of medical expenses. The damage was assessed by competent surveyor as Rs.15,138/- and report is marked Ext.B2 document. Ext.B2 document would show that Rs. 15,138.73/- is found as liability of the opposite parties. It is argued that Rs.15,138/- has been paid to the complainant IDV of the vehicle was only Rs. 54,000/-.
9. It is contended by the opposite parties that no claim application was received from the complainant with respect to the reimbursement of medical expenses incurred as per Ext.A6 and Ext.A7 documents. Moreover the complainant is not eligible for reimbursement of any kind of treatment expenses as per policy conditions. The terms and conditions including policy certificate is produced by the opposite parties and marked as Ext. B1 document. Moreover, it is argued that Rs. 8,210/- paid as premium was not for personal accident coverage.
10. In the evaluation of evidence it can be seen that opposite party admitted insurance policy coverage as per Ext.A1 document. The opposite party also produced same document along with its terms and conditions and same was considered the Commission as Ext.B1 document. The Commission find that there is no merit in the argument of the complainant alleging deficiency in service against the opposite parties. The very case of the complainant is that he is eligible for reimbursement of entire amount in the strength of Ext.A1 document. But in examination, it is find that the complainant is not eligible for reimbursement of medical expenses incurred for his treatment as per Ext.A6 and 7 documents. As per policy conditions as envisaged in Ext.B1 document, it can be seen that the opposite party has undertaken to pay to the owner/driver of the insured vehicle 100% compensation in case of death, 100% compensation for loss of two limbs or sight of two eyes or one limb and sight of one eye , 50% of compensation in case of loss of one limb or sight of one eye and 100% compensation if permanent total disablement from injuries other than above mentioned. So the Commission find that the complainant has miserably failed to prove that he is entitled for availing benefits as prayed in the complaint. The Commission find that Section 4 of terms and conditions of Ext.B1 document exclude the claim of the complainant. The Commission also examined Ext.B2 document and find that the opposite party has duly reimbursed amount incurred for the expenses of repair work of the vehicle. The complainant does not bring any evidence before the Commission to show that he is entitled for full amount mentioned in Ext. A5 document. Moreover, the complainant also failed to show that he had remitted premium of Rs. 8,210/- for personal accident cover. In the examination of Ext. A1 document, it can be seen that the complainant did not remit premium of Rs. 8,210/- for personal accident claim. The complainant also failed to bring evidence to show that he had duly submitted a claim application for reimbursement of medical expenses before the opposite parties. In the light of the discussions made above it is find that complainant has failed to prove his pleadings made in the complaint and there is no deficiency in the service on the part of the opposite parties. Hence complaint is dismissed.
Dated this 28th day of February, 2024.
MOHANDASAN K., PRESIDENT
PREETHI SIVARAMAN C., MEMBER
MOHAMED ISMAYIL C.V., MEMBER
APPENDIX
Witness examined on the side of the complainant : Nil
Documents marked on the side of the complainant : Ext.A1to A6
Ext.A1 : Document is the copy of insurance certificate issued by the opposite parties
in favour of former owner of the vehicle showing its validity from 22/3/2021
to 21/03/2022.
Ext.A2 : Document is the copy of certificate of registration of the vehicle showing the
ownership of the vehicle in favour of the complainant.
Ext.A3: Document is the copy of Commercial Motor Passenger Carrying Endorsement
issued by the opposite parties showing transfer of insurance coverage in
favour of the complainant.
Ext.A4 : Document is the copy of relevant portion of General Diary of Valancheri
Police Station showing the details of accident occurred to the vehicle of
complainant as averred in the complaint.
Ext.A5: Document is the copy of work bill dated 23/05/2022 issued by Pang Auto
Garage showing the expenses of repair work of the vehicle.
Ext.A6 : Document is the copy of discharge bill dated 23/03/2022 issued by EMS
Memorial Co-operative Hospital in favour of the complainant.
Ext.A7: Document is the copy of discharge bill dated 21/05/2022 issued by Shafi
Ayurvedic Nursing Home in favour of the complainant.
Witness examined on the side of the opposite party : Nil
Documents marked on the side of the opposite party : Ext. B1 & B2.
Ext.B1 : Document is the copy of certificate of Policy and its conditions issued in
favour of the former owner of the vehicle.
Ext.B2: Document is the copy of survey report in connection in the damage of vehicle
of the complainant.
MOHANDASAN K., PRESIDENT
PREETHI SIVARAMAN C., MEMBER
MOHAMED ISMAYIL C.V., MEMBER
