Date of Filing : 16.06.2011

  Date of Order : 03.04.2012

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KOLAR

Dated 3^rd APRIL 2012

PRESENT

Sri. H.V. RAMACHANDRA RAO, B.Sc., BL,   …….                PRESIDENT

Sri. T.NAGARAJA, B.Sc., LLB.                        ……..     MEMBER

Smt. K.G.SHANTALA, B.A., LLB.                    ……..     MEMBER

CC No. 152 / 2011

Sri. V. Manjunath,

S/o. N. Venkateshappa, Aged about 25 years,

R/o. Doopian Silk Factor,

(Near Madhu Tailor), Railway Station,

Kolar.

(By Sri. A. Lakshmi Narayana, Adv.)                      ……. Complainant

V/s.

The Manager,

M/s. United India Insurance Co. Ltd.,

Branch Office,

First Floor, Bagalur Mansion, Doddapet,

Kolar.

(By Sri. L.N. Ramanatha, Adv.)                              …… Opposite Party

ORDER

By Sri. H.V. RAMACHANDRA RAO, PRESIDENT

The brief antecedents that lead to the filing of the Complainant made u/s. 12 of the C.P. Act seeking direction to the OP to pay to the Complainant Rs.15,00,000/- are necessary:

Complainant has insured his Toyota Qualis Car bearing Reg. No. KA-02/Z-3371 with the OP and the insurance was valid between 28.11.2008 & 24.11.2009.  He had DL also.  On 27.04.2009 while he was driving, the vehicle had met with an accident, as a result, the vehicle damaged and he suffered severe head injuries, right leg was fractured, there was injury on the face, eyes and also injuries to his body.   He was taken to local Hospital and to NIMHANS and then shifted to Abai Hospital, Bangalore, wherein he has undergone operation twice.  Skull was also removed at the time of operation, he was advised to undergo operation again.  A case was registered in FIR No. 373/2009 by the jurisdictional police for the offence u/s. 279, 337 of IPC.  Complainant has spent large amount towards his treatment.  Ops on information of the accident have paid the claim amount towards damages to the vehicle.  Hence, for his injuries Ops are liable to compensate.

2.       In brief the version of Ops are:-

Complainant is not a consumer.  Insurance is admitted.  As per Section III, Clause-I, Complainant is not entitled to get any compensation from the OP under the Head “Personal Accident Cover” under the Policy.  All the allegations to the contrary are denied.

3.       To substantiate their respective cases, parties have filed respective affidavits and documents.  Arguments were heard.

4.       The points that arise for our consideration are:

POINTS

(A)     Whether there is deficiency in service ?

(B)     What order ?

5.       Our findings are:

(A)     Negative

          (B)     As per detailed order for the following reasons

REASONS

6.       Pleadings of the parties are summarized supra and the same be read herein again.  Reading the pleadings in conjunction with the affidavits & documents on record, it is an admitted fact that the Complainant has obtained Policy No. 071501/31/08/01/00001849 and it was valid between 25.11.2008 & 24.11.2009 and also covered under the “Personal Accident Cover” to an extent of Rs.2,00,000/-.  It is also an admitted fact that on 27.04.2009 while Complainant was driving his vehicle, he met with an accident due to which the vehicle sustained damages and he sustained certain injuries.  Regarding that he laid the claim.  It is also an admitted fact regarding damage to the vehicle OP has paid the amount.

7.       Ops have denied the claim regarding personal injuries to the Complainant.  Wound Certificate produced by the complainant clearly proves what the injuries he has sustained, which reads thus:

That means Complainant has sustained certain injuries of black eye, fracture and bleeding etc.

8.       Section III of the Policy with respect to Personal Accident Cover for owner-cum-driver reads thus:

1)       The Company undertakes to pay compensation as per the following scale for bodily injury / death sustained by the owner-driver of the vehicle, in direct connection with the vehicle insured or whilst driving or mounting into / dismounting from the vehicle insured or whilst traveling in it as a co-driver, caused by violent accident external and visible means which independent of any other cause shall within six calendar months of such injury result in:

          Provided always that:

(A)     compensation shall be payable under only one of the items (i) to (iv) above in respect of the owner-driver arising out of any one occurrence and the total liability of the insurer shall not in the aggregate exceed the sum assured of Rs.2 lakhs during any one period of insurance.

(B)     no compensation shall be payable in respect of death or bodily injury directly or indirectly wholly or in part arising or resulting from or traceable to (1) intentional self injury suicide or attempted suicide physical defect or infirmity or (2) an accident happening whilst such person is under the influence of intoxicating liquor or drugs.

(C)     Such compensation shall be payable directly to the insured or to his/her legal representatives whose receipt shall be the full discharge in respect of the injury to the insured.

          2)       This cover is subject to

(a)      the owner-driver is the registered owner of the vehicle insured herein;

(b)     the owner-driver is the insured named in this policy;

(c)     the owner-driver holds an effective driving licence, in accordance with the provisions of Rule 3 of the Central Motor Vehicles Rules, 1989, at the time of the accident.

That means regarding the accident by the owner himself, only if there is death, loss o 2 limbs or sight or two eyes or one limb and sight of one eye, insurer has to pay 100% of assured amount and for permanent disability from the injuries, then insurer has to pay 100% of the assured amount and in case of loss of one limb or sight of one eye 50%  of the assured amount has to be paid.  Here Complainant is alive.  There is no loss of 2 limbs or sight or two eyes or one limb and sight of one eye, there is no permanent total disability from the injuries.  There is no loss of one limb or sight of one eye.  Hence, Complainant is not entitled to any amount under the Personal Accident Cover as rightly contended.

9.       If the Complainant has any claim in the insurance regarding MVC if he is entitled, he can claim under MVC for which this Order will not come any way.  But as under the Policy he is not entitled to any amount regarding Personal Insurance Cover.  Hence we hold the point accordingly and pass the following order:

ORDER

1.       Complaint is dismissed.

2.       Send copy of the Order to the parties concerned free of cost.

3.       Return extra sets to the parties concerned under Regulation 20(3) of Consumer Protection Regulations 2005.

(Dictated to the Stenographer, got it transcribed and corrected and pronounced in the open Forum on this the 3^rd day of April 2012)

T. NAGARAJA          K.G.SHANTALA           H.V.RAMACHANDRA RAO

    Member                         Member                                       President

SSS