Karnataka

Chitradurga

CC/94/2015

Sri. P.B.Umesha alias Umesha Gowda, S/o. P.S.Basavaraja - Complainant(s)

Versus

The Branch Manager, National Insurance Co.Ltd., - Opp.Party(s)

Shri.G.Nataraj

29 Sep 2016

ORDER

COMPLAINT FILED ON : 17/11/2015

     DISPOSED ON: 29/09/2016

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHITRADURGA

 

CC. NO. 94/2015 DATED:  29th September 2016

 

PRESENT :-     SRI. T.N. SREENIVASAIAH      PRESIDENT                                      B.A., LL.B.,

                        SRI.N. THIPPESWAMY             MEMBER

                                         B.A., LL.B.,     

COMPLAINANT	P.B. Umesha Umesh Gowda, S/o P.S. Basavaraja, Age: 28 Years, R/o Byrapura Village, Molakalmur Taluk, Chitradurga.   (Rep by Sri. G. Nataraj, Advocate)
OPPOSITE PARTY	The Branch Manager, National Insurance Co. Ltd., Jagalur MahalingappaComplex, , B.D. Road, Chitradurga.      (Rep by Sri. B.M. Ravichandra,  Advocate)

SRI. T.N. SREENIVASAIAH. PRESIDENT.

ORDER

 

The complainant has filed a complaint U/s 12 of C.P. Act 1986 against the OP for a direction to the OP to pay Rs.25,000/- towards disability, Rs.50,000/- towards medicines, Rs.14,763/- towards vehicle damage with interest at the rate of 18% p.a, Rs.5,000/- towards mental, cost  and such other reliefs.  

2.     The brief facts of the case of the complainant are that, he is the RC owner of Super Splendor Bike bearing Reg. No.KA-16 S-1394 and the same has been insured with the OP under policy No.603703/11/6200010582, which was valid for the period from 23.12.2011 to 22.12.2012 covering the risk of own damage for an IDV of Rs.27,000/- and the personal accident cover to owner cum driver for a sum of Rs.1,00,000/-.  Complainant has paid total premium of Rs.900/- and the policy issued by the OP does not disclose the terms and conditions.  It is further submitted that, on 04.06.2012 when the complainant and his father while returning from Chitradurga to Byrapura at about 5-00 PM, complainant lost control over the vehicle and suddenly dashed against the cement traffic caution near B.G. Kere, S.H-19.  In the said accident, the vehicle damaged and the complainant and his father sustained grievous injuries.  Soon after the accident, complainant and his father were shifted to Government Hospital, Molkalmuru, later on complainant shifted to VIMS Hospital, Bellary for higher treatment.  It is further submitted that, he has intimated about the accident to OP through telephone, OP appointed a surveyor to assess the damage caused to the vehicle.  Complainant repaired his vehicle at Veerendra Motors, Molakalmuru by incurring an expenses of Rs.14,763/- and submitted claim to the OP at Bellary on 10.11.2012 through post but, the OP neither settled the claim nor repudiated the claim of the complainant.  It is further submitted that, his father filed a claim petition in MVC No.1016/2012 before I Additional District and Sessions Judge, Bellary and the same was allowed but, the claim of the complainant with the OP has not been settled.  Complainant has taken treatment at VIMS Hospital, Bellary and later with Dr. Shiva Naik. R in Asha Hospital, Bellary, who is an Orthopedic from 04.08.2012 to 21.06.2012 as an inpatient wherein the disability certificate has been issued to the extent of 25%.  Complainant has incurred a sum of Rs.60,000/- towards medicines and nourishment.  The insurance policy is covered the risk of personal accident for a sum of Rs.1,00,000/-.  The cause of action arose to file this complaint was on 04.06.2012, the date of accident and on 10.11.2012 the claim submitted by the complainant.  It is further submitted that, earlier this complainant has filed the complaint in C.No.163/2014 before the District Consumer Forum, Bellary and the same has been returned with a direction to get the relief from this Forum vide order dated 09.10.2015.   The conduct of the OP in non settling of the claim made by the complainant amounts to deficiency of service so, he sustained financial loss and mental agony and etc., and prayed for allow the complaint.

