In a road accident that occurred at about 9 PM on 15-10-2014 near Bus Stand in Sriramangar on Gangavathi – Sindhanoor main road, the complainant herein, who is a owner of Bajaj Discover motorcycle No.KA-37/S-8569 was a pillion rider while the vehicle was driven by one Shambulinga, suffered fracture of right clavicle and right radius, which are grivious in nature. On account of which the complainant claims to have spent Rs.1.00 Lakh for treatment. The motorcycle was insured with the OP Company. Policy was in force on the date of accident. The complainant made a claim for Rs.1.00 lakh towards personal accident coverage by issuing a notice as per Ex.A10 dated: 09-11-2014, which has not been responded. Therefore, the complainant approached this Forum seeking compensation of Rs.1,85,000/- on various counts alleging deficiency in service on the part of the insurance company for non-payment of amount claimed.
2. The OP company resisted the claim. The main contention is in paragraph – 10 of the written version, which reads as follows;
“10. xxxx, as per the terms as shown in the Policy se SECION IV: PERSONAL ACCIDENT COVER FOR OWNER-DRIVER:
Subject otherwise to the terms exceptions conditions and limitations of this policy, the company undertakes to pay compensation as per the following scale for bodily injury/death sustained by the owner-driver of the vehicle direct connection with the vehicle insured or whilst mounting into/dismounting from or travelling in the insured vehicle as a do driver, caused by violent accidental external and visible means which independent of any other cause shall within six calendar months of such injury result in:
Nature of Injury | Scale of compensation |
- Death
| 100% |
ii) Loss of two limbs or sight of two eyes or one limb or singht 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% |
But, in the instant case the injuries sustained by the complainant will not come under the above mentioned table as per the terms of the policy.
3. In the instant case, there is no proof of permanent disablement from the injuries suffered by the complainant due to accident and therefore, the personal accident cover is not payable.
4. The complainant is an agriculturist. The injury suffered by him may be permanent but not resulted in total disablement making him in incapable for performing his work. Therefore the decision in Life Insurance Corporation of India & Anr. V/s Sri Hari – 2014 (1) CPC relied upon by counsel for the complainant is not applicable to the facts of the case.
5. There is another important aspect. The personal accident cover is for owner-cum-driver. Undisputedly, the complainant was owner of the vehicle was not driven the vehicle at the time of accident. He was a pillion rider. The motorcycle was driven by one Mr.Shambulinga, arraigned as accused in C.C. No.198/2013 on the file of the JMFC, Gangavathi. On this count also, the personal accident coverage under the policy is not payable.
6. For the reasons stated above, the complaint deserves to be dismissed and the same is accordingly dismissed.
// ANNEXURE //
List of Documents Exhibited for the Complainant.
Ex.A.1 | Copy of Claim letter | 01-04-2014 |
Ex.A2 | Copy of Charge sheet | 15-10-2013 |
Ex.A.3 | Copy of FIR | 15-10-2013 |
Ex.A.4 | Copy of Crime Details Form | 16-10-2013 |
Ex.A.5 | Copy of Motor Vehicle Accident Report | 17-10-2013 |
Ex.A.6 | Copy of Medico legal/Wound Certificate | 31-10-2013 |
Ex.A.7 | Copy of Certificate of Registration of vehicle | - |
Ex.A.8 | Copy of driving license | - |
Ex.A.9 | Copy of policy | - |
Ex.A.10 | Copy of legal notice | 11-09-2014 |
Ex.A.11 | Postal receipt | 11-09-2014 |
Ex.A.12 | Postal acknowledgment | - |
List of Documents Exhibited for the Opposite Party |
Ex.B.1 | Copy of policy | - |
Witnesses examined for the Complainant / Respondent.
P.W.1 | Sri. R.Hemasundarareddy S/o. R.Purushottamareddy, R/o. Sriramanagar. |
R.W.1 | Sri. Sharanappa Shahu S/o: Bhagawantappa,
R/o. Hospet. |
