Karnataka

Chitradurga

CC/121/2017

Prashanthkumar K.R - Complainant(s)

Versus

The Branchmanager,National Insurance Co.ltd., - Opp.Party(s)

Sri.H.S.Niranjanmurthy

24 Apr 2018

ORDER

COMPLAINT FILED ON:24/11/2017

DISPOSED      ON:24/04/2018

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHITRADURGA.

 

CC.NO: 121/2017

 

DATED:  24^th APRIL 2018

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

                   SRI.N. THIPPESWAMY        : MEMBER

                          B.A., LL.B., PGD., CLP   

 

……COMPLAINANT/S	Prashanthkumar. K.R, S/o Rajanna, Represented by his natural guardian mother Smt. Jayamma, W/o Rajanna, Age: 42 Years, Household, Kolahal Village, Bharamasagara Hobli, Chitradurga Taluk and District.   (Rep by Sri.H.S. Niranjanamurthy, Advocate)
V/S
…..OPPOSITE PARTY	The Branch Manager, National Insurance Company Limited, Jagalur Mahalingappa Complex, P.B. Road, Chitradurga Branch.   (Rep by Sri. B.M. Ravichandra, Advocate)

ORDER

SRI. T.N. SREENIVASAIAH:   PRESIDENT

The above complaint has been filed by the complainant u/Sec.12 of the C.P Act, 1986 for the relief to direct the OP to pay the personal accident benefit of Rs.2,00,000/- along with interest at the rate of 12% p.a, Rs.50,000/- towards mental shock and such others reliefs.

2.      The brief facts of the case of the above complainant are that, her son by name Prashanthkumar.K.R was travelling as a pillion rider in a bike bearing Registration No.KA-16 W-9129 from Jammenahalli to Kolahal on 16.06.2013.  While they travelling near Sirigere village, the driver of the said motor cycle drove the same in a rash and negligent manner and fell down.  Due to the said accident, the son of the complainant sustained grievous injuries over his head and other parts of the body.  Immediately, he was shifted to SSIMS Hospital, Davanagere for treatment.  In spite of giving treatment, the said Prashanthkumar was not recovered and, not able to walk or speech and till now he was in a coma condition and not able identify anything.  The mother of said Prashanthkumar i.e., complainant has spent nearly Rs.4 to 5 lakhs.  On 24.07.2017, the Doctor examined said Prashanthkumar and gave a certificate stating that, he has sustained 75% disability due to the accident occurred on 31.08.2014.   The case was registered before the Bharamasagara Police Station in C.C.No.240/2013.  On 19.08.2017, the mother of the said Prashanthkumar, the complainant herein has filed an application claiming compensation under personal accident benefit.  As she is an illiterate lady, she has filed an application after the limitation period.  But, the OP did not give any reply or to settle the claim made by the complainant.  Therefore, she send legal notice on 06.10.2017 through her counsel by way of RPAD, the same was served to the OP but, the OP never replied or settle the claim.  The cause of action for this complaint has arose on 19.08.2017 when the mother of the policy holder has filed an application before the OP claiming personal accident benefit and when the legal notice issued on 06.10.2017 which is within the jurisdiction of this Forum.  Therefore, the complainant respectfully prayed before this Forum to allow her complaint with cost. 