 

3. On service of notice OP appeared through Sri. B.M. Ravichandra, Advocate and filed version admitting about the issuance of policy for the period from 23.12.2011 to 22.12.2012 in the name of complainant to his vehicle bearing Reg. No.KA-16 S-1394 covering the risk of 3^rd party injury and death unlimited and PA to owner cum driver for a sum of Rs.1,00,000/- and third party property damage is limited as per the Act and the said policy covers IDV for an amount of Rs.27,000/- as per the terms and conditions and confirmation of 64 VB and also to the terms and conditions of M.V. Act.  It is further submitted that, complainant intimated about the accident on 12.09.2012 through claim petition along with estimation of Veerendra Motors stating that, his vehicle met with an accident on 04.06.2012 and the OP appointed its surveyor by name Suryanarayana to conduct final survey and the said surveyor conducted survey and given his report on 02.02.2013 stating that, the insurers liability towards damage to the vehicle at Rs.6,838/-.  After obtaining final survey report from the surveyor, OP has issued letter through RPAD to the complainant on 20.02.2013 and on 07.08.2013 calling upon the complainant for production of DL, RC Book, Bills and stamped receipt for the payment made to the garage and cash memos for the part sanction but, the complainant replied nor given documents.  Again on 02.09.2013 OP issued letter through RPAD to the complainant calling upon to produce the above said documents within 3 days but, the replied nor produced the documents.  Hence, there is no deficiency of service on the part of OP.  It is further submitted that, the complainant intimated about the accident to the OP on 12.09.2012, wherein the accident took place on 04.06.2012 and the FIR was lodged to the concerned police on 04.06.2012 i.e., after 101 days from the date of accident, which is a violation of terms and conditions of the Motor policy, wherein it has been mentioned that, Notice shall be given in writing to the company immediately upon the occurrence of any accidental loss or damage in the event of any claim and thereafter the insured shall give all such information and assistance as the company shall require.  Every letter claim writ summons and/or process or copy thereof shall be forwarded to the company immediately on receipt by the insured.  Notice shall also be given in writing to the company immediately the insured shall have knowledge of any impending prosecution, inquest or fatal injury in respect of any occurrence which may give rise to a claim under this policy.  Complainant has intimated to the OP about the accident on 12.09.2012 along with claim form and estimation to settle his claim.  After receiving the said letter, OP issued notice dated 20.02.2013, 07.08.2013 and on 02.09.2013 calling upon him to explain about the delay in intimating about the accident but, the complainant has not replied, therefore, OP closed the claim of the complainant as "the file be closed" and the same has been intimated to the complainant.  It is further submitted that, OP has collected Rs.50/- towards IMT 18 i.e., personal accident benefit to owner cum driver for an amount of Rs.1,00,000/-.  It is further submitted that, the records produced by the complainant will not attract as per the policy condition No.III of P.A claim and also as per the said condition, OP is not liable to pay any P.A claim and also the said policy does not cover to give benefit towards medical bills. Therefore, there is no deficiency of service on the part of OP and hence, prayed for dismissal of the complaint.   

        4. Complainant himself examined as PW-1 by filing affidavit evidence and documents are marked at Ex.A-1 to Ex.A-22. 

5.     On behalf of OP one Sri. Malatesh, the Assistant Manager of OP examined as DW-1 by filing affidavit evidence and Ex.B-1 to B-12 documents have been got marked.   

 

        6. Arguments heard.

 

7. Now the Points that arise for our consideration for the decision of the complaint are that:

 

Point No.1:- Whether the complainant proves that, OP has committed deficiency of service in settling the claim made by him and he is entitled for compensation as stated in his complaint?

 

Point No.2:- What order?

 

        8. Our findings on the above points are as follows:

 

        Point No.1:- In Negative.

