By. Sri. Chandran Alachery, Member:
The complaint is filed under section 12 of the Consumer Protection Act for an Order directing the opposite party to pay Rs.1,00,000/- as insurance amount and also to pay Rs.50,000/- as compensation and Rs.2,500/- as cost of the proceedings.
2. Brief of the complaint:- The complainant took insurance over his vehicle TVS Appache RTR 180 2014 model and validity of the policy is there up to 30.01.2015. ON 19.07.2014, the complainant fell down from the bike at the courtyard of his house and sustained injury to his index finger and the index finger is cut off. Immediately, he was taken to medical college in an ambulance and the doctor tried to join the finger but failed. Then taken to Baby Memorial Hospital and they also failed to join the finger. Later the medical college doctors joined the finger partially but the finger is not useful. The complainant spend huge amount towards treatment expenses. The opposite party firm did not receive the claim form and did not give the claim. The act of opposite party is nothing but deficiency of service and unfair trade practice. The complainant was a painter and was earning Rs.700/- per day as coolie. Aggrieved by the act of opposite party, the complaint is filed for redressal of grievances.
3. On receipt of complaint, notice was issued to opposite party. Opposite party appared before the Forum and filed version. In the version, opposite party contented that consumer court have no jurisdiction to try the case since it is claim for compensation on the basis of motor accident. The opposite party admitted insurance and the validity is from 31.01.2014 to 30.01.2015. The liability of opposite party is limited to the terms and conditions. The opposite party did not receive claim form. The opposite party denied the accident and injury. The allegation that the complainant met with accident on 19.07.2014 is to be proved by the complainant with documents. But no document is produced to prove it. As per terms and conditions of the policy, there is no mention regarding the loss of fingers in section III (personal accident cover for insured person) of the Motor policy, there is no provision for getting compensation under policy.
4. On perusal of complaint, version and document the Forum raised the following points for consideration:-
1. Whether there is any deficiency of service and unfair trade practice from the
part of opposite party?
2. Relief and cost.
5. Point No.1:- The complainant filed proof affidavit and is examined as PW1 and documents are marked as Ext.A1 to Ext.A4. Ext.A1 is the copy of Registration Certificate and Ext.A2 is the policy. Ext.A3 is the cash bill for ambulance service and Ext.A4 series are medical records and medical bills. The opposite party also filed proof affidavit and the opposite party is examined as OPW1 and Ext.B1 is marked. Ext.B1 is the policy. The case of opposite party is that the complainant did not produce any document to prove the accident and injury. But on going through the Ext.A4 series documents, in Ext.A4(1), it is seen that the complainant was treated at Medical College Hospital, Calicut on 19.07.2014 at 10.06 AM and reported the clinical History as “Finger got stuck in bike chain” and “c/o fracture to ( R) index finger”. In the overleaf of Ext.A4(1), it is written by the Hospital authority that Right index finger tip of complainant was cut off and it is not possible to rejoin it. The case of the complainant is that the opposite party refused to accept the claim form from the complainant even if the complainant went to the office of opposite party to submit the claim form with documents. In the cross-examination of opposite party, opposite party deposed that the opposite party did not check the computer to know the details of vehicle of the complainant involved in the accident. As per Ext.A2 and Ext.B1 policy document, there is a clause for personal accident benefit for owners or drivers of the insured vehicle. As per section III of the policy, the nature of injury and scale of compensation is stated as if lose of one limb or sight of one eye, the scale is 50% of the policy amount. Hence the complainant sustained injury to his right index finger and the tip of index finger is lost. The Forum while examining the complaint, convinced that tip of right index finger is lost. It is not a loss of one limb fully. It is a partial loss of limb. So the complainant is not entitled for the full benefit as per section. The complainant is entitled for medical expenses also. Non accepting the claim form from the complainant and non issue of claim amount is a deficiency of service from the part of opposite party. Point No.1 is found accordingly.
6. Point No.2:- Since Point No.1 is found in favour of complainant, he is entitled for cost and compensation.
In the result, the complaint is partly allowed and the opposite party is directed to pay Rs.25,000/- (Rupees Twenty Five Thousand) to the complainant as accident benefit and Rs.3,350/- (Rupees Three Thousand Three Hundred and Fifty) as medical expenses to the complainant. The opposite party is also directed to pay Rs.1,000/- (Rupees One Thousand) as compensation and Rs.1,000/- (Rupees One Thousand) as cost of the proceedings. The opposite party shall comply the Order within 30 days from the date of receipt of this Order failing which the complainant is entitled to get 12% interest for the whole sum.
Dictated to the Confidential Assistant, transcribed by him and corrected by me and Pronounced in the Open Forum on this the 4th day of September 2015.
Date of Filing:29.09.2014.
PRESIDENT :Sd/-
MEMBER :Sd/-
MEMBER :Sd/-
/True Copy/
Sd/-
PRESIDENT, CDRF, WAYANAD.
APPENDIX.
Witness for the complainant:-
PW1. Salim. Complainant.
Witness for the Opposite Party:-
OPW1. Sajeevan. Branch Manager, United India Insurance Co Ltd,
Sulthan Bathery.
Exhibits for the complainant:
A1. Copy of Registration Certificate.
A2. Insurance Policy Document.
A3. Cash Bill. Dt:19.07.2014.
A4(1). Emergency Outpatient Prescription.
A4(2). Medical Bill.
A4(3). Out Patient Bill.
A4(4). Out Patient Bill.
A4(5). Prescription. Dt:26.07.2014.
A4(6). Prescription. Dt:18.08.2014.
Exhibits for the opposite party:-
B1. Copy of Insurance Policy Document.
Sd/-
PRESIDENT, CDRF, WAYANAD.
a/-