3.      After issuance of notice to the OP, OP appeared through Sri. B.M. Ravi Chandra, Advocate and filed version.  As per the version of the OP, the personal accident benefit policy bearing No.3901023113620985955 was in force for the period from 16.06.2013 to 15.06.2014 in the name of Prashanth Kumar S/o Rajanna to the motor cycle bearing Registration No.KA-16 W-9129 covering the risk of 3^rd party injury and death unlimited, PA to owner cum driver for an amount of Rs.1,00,000/- only and third party property damage is limited as per the Act and the said policy covers IDV of for an amount of Rs.35,710-/- as per the terms and conditions.  The OP has collected premium of Rs.50/- towards personal accident benefit to owner cum driver for an amount of Rs.1,00,000/-.  As per the said policy, the owner should be on wheels at the time of accident and he should have to possess a proper and valid DL to drive a specific class of vehicle.  Further it is stated that, the complainant has not approached the OP insurance company till this day and also not produced any documents to the OP and not given an opportunity to see the injured person, the place of accident and not produced any single document to the OP to show that, he is suffering from permanent total disability and he has not produced  accident claim form along with necessary documents before the Insurance Company, since the insurance company cannot settle the claim but, the complainant has to prove that, he is suffering from permanent total disability.  The insurance company is not liable for payment of any compensation including medical expenses to the complainant.  Further the complainant has violated the condition No.1 of the policy and as per the policy Condition No.1, the notice shall be given in writing to the complainant 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.  In this case, the complainant has not issued any notice to the OP.  Further the complainant has not issued any notice to the OP.  Further the complainant has not properly approached this Forum.  The accident took place on 30.08.2013 and legal notice was sent on 06.10.2017 and the intimation to the OP Company has been issued after lapse of four years and two months that means, the complainant has violated the condition No.1 of the policy.  The OP has not committed any deficiency in service and hence, prayed for dismissal of the complaint.    

4.      The natural guardian of the complainant Smt.Jayamma has examined as PW-1 by filing affidavit evidence and the documents Ex.A-1 to A-14 were got marked and closed his side. On behalf of OP, one Sri. Malatesh C. Hallur, the Assistant Manager, has examined as DW-1 by filing the affidavit evidence and Ex.B-1 and B-2 documents have been got marked.  

5.      Arguments of both sides heard.

6.      Now the points that arise for our consideration for decision of above complaints are that;

 

(1)  Whether the complainant proves that, her son Prashanth Kumar K.R has sustained grievous injury in a motor bike accident and the OP has committed deficiency of service for not settling the personal accident benefit of his son and entitled for the reliefs as prayed for in the above complaint?

              (2) What order?

          7.      Our findings on the above points are as follows:-

          Point No.1:- Partly in Affirmative.

          Point No.2:- As per final order.

REASONS

8.      It is not in dispute that, one Prashanth Kumar K.R is the owner of bike bearing Reg. No. KA-16 W-9129.   On 31.08.2013 at about 5-00 PM, he was travelling as a pillion rider along with his friend in the said motor cycle from Jammenahalli to Kolahal village.  By that time, due to rash and negligent driving of the driver, the accident took place near Sirigere village and fell down.  Due to the said accident, the said Prashanth Kumar. K.R was sustained grievous injuries over his head and other parts of the body.  After the accident, he was shifted to SSIMS Hospital, Davanagere for treatment.  The said Prashanth Kumar has obtained personal accident benefit policy bearing No.35100731126200762424 to his vehicle and paid Rs.50/- towards the policy premium which was valid for the period from 16.06.2013 to 15.06.2014.  After the accident, the mother of the complainant has shifted him to SSIMS Hospital, Davanagere and taken treatment by spending huge sum i.e., nearly Rs.4 to 5 lakhs.  Doctors have given a report/certificate on 24.07.2014 that, the said Prashanth Kumar has sustained total permanent disability at 75%.  A case was registered before the Bharamasagara Police Station in Crime No.240/2013.  On 19.08.2017, the mother of the complainant has filed an application claiming compensation before the OP but, the OP has not taken any care for settlement of the claim.  The OP has taken a main contention in the version that, the complainant or his mother have not approached the OP Company after the accident and they never filed any application before the OP claiming compensation.  As per condition No.1 of the policy, if any accident took place, party shall intimate the same to the OP Company immediately.  In this case, the incident happened on 31.08.2013 and the intimation was given to the OP company through legal notice dated 06.10.2017 after the lapse of 4 years 2 months.  The OP has taken main contention before this Forum that, before filing a complaint before the Forum, first the insurer has to approach the insurance company for settlement of the claim, if any repudiation made by the OP, then only, the insurer is at liberty to approach the Forum claiming compensation.  The OP has stated that, the complainant has violated the condition No.1 of the policy but, as per the documents produced by the complainant, he has not violated any terms and conditions.  As per Ex.B-2, the certificate cum policy schedule shows the name of Prashanth KumarK.R as insured at column insured, which was valid for the period from 16.06.2013 to midnight of 15.06.2014, which shows the complainant is the policy holder and the same is in force as on the date of accident, therefore, the OP is liable to compensate the injured person.  