        Point No.2:- As per the final order.

                                        ::REASONS::

9. Point No. 1:- It is not in dispute that, complainant is the RC owner of Super Splendor Bike bearing Reg. No.KA-16 S-1394 and the same has been insured with the OP under policy No.603703/11/6200010582 for the period from 23.12.2011 to 22.12.2012 covering the risk of own damage for an IDV of Rs.27,000/- and the personal accident cover to owner cum driver for a sum of Rs.1,00,000/-.  On 04.06.2012 at about 5-00 PM, the said vehicle met with an accident near B.G. Kere, S.H-19 and damaged and the complainant who is the driver at that time and his father who is a pillion rider sustained grievous injuries.  Soon after the accident, complainant and his father were shifted to Government Hospital, Molkalmuru, later on complainant shifted to VIMS Hospital, Bellary for higher treatment.  He has intimated about the accident to OP through telephone, OP appointed a surveyor to assess the damage caused to the vehicle.  Complainant repaired his vehicle at Veerendra Motors, Molakalmuru by incurring an expenses of Rs.14,763/- and submitted claim to the OP at Bellary on 10.11.2012 through post but, the OP neither settled the claim nor repudiated the claim of the complainant.  Complainant has taken treatment at VIMS Hospital, Bellary and later with Dr. Shiva Naik. R in Asha Hospital, Bellary, who is an Orthopedic from 04.08.2012 to 21.06.2012 as an inpatient wherein the disability certificate has been issued to the extent of 25%.  Complainant has incurred a sum of Rs.60,000/- towards medicines and nourishment.  The insurance policy is covered the risk of personal accident for a sum of Rs.1,00,000/-.  As on the date of accident, insurance policy was in force.  It is the main contention of the complainant that he made a claim to the OP along with claim petition but, the OP has not settled the claim.  Hence, filed a complaint.   

 

        10.  In support of his contentions,  complainant has relied on his affidavit evidence in which he has reiterated the contents of complaint.  Complainant has also relied on documents like certified copy of order in C.C.No.163/2014 passed by District Consumer Forum, Bellary marked as Ex.A-1, Original complaint copy in C.C.No.163/2014 marked as Ex.A-2, Certified copy of version in C.C.No.163/2014 marked as Ex.A-3, Certified copy of affidavit of the complainant in C.C.No.163/2014 marked as Ex.A-4, Certified copy of affidavit of the witness in C.C. No.163/2014 marked as Ex.A-5, Certified copy of the affidavit of OP in complaint No.163/2014 marked as Ex.A-6, Copy of the FIR marked as Ex.A-7, Copy of IMV report marked as Ex.A-8, copy of policy marked as Ex.A-9, copies of medical bills in all 6 marked as Ex.A-10, Copy of wound certificate marked as Ex.A-11, Disability certificate marked as Ex.A-12, copies of 2 OPD slips issued by VIMS, Bellary marked as Ex.A-13, Copy of cash bill issued by Asha Hospital, Bellary marked as Ex.A-14, letter dated 10.11.2012 written by complainant to OP marked as Ex.A-15, copy of policy marked as Ex.A-16, certified copy of survey report marked as Ex.A-17, certified copy of motor claim form marked as Ex.A-18, certified copies of 3 letters issued by OP marked as Ex.A-19 to Ex.A-21, certified copies of postal acknowledgements marked as Ex.A-22.                

 

