Complaint filed on: 13.07.2016
Complaint Disposed on:07.04.2017
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AT CHICKMAGALUR.
COMPLAINT NO.78/2016
DATED THIS THE 7th DAY OF APRIL 201
:PRESENT:
HON’BLE SRI RAVISHANKAR, B.A.L, LL.B., - PRESIDENT
HON’BLE SMT B.U.GEETHA, M. COM., LL.B., -MEMBER
HON’BLE SMT H. MANJULA, B.A.L., LL.B., - MEMBER
COMPLAINANT:
Sri.Mathew M.M S/o Matai M.M.,
Aged about 49 years, R/o Bilalkoppa,
Honnekodige Post, N.R Pura Taluk.
(By Sri/Smt. Umesh M.P, Advocate)
V/s
OPPONENT:
The Divisional Manager,
United India Insurance Co. Ltd.,
Cresent Court, K.M Road,
Chikmagalur.
(OP By Sri/Smt. T.R.Harish, Advocate)
By Hon’ble President Sri. Ravishankar,
:O R D E R:
The complainant filed this complaint U/s 12 of the Consumer Protection Act 1986 against OP alleging deficiency in service in not settling the claim towards personal accident. Hence, prays for direction against OP to pay Rs.2,00,000/- towards medical expenses and also to pay Rs.5,000/- towards vehicle repair charges along with compensation of Rs.20,000/- for deficiency in service.
2. The brief facts of the complaint is that:
The complainant is the owner of Bajaj Platina 100 motor bike bearing registration No.KA-18/U-8682 and obtained the insurance policy from Op Company which is valid from 21.10.2015 to 20.10.2016. Such being the case, on 22.10.2015 when he was riding the bike toward his banana plantation at Aralikoppa, along with one P.E.Viju, one cattle suddenly jumped on the road and complainant tried to avoid dashing to the cattle applied a brake, immediately the vehicle fell down and complainant along with pillion rider suffered injuries. Immediately after the accident the complainant was shifted to Taluk Government Hospital, N.R Pura and initial treatment were taken, subsequently he was shifted to Kasturba Hospital, Manipal, where he took treatment as an inpatient from 22.10.2015 to 26.10.2015, during his treatment the complainant spent nearly Rs.2,00,000/- towards medical expenses and also spent Rs.5,000/- towards repair of the vehicle.
Subsequently, complainant informed the accident through telephone and also wrote a letter dated 24.05.2016 and requested the Op to settle the claim, but Op refused to settle the claim without any valid reasons. In this regard Op also issued repudiation letter dated 02.06.2016. The repudiation made by Op is against to law and without any valid reasons. Hence, Op rendered deficiency in service in not settling the claim towards personal accident and own damage of the vehicle. Hence, prays for direction against Op to settle the claim along with compensation for deficiency in service.
3. After service of notice Op appeared through his counsel and filed version and contended that they have issued a policy relating to the motor cycle bearing registration no.KA-18/U-8682 in the name of complainant vide policy no.2414003115P108366947, the policy is valid from 21.10.2015 to 20.10.2016. The liability of this Op is subject to the terms, conditions, exceptions and limitations of the policy. At the time of issuance of the policy they have collected an additional premium of Rs.50/- towards personal accident claim. The maximum liability of the Op is only up to Rs.1,00,000/-.
As per the terms and conditions of the policy the accidental claim including the damages caused to the vehicle is to be reported immediately, whereas in the instant case the complainant made a claim on 24.05.2016, whereas the accident took place on 22.10.2015. The complainant made a claim after a gap of more than 7 months.
This Op do not admitted that the complainant met with an accident while he was riding the said motor cycle on 22.10.2015 and also not admits that pillion rider also got injuries in the accident, immediately shifted to the hospital on the same day and subsequently taken treatment at Kasturba Hospital, Manipal as an inpatient from 22.10.2015 to 26.10.2015. This Op also do not admit that the complainant spent Rs.2,00,000/- towards medical treatment and Rs.5,000/- towards repair charges. The said facts to be established through proofs.