9.   We have gone through the entire documents filed by the complainant and the OP.  In the evidence given by the OP, it has not denied about the accident took place on 31.08.2013 and the OP has admitted that, the policy was in force at the time of accident.  But the OP has taken a contention that, the complainant or his mother never intimated the same to the OP well in time.  The same has been intimated by the mother of the complainant after a lapse of four years 2 months.  According to the version and affidavit filed by the OP, first the complainant has to approach the OP claiming compensation, if any repudiation made by the OP, then only the complainant has to approach the Forum seeking redressal.  OP in its version has stated that, the complainant has not approached the OP claiming relief.  But, as per the document produced by the complainant shows that, he has approached the OP claiming compensation along with necessary documents.  In the version, the OP has stated that, if the person died in an accident, he will get compensation at 100%, if loss of two limbs or sight of two eyes or one limb and sight of one eye the compensation will be 100%.  In this case, the said Prashanth Kumar K.R is suffering from 100% total permanent disability due to the accident took place on 31.08.2013 at about 5-00 PM near Sirigere Village.  As on the date of accident, the policy was in force.  Therefore, the complainant is entitled to get compensation for permanent total disability to the tune of Rs.1,00,000/- as per the policy condition.  Accordingly, this Point No.1 is held as partly affirmative to the complainant.          

            10.     Point No.2:- As discussed on the above point and for the reasons stated therein we pass the following:-

ORDER

            The complaint filed by the complainant U/s 12 of CP Act 1986 is partly allowed.

            It is ordered that the OP is hereby directed to pay a sum of Rs.1,00,000/- to the complainant along with interest @ 9% p.a to the complainant from the date of complaint till realization.

            It is further ordered that, the OP is hereby directed to pay Rs.10,000/- towards mental agony and Rs.5,000/- towards cost of the proceedings to the complainant. 

            It is further ordered that, the OP is hereby directed to comply the above order within 30 days from the date of this order.

 (This order is made with the consent of Member after the correction of the draft on 24/04/2018 and it is pronounced in the open Court after our signatures)         

 

                                     

 MEMBER                                                   PRESIDENT

 

-:ANNEXURES:-

Witnesses examined on behalf of Complainant:

PW-1:  Complainant by way of affidavit evidence.

Witnesses examined on behalf of OP:

DW-1:  Sri. Malatesh C. Hallur, Assistant Manager of OP by way of affidavit evidence. 

Documents marked on behalf of Complainant:

01	Ex-A-1:-	True copy of FIR
02	Ex.A-2:-	True copy of complaint by one Raviraj
02	Ex-A-3:-	True copy of Spot Mahazar
03	Ex-A-4:-	True copy of statement of one Sharanappa
04	Ex-A-5:-	True copy of IMV report
05	Ex-A-6 & 7:-	True copies of wound certificates
06	Ex-A-8:-	True copy of charge sheet
07	Ex-A-9:-	Original disability certificate
08	Ex-A-10:-	Two photos
09	Ex-A-11:-	Letter by Jayamma to OP dated19.08.2017
10	Ex-A-12:-	Legal notice dated 06.10.2017
11	Ex-A-13 & 14:-	Postal receipts and acknowledgements

 

Documents marked on behalf of OP:

01	Ex-B-1:-	Original Policy
02	Ex-B-2:-	Certificate cum policy schedule

 

 

 

MEMBER                                                            PRESIDENT

Rhr**