Karnataka

Belgaum

CC/158/2016

Mohan G Haval - Complainant(s)

Versus

The Divisional Manager , United Insurance Ltd - Opp.Party(s)

R S Kamat

29 May 2017

ORDER

IN THE DIST.CONSUMER DISPUTES REDRESSAL FORUM BELAGAVI.

 

Dated this 29^th day of May 2017

Complaint No. 158/2016

Present:              1)      Shri.B.V.Gudli,                       President  

2)      Smt. Sunita,                           Member

-***-

 

Complainant/s:          Sri.Mohan S/o.Gopal Haval,

Age: 46 years, Occ: Tailoring work (now Nil),

R/o.Konnur village, Tq.Gokak,

Dist. Belagavi.

 

(By Sri.R.S.Kamat, Advocate)

 

V/s.

                                                                     

Opponent/s:                The Divisional Manager,

United India Insurance Co. Ltd.,

Branch: Maruti Galli, Belagavi.

 

(by Sri.V.B.Malannavar, Adv.)

 

 

 (Order dictated by Sri.B.V.Gudli, President)

 

ORDER

          U/s. 12 of the C.P. Act, the complainant has filed the complaint against the O.P. alleging deficiency in service in not paying insurance claim amount.

          2) Upon issuance of notice from the forum the O.P appeared through his advocate and filed objections, affidavit, written synopsis and produced some documents.

           3) In support of the claim of the complaint, the complainant has filed his affidavit, written arguments and produced some documents.  

4) We have also heard on both side and perused the records.

          5) Now the point for our consideration is that whether the complainant has proved deficiency in service on the part of O.P & entitled to the reliefs sought?

          6) Our finding on the point is in partly affirmative for the following reasons.

:: R E A S O N S ::

            7)       On perusal of allegations of the complainant and affidavit of complainant, on 23.06.2015 the complainant was in his house and at about 4-00 hours suddenly his right hand and knee starts pain and in order to take treatment through Dr.Shindolimath by riding his Hero Honda Passion vehicle bearing KA 49 H 9056 gone to the said hospital and took treatment and while returning the complainant met with an accident  at 7-30 hours when an unknown rider came in a wrong side and touched to the vehicle of complainant, at that time complainant immediately applied break of his vehicle and the vehicle of the complainant was skid and he fell down on the road. Due to the said impact complainant sustained injuries to his right leg  and hand and was admitted to Nimbra Hospital, Gokak and due to the said accident complainant had to spent more than Rs.4 lakhs towards medical expenses. The Gokak Town PS registered the Crime SHDE No.29/15 on 24.06.2015. The vehicle of the complainant was insured with OP under policy no.2401023114P-107108423 valid from 04.12.2014 to 03.12.2015. That prior to the said accident the complainant was hale and healthy and earning more than Rs.10000/- p.m., but due to the said accident he is not in a position to earn his livelihood. Thereafter on 15.12.2015 the complainant got issued legal notice through his advocate to OP, the said legal notice was served on OP, but OP issued false and evasive reply dt.22.12.2015. Hence the complainant is constrained to file this complaint against OP. 

8)      The OP filed his objections denying & disputing the complaint averments & contended that the vehicle owned by the complainant is validly insured with OP. The insurance policy in question specifically covers the following events:

Nature of Injury	Scale of Compensation
Death	100%
Loss of 2 limbs or sight of 2 eyes or one limb & sight of 1 eye	100%
Loss of limb & sight of 1 eye	50%
Permanent total disablement from injuries other than named above	100%

 

In this case the injuries sustained by the complainant are not covered in any of the category as noted supra. Hence the OP is not under obligation to pay any compensation to the complainant. There is no deficiency of service on the part of OP & prays for dismissal of the complaint with cost.

9)      On perusal of contents of complaint and objections filed by the parties there is no dispute with regard to the accident & injuries sustained by the complainant on 23.06.2015. The contention taken by the OP is, the injuries sustained by the complainant are not covered in any of the category. On perusal of motorcycle package policy schedule produced by the complainant, wherein in the column of Limits of Liability it is clearly mentioned that Death or bodily injury in respect of any one accident; as per MV Act 1988. As discussed above there is no dispute with regard to the accident & injuries sustained by the complainant on 23.06.2015. When the OP has collected premium, it is the bounden duty of OP to pay the claim amount to the complainant.

10)    In this regard this forum would like to rely on a decision III (2007) CPJ 34 (NC), National Insurance Co. vs. D.P. Jain, wherein their lordships have observed that,

“If exclusion clauses not explained, regulations not binding on insured – Said clauses required to be ignored while considering claim of insured – Exclusion clauses should be read, as they are – When statute provides manner in which particular thing must be done, same must be done in that manner only.

33. It is to be stated that terms which are mentioned at the over leaf of the insurance certificate are in very small print, and require magnifying glass for reading the same. So, we can draw an inference that it is not read by anyone”.

 

The above said decision is amply applicable to the case on hand because, on perusal of insurance policy, the insurance certificate are in very small print, and require magnifying glass for reading the same. Hence it is treated as, it is not read by anyone.

 

11)    In this case the complainant has claimed Rs.4 lakhs towards compensation, but as per the policy terms and conditions the complainant is entitled to only Rs.1 lakh towards insurance claim. 

          12) Taking into consideration of the facts, evidence on record and the discussion made here before deficiency in service on the part of the O.P has been proved.

          13)    Accordingly the following

ORDER

          The complaint filed by the complainant is partly allowed.

The OP as shown in the cause title is hereby directed to pay Rs.1 lakh to the complainant towards insurance claim amount, with 9% interest P.A. from the date of filing this complaint till realization.

Further the OP is hereby directed to pay Rs.2,000/- to the complainant towards loss and mental agony and Rs.1,000/- towards cost of the proceedings.

The award shall be complied within 30 days from today.

(Order dictated, corrected and then pronounced in the open Forum on: 29^th day of May 2017)

 

 

 

MSR