In fact the complainant made claim towards above said expenses and same was repudiated through letter dated 02.06.2016 as the claim does not fall within the terms and conditions of the insurance policy. This Op is not liable to pay compensation towards medical expenses as per the terms and conditions of the policy. The Relevant conditions of the policy reads as below:
Section III: PERSONAL ACCIDENT COVER FOR OWNER/DRIVER
The company undertakes to pay compensation as per the following scale for bodily injury/death sustained by the owner/driver of the vehicle, indirect connection with the vehicle insured whilst mounting into/dismounting from or travelling in the insured vehicle as a co-driver, caused by violent accidental external and visible means which independent of any other cause shall within 6 calendar months of such injury results in
- Death-100%
- Loss of two limbs or sight of two eyes or one limb and sight of one eye – 100%
- Loss of one limb or sight of one eye – 50%
- Permanent total disablement from injuries other than named above -100%
Op further contended that in so far as own damage caused to the vehicle the complainant has not intimated the accident immediately, if the complainant informed the accident immediately, this Op would have deputed the surveyor in order to quantify the damages caused to the vehicle. Due to non-intimation of the accident immediately this Op could not arrange the surveyor to assess the loss caused to the complainant. The complainant neither produced the estimate nor the bills towards repair of the vehicle and also not filed any claim with respect to the own damage. Hence, they have not settle the claim under own damage also. The repudiation made by this Op is only as per the terms and conditions of the policy and there is no deficiency in service on the part of this Op and hence prays for dismissal of the complaint.
4. Complainant filed affidavit and marked documents as Ex.P.1 to P.11. Op also filed affidavit and marked policy issued in the name of complainant as Ex.R.1.
5. Heard the arguments.
6. In the proceedings, the following points do arise for our consideration and decision:
- Whether there is deficiency in service on the part of OP.
- Whether complainant entitled for any relief & what Order?
7. Our findings on the above points are as follows:-
- Point No.1: Affirmative.
- Point No.2: As per Order below.
: R E A S O N S :
POINT NOs. 1 & 2:
8. On going through the pleadings, affidavits and documents produced by both complainant and Op, we are of the opinion that the complainant met with an accident at the moment when the cattle come across the road and in order to avoid the major accident complainant applied a brake and suffered injuries. In this regard the police have filed FIR marked as Ex.P.1. N.R Pura Police also prepared spot mahazar as per Ex.P.3, subsequently after the accident complainant took first aid in Government Hospital at N.R Pura, subsequently he went to Kasturba Hospital for further treatment, where he was hospitalized from 22.10.2015 to 26.10.2015, in this regard he also produced one wound certificate marked as Ex.P.4, the complainant also produced nearly 22 medical bills to show that he has spent certain amount towards medical treatment marked as Ex.P.5 and also produced letter dated 24.05.2016 issued in favour of Op marked as Ex.P.6 the estimation he had claimed under personal accident benefit. Further complainant also produced a repudiation letter marked as Ex.P.8. On going through the spot mahazar we observed that the complainant had suffered grievous injuries due to the accident and also the vehicle was damaged due to said accident. The wound certificate i.e., Ex.P.4 also establishes that the complainant suffered grievous injuries due to the accident. Subsequently complainant had sworn affidavit and states that he had intimated the accident to Op on the same day, subsequently he wrote a letter for claim of the benefits under personal accident benefits as per Ex.P.6, for which Op had repudiated the claim for the reason that as per the terms and conditions of the policy they are only entitled to give compensation under the personal accident benefit if only,
1) death occurred,
2) loss of two limbs or sight of two eyes or one limb and sight of one eye,
3) Loss of one limb or sight of one eye,
4)Permanent total disablement from injuries other than named above.