 11. On the other hand, it is argued by the Advocate for OP that, it has issued insurance policy for the period from 23.12.2011 to 22.12.2012 in the name of complainant to his vehicle bearing Reg. No.KA-16 S-1394 covering the risk of 3^rd party injury and death unlimited and PA to owner cum driver for a sum of Rs.1,00,000/- and third party property damage is limited as per the Act and the said policy covers IDV for an amount of Rs.27,000/- as per the terms and conditions and confirmation of 64 VB and also to the terms and conditions of M.V. Act.  Complainant has intimated about the accident on 12.09.2012 through claim petition along with estimation of Veerendra Motors even though, his vehicle met with an accident on 04.06.2012. OP appointed its surveyor by name Suryanarayana to conduct final survey who conducted survey and given his report on 02.02.2013, the insurers liability towards damage to the vehicle was at Rs.6,838/-.  After obtaining final survey report, OP has written a letter through RPAD to the complainant on 20.02.2013, 07.08.2013 and on 02.09.2013 calling upon the complainant to produce DL, RC Book, Bills and stamped receipt for the payment made to the garage and cash memos for the part sanction but, the complainant replied nor given documents but, the complainant replied nor produced any documents.  Hence, there is no deficiency of service on the part of OP.  The complainant intimated about the accident to the OP on 12.09.2012, even though the accident took place on 04.06.2012 and the FIR was lodged to the concerned police on 04.06.2012 i.e., after 101 days from the date of accident, which is a violation of terms and conditions of the Motor policy.  As per the policy terms and conditions, Notice shall be given in writing to the company immediately upon the occurrence of any accidental loss or damage in the event of any claim and thereafter the insured shall give all such information and assistance as the company shall require and Notice shall also be given in writing to the company immediately the insured shall have knowledge of any impending prosecution, inquest or fatal injury in respect of any occurrence which may give rise to a claim under this policy.  After receiving the his  letter dated 12.09.2012, OP issued notice dated 20.02.2013, 07.08.2013 and on 02.09.2013 calling upon him to explain about the delay in intimating about the accident but, the complainant has not replied, therefore, OP closed the claim of the complainant as "the file be closed" and the same has been intimated to the complainant.  The records produced by the complainant will not attract as per the policy condition No.III of P.A claim and also as per the said condition, OP is not liable to pay any P.A claim and also the said policy does not cover to give benefit towards medical bills.

12.   In support of its contention, OP has relied on affidavit evidence of its Assistant Manager, in which he has reiterated the contents of version.  OP has also relied on documents like certified copy of policy marked as Ex.B-1, Two wheeler package policy marked as Ex.B-2, Intimation letter dated 12.09.2012 by the complainant marked as Ex.B-3, Original Claim Form marked as Ex.B-4, Original estimation marked as Ex.B-5, Final Survey report marked as Ex.B-6, Certified copy of FIR marked as Ex.B-7, Certified copy of Charge Sheet marked as Ex.B-8, letters dated 20.02.2013, 07.08.2013 and 02.09.2013 marked as Ex.B-9 to Ex.B-11 and three postal acknowledgements marked as Ex.B-12.

13.   On the rival contentions of both the parties and on perusal of the complaint, version and documents, it is seen that, the complainant is the RC owner of motor cycle bearing Reg. No.KA-16 S 1394 and the same was insured with the OP under policy No.603703/11/6200010582 and the same was valid for the period from 23.12.2011 to 22.12.2012 for and IDV value of Rs.27,000/- and the PA cover to owner cum driver for an amount of Rs.1,00,000/-, which is not in dispute.  But, the OP has taken a  contention that, the accident took place on 04.06.2012 but, the same has not been intimated to the OP well in time.  The complainant has intimated about the accident to the OP on 12.09.2012 i.e., after 101 days of occurrence of an accident.  After intimation, OP sent a letter to the complainant to furnish necessary original documents to the insurance company but, the complainant never produced any documents to the OP.  It clearly goes to show that, the complainant is negligent in producing the required documents to the OP. Therefore, there is no deficiency of service on the part of OP.  The main point to consider is as to whether the complainant  intimated about the accident immediately to the OP or not? Here   admits about issuance of policy to the above said motor cycle.  Here, the complainant intimated about the accident to the OP after 101 days of occurrence of incident.  Moreover, after the claim intimation, OP has sought for production of documents but, the complainant has not produced any documents to the OP to consider his claim, which shows the negligence on the part of complainant.  The OP has relied on a decision reported in "CPJ 2003 page 77 NC" where, the theft of the vehicle has been reported to the insurance company after one month, wherein it is observed that, if the insurance company repudiated the claim of the complainant on the said ground, which is not a deficiency of service.  OP has also relied on another judgment passed in First Appeal No.321/2005 of Hon'ble National Commission dated 09.12.2009 wherein it is observed that, the delay in intimating the theft of the vehicle, the company is not liable to pay any compensation.  The legal notice was by the complainant on 10.11.2012 claiming benefit under the policy and the OP has issued notice calling upon to produce the necessary documents and explain as to why the delay in intimating about the accident but, the complainant has not replied to the same.  So, the complainant himself is deficient in fulfilling requirements sought for by the OP.  So, the complainant has failed to prove the deficiency of service committed by the OP.  Therefore, the citation and judgment quoted by the OP is applicable to the case on hand. Therefore, we come to the conclusion that, there is a no deficiency of service on the part of OP/insurance company.  Hence, the complainant is not entitled for compensation as claimed.  Accordingly, this Point No.1 is held as Negative to the complainant.

