COMPLAINT FILED: 29.12.2008 BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AT BANGALORE (URBAN) 09th MARCH 2009 PRESENT :- SRI. A.M. BENNUR PRESIDENT SMT. M. YASHODHAMMA MEMBER SRI. A. MUNIYAPPA MEMBER COMPLAINT NO. 2844/2008
COMPLAINANT Sri. B.A. Prabhakar Rai, S/o. Late Sri Kantha Rai, Age 68 years, No. 345, ‘Samrudha’, 7th Cross, Sri Lakshmi Road, Shanthinagar, Bangalore. Advocate (Ranganatha Gowda)
OPPOSITE PARTY M/s. Bajaj Alianz General Insurance Company Ltd., Rept. By Manager, Regional Office, No. 31, Ground Floor, T.B.R. Towers, 1st Cross, New Mission Road, Next to Bangalore Stock Exchange, Bangalore – 560 024. Advocate (Manoj Kumar M.R.)
O R D E R
This is a complaint filed U/s. 12 of the Consumer Protection Act of 1986 by the complainant seeking direction to the Opposite Party (herein after called as O.P) to settle the insurance claim for Rs.2,00,000/- and pay a compensation of Rs.50,000/- and for such other reliefs on an allegations of deficiency in service. The brief averments, as could be seen from the contents of the complaint, are as under: Complainant is the R.C. Owner of the vehicle bearing No. KG-01-MA-6920. OP covered the insurance of the said vehicle which was valid from 06.04.2005 to 05.04.2006. OP has also collected Rs.100/- towards the personal accident cover for owner-driver under section 3 of the insurance policy covering the risk to the tune of Rs.2,00,000/-. On 18.07.2005 at about 2 p.m. while complainant along with his family traveling in the said car driven by his son met with an accident. In the said accident complainant suffered severe injuries including that of fractures. He was admitted to P.S.G. Hospital, Coimbatore. He took treatment at Bangalore Hospital and underwent the surgery for D.C.P. Plating, etc. Complainant did possess the valid and effective driving licence to drive his vehicle. After the discharge from the hospital complainant made a claim to the OP, unfortunately OP repudiated the claim on the ground that the connecting documents are not produced.
Then complainant filed a Complaint No. 542/2008 before the Ist Additional District Consumer Disputes Redressal Forum, which came to be disposed of with certain direction to the complainant to resubmit his claim with relevant documents and OP has to consider the same and settle it within 8 weeks. Though complainant complied all the requirements as per the orders, but OP failed to settle the claim. Thus complainant felt the deficiency in service on the part of the OP. Under the circumstances he is advised to file this complaint and sought for the relief accordingly.
2. On appearance, OP filed the version denying all the allegations made by the complainant in toto. According to OP the Disability Certificate produced by the complainant would not fall in any of the nature of injuries as stated in the policy with respect to section 3 of personal accident cover for owner-driver. After considering all the facts and circumstances and the documents produced, OP has repudiated the said claim well within the stipulated time and intimated the complainant. So there is no deficiency in service of any kind on the part of the OP. The complaint is devoid of merits. The allegations are baseless. Among these grounds, OP prayed for the dismissal of the complaint.
3. In order to substantiate the complaint averments, the complainant filed the affidavit evidence and produced some documents. OP has also filed the affidavit evidence and produced the documents. Then the arguments were heard.
4. In view of the above said facts, the points now that arise for our consideration in this complaint are as under: Point No. 1 :- Whether the complainant has proved the deficiency in service on the part of the OP? Point No. 2 :- If so, whether the complainant is entitled for the reliefs now claimed? Point No. 3 :- To what Order?
5. We have gone through the pleadings of the parties, both oral and documentary evidence and the arguments advanced. In view of the reasons given by us in the following paragraphs our findings on: Point No.1:- In Affirmative Point No.2:- Affirmative Point No.3:- As per final Order.
R E A S O N S
6. At the outset it is not at dispute that the complainant is the R.C. Owner of the vehicle bearing No. KG-01-MA-6920 and OP covered the insurance of the vehicle which was valid from 06.04.2005 to 05.04.2006. It is also not at dispute that OP collected Rs.100/- towards the personal accident cover for owner-driver under section 3 of the insurance policy covering the risk of Rs.2,00,000/-. It is contended by the complainant that on 18.07.2005 while himself and his family members traveling in his car which was driven by his son, who possess the valid and effective driving licence met with a road traffic accident and in that accident he has sustained grievous injuries including that of fractures, thus suffered permanent disability. The fact that he took treatment at P.S.G. Hospital at Coimbatore, then underwent surgery at Bangalore for D.C.P. Plating, etc., is not at dispute.
7. Now the grievance of the complainant is that after the discharge from the Hospital he sent the claim to the OP. As per the orders passed by the Hon’ble Ist Addition District Consumer Forum OP is expected to settle the claim within a reasonable time. Though complainant complied all the requirements and produced all the relevant records and documents, OP failed to settle the said claim well within the reasonable time. It is further stated that the so called repudiation letter sent by the OP is an altered and manipulated one. The repudiation is illegal, arbitrary, unjust and without due application of mind. For no fault of his, complainant is made to suffer both mental agony and financial loss.
Though complainant has substantially produced the relevant documents to speak about the permanent disability OP had not considered the same.
8. The evidence of the complainant which finds full corroboration with the contents of the undisputed documents, appears to be very much natural, cogent and consistent. There is nothing to discard his sworn testimony. Of course one of the documents produced by the complainant marked at Exhibit P7 itself shows that the disability is 60%. As against this it is contended by the OP that the so called Disability Certificate produced by the complainant, injuries noted therein would not fall in any of the categories of injuries noted in section 3 of the personal accident cover for owner-driver policy. We do not find force in the said defence. When we go through the policy, terms and conditions and take note of nature of injury, scale of compensation, even for loss of one limb or sight of one eye scale compensation is 50%. When Exhibit P7 shows to the Permanent Disability to the tune of 60%, then OP ought to have considered the claim of the complainant. Under such circumstances the repudiation made by OP appears to be arbitrary.
9. The fact that the complainant is the R.C. Owner of the vehicle having a valid and effective driving licence is not at dispute. There is no such delay caused by the complainant in seeking redressal with regard to the settlement of the claim, but still OP went on technicalities. The hospital records and other connected documents, discharge summary speaks to the nature of grievous injuries suffered by the complainant, the owner-driver of the said vehicle. The content of the documents produced by the complainant are not at dispute. When there is a proof of Permanent Disability, the repudiation made by the OP speaks loudly about the deficiency in service. For no fault of his, he is made to suffer both mental agony and financial loss.
10. We are satisfied that the complainant is able to prove the deficiency in service on the part of the OP. As against the unimpeachable evidence of the complainant, the defence set out by the OP appears to be defence for defence sake, just to shirk their responsibility and obligation. The approach of the OP does not appears to be fair and honest. Under such circumstances we find it is a fit case, wherein the complainant deserves certain relief. Accordingly we answer point nos.1 and 2 and proceed to pass the following:
O R D E R
The complaint is allowed in part. OP is directed to settle the claim for Rs.2,00,000/- and pay the same to the complainant. In view of the nature of dispute no order as to costs. This order is to be complied within 4 weeks from the date of its communication. Failing in which the complainant is entitled to claim interest at the rate of 9% p.a. on Rs.2,00,000/- from the date of repudiation till realization along with a litigation cost of Rs.1,000/-.