And expressed inability to settle the claim. But we are of the opinion that the policy only discloses that who are all entitled 100% compensation of Rs.1,00,000/- under personal accident benefit, it also discloses that who are all only entitled 50% under personal accident clause, but nowhere in the policy have expressed that owner/driver are not entitled for reimbursement of the medical expenses towards injuries caused in the accident.
The learned advocate for Op vehemently argued that the Op Company had collected an additional premium of Rs.50/- only towards personal accident coverage, if the owner/driver suffered death or permanent disabilities. Hence, the company had repudiated the claim and submits no deficiency in service.
On contrary the learned advocate for complainant by cited one decision reported in the year 2013 AAC page 1735 between M/s.Bajaj Alianz General Insurance Company Limited V/s C.Ramesh as follows:
- Motor Vehicles Act (59 of 1988), S.147 – Liability of insurer – Personal Accident, cover policy – Benefit under Policy should be extended to all kinds of injuries.
And submits that the complainant is the owner of the vehicle bearing registration no.KA-18/U-8682 and suffered grievous injuries, who spent nearly Rs.2,00,000/- towards medical treatment and also submits that the vehicle also suffered damages. Being beneficiary of the policy complainant is entitled to get personal accident benefit and own damage claim and hence prays for settlement of the claim. Basing on the principals laid down in the above said decision in this case also Op is liable to extend benefits to the grievous injuries caused to the complainant and they are liable to pay eligible medical expenses to the complainant under the head of personal accident benefit. We further of the opinion that the complainant is also entitled to get own damage claim under the policy. The complainant had sworn affidavit that he spent nearly Rs.5,000/- only towards repair of the vehicle. The complainant has spent meager (small) amount towards own damage, for this purpose the appointment of surveyor is not required, the Op would have settled the claim of both personal accident benefit and own damage claim basing on the FIR and Spot mahazar, but instead of settling the claim Op have repudiated the genuine claim of the complainant which amounts to deficiency in service. Hence, Op also liable to pay own damage claim of Rs.5,000/- and also compensation of Rs.5,000/- for deficiency in service in repudiated the both claims of the complainant along with litigation expenses of Rs.1,000/- to the complainant. As such for the above said reasons, we answer the above point no.1 and 2 in the Affirmative and proceed to pass the following:-
: O R D E R :
- The complaint filed by the complainant is partly allowed.
- OP is directed to pay eligible medical expenses under the head of personal accident benefit and vehicle repair charges of Rs.5,000/- (Five thousand Rupees only) to the complainant.
- Op further directed to pay compensation of Rs.5,000/- (Five thousand Rupees only) for deficiency in service along with litigation expenses of Rs.1,000/- (One thousand Rupees only) to the complainant.
- The OP further directed to comply the above order within 30 days from the date of receipt/knowledge of the order, failing which the payable amount shall carry interest @ 9% P.A. till realization.
- Send free copies of this order to both the parties.
(Dictated to the Stenographer transcribed typed by her, transcript corrected by me and then pronounced in Open Court on this the 7th day of April 2017).
(B.U.GEETHA) (H. MANJULA) (RAVISHANKAR)
Member Member President
ANNEXURES
Documents produced on behalf of the complainant:
Ex.P.1 - FIR.
Ex.P.2 - Police complaint.
Ex.P.3 - Spot Mahazar.
Ex.P.4 - Wound Certificate.
Ex.P.5 - 22 Medical bills.
Ex.P.6 - Letter issued by complainant to Op for claim of personal
accident coverage.
Ex.P.7 - Claim form.
Ex.P.8 - Repudiation Letter.
Ex.P.9 - Copy of the policy.
Ex.P.10 & 11 - Copy of the D.L & RC of complainant.
Documents produced on behalf of the OPs:
Ex.R.1 - True copy of the insurance policy.
Dated:07.04.2017 President
District Consumer Forum,
Chikmagalur.