 

15.  Point No.2:- For the foregoing reasons, we pass the following.

ORDER

The complaint filed by the complainant U/s 12 of CP Act 1986 is hereby dismissed.  No order as to costs.

         (This order is made with the consent of Member after the correction of the draft on 29/09/2016 and it is pronounced in the open Court after our signatures.)

 

 

 

MEMBER                                         PRESIDENT

 

-:ANNEXURES:-

 

Complainant by filing affidavit evidence taken as PW-1

Witness examined on behalf of Complainant:

                                                          -Nil-

On behalf of OPs one Sri. Malatesh, Assistant Manager of OP by filing affidavit evidence taken as DW-1

Witnesses examined on behalf of OPs:

 -Nil-

Documents marked on behalf of Complainant:

01	Ex-A-1:-	Certified copy of order in C.C.No.163/2014 passed by District Consumer Forum, Bellary
02	Ex-A-2:-	Original complaint copy in C.C.No.163/2014
03	Ex-A-3:-	Certified copy of version in C.C.No.163/2014
04	Ex-A-4:-	Certified copy of affidavit of the complainant in C.C.No.163/2014
05	Ex-A-5:-	Certified copy of affidavit of the witness in C.C. No.163/2014
06	Ex-A-6:-	Certified copy of the affidavit of OP in complaint No.163/2014
07	Ex-A-7:-	Copy of the FIR
08	Ex-A-8:-	Copy of IMV report
09	Ex-A-9:-	Copy of policy
10	Ex-A-10:-	Copies of medical bills in all 6
11	Ex-A-11:-	Copy of wound certificate
12	Ex-A-12:-	Disability certificate
13	Ex-A-13:-	Copies of 2 OPD slips issued by VIMS, Bellary
14	Ex-A-14:-	Copy of cash bill issued by Asha Hospital, Bellary
15	Ex-A-15:-	Letter dated 10.11.2012 written by complainant to OP
16	Ex-A-16:-	Copy of policy
17	Ex-A-17:-	Certified copy of survey report
18	Ex-A-18:-	Certified copy of motor claim form
19	Ex-A-19 to 21:-	Certified copies of 3 letters issued by OP
20	Ex-A-22:-	Certified copies of postal acknowledgements

Documents marked on behalf of Opponent:

01	Ex-B-1:-	Certified copy of policy
02	Ex.B-2:-	Two wheeler package policy
03	Ex.B-3	Intimation letter dated 12.09.2012 by the complainant
04	Ex.B-4:-	Original Claim Form
05	Ex.B-5:-	Original estimation
06	Ex-B-6:-	Final Survey report
07	Ex.B-7:-	Certified copy of FIR
08	Ex.B-8:-	Certified copy of Charge Sheet
09	Ex.B-9 to 11:-	Letters dated 20.02.2013, 07.08.2013 and 02.09.2013
10	Ex.B-12:-	Three postal acknowledgements

 

 

 

MEMBER                                         PRESIDENT

Rhr.