By Smt. C.S. Sulekha Beevi, President,

1. Complainant who is the owner of KL 10/Z 2461 motor cycle had insured the vehicle with opposite party. As per the terms of policy personal accident risk of the insured as well as the rider of the vehicle was also covered. During the currency of the policy, on 05-10-2006 the complainant's son who was riding the vehicle sustained injuries in an accident involving the vehicle. He was taken to Al-Shifa hospital and admitted and treated for one day. Complainant incurred Rs.35,000/- towards treatment and transport expenses. Complainant preferred a claim before opposite party along with relevant documents. Opposite party did not respond and so complainant issued a registered lawyer notice claiming compensation. Though opposite party received the notice opposite party did not heed to the claim of the complainant. Hence this complaint alleging deficiency in service.

2. Opposite party entered appearance through counsel and filed written version. Opposite party admitted the issuance of policy with personal accident risk coverage. Opposite party has denied coverage to the rider of the vehicle. Without admitting the accident and injuries sustained by the son of complainant it is submitted by opposite party that the claim of the complainant for the injury of his son is unsustainable as it was not covered under the policy. As per the policy only the personal accident of the owner who is the driver of the vehicle was covered. This cover was only in the case of either death or permanent disablement as specified in the policy and not for any medical expenses. No extra premium was paid for P.A. Benefit to either named person or unnamed person or for paid driver. The complainant is not entitled to get damages for personal injuries of his son. That there is no deficiency in service.

3. Evidence consists of the affidavit filed by complainant and Exts.A1 to A3 marked for complainant. Opposite party filed counter affidavit and Ext.B1 marked for opposite party. Either side did not adduce any oral evidence.

4. In the version though opposite party denied insurance coverage at the time of hearing, learned counsel for opposite party was fair enough to admit that in Ext.A1 policy Rs.70/- was paid as premium for personal accident benefit of un-named person and therefore the risk of accident to the son was covered under the policy. The complaint was thereafter resisted by opposite party upon the contention that as per Section III the compensation was payable only to the nature of injuries described in the schedule stated which is as under:

Nature of injury Scale of compensation

( i) Death 100%

(ii) Loss of two limbsor sight of two eyes or one limb

and sight of one eye. 100%

(iii) Loss of one limb or sight of one eye. 50%

(iv) Permanent total disablement from injuries other than

named above. 100%

5. It is clear that compensation cannot be claimed for bodily injuries which are outside the scope of this schedule. Complainant has not produced any disability certificate nor does the injuries come within (ii) to (iv) of the above schedule. For this reason we cannot hold the denial of claim by opposite party to be unjustifiable. But in any case the consumer who has preferred a claim has a right to receive a reply/response from the company either denying or settling his claim. Opposite party has no case that they issued any reply to his claim. Even the registered lawyer notice issued by the complainant was not responded to by opposite party. Total silence on the part of the company and thereby burdening the consumer with unnecessary litigation is imperfect service which amounts to deficiency in service as defined under Sec.2(1)g) of Consumer Protection Act. We therefore consider that complainant is entitled to cost of the proceedings which we quantify to be Rs.2,000/-. This will serve as a message to the service provider to be more consumer sensitive and make a qualitative change in rendering service in future.

6. In the result we dismiss the complaint and order opposite party to pay costs of Rs.2,000/- (Rupees Two thousand only) to the complainant within one month from the date of receipt of copy of this order.

Dated this 25th day of August, 2009.

Sd/-

C.S. SULEKHA BEEVI, PRESIDENT

Sd/-

MOHAMMED MUSTAFA KOOTHRADAN, Sd/-

MEMBER E. AYISHAKUTTY, MEMBER

APPENDIX

Witness examined on the side of the complainant : Nil

Documents marked on the side of the complainant : Ext.A1 to A3

Ext.A1 : Premium computation table given by opposite party to complainant.

Ext.A2 : Lawyer notice dated, 19-01-2007 issued by complainant's counsel to

opposite party.

Ext.A3 series : Prescription (5 Nos.) and Bills (27 Nos.) .

Witness examined on the side of the opposite parties : Nil

Documents marked on the side of the opposite parties : Ext.B1

Ext.B1 : Reliance General Insurance Two wheeler package policy issued by

opposite party to complainant.

Sd/-

C.S. SULEKHA BEEVI, PRESIDENT

Sd/-

MOHAMMED MUSTAFA KOOTHRADAN, Sd/-

MEMBER E. AYISHAKUTTY, MEMBER