State Consumer Disputes Redressal Commission
National Insurance Co. Ltd vs Bhartesh on 2 August, 2022
Cause Title/Judgement-Entry KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION BASAVA BHAVAN, BANGALORE. First Appeal No. A/172/2020 ( Date of Filing : 24 Feb 2020 ) (Arisen out of Order Dated 21/01/2020 in Case No. Complaint Case No. CC/545/2018 of District Belgaum) 1. National Insurance Co. Ltd Divisional Office, No.1732, II floor, Prabhu Building Ramadev Galli, Belagavi Rep. by its Regional manager Karnataka ...........Appellant(s) Versus 1. Bhartesh S/o Shivgonda Sambhaji, Aged about 26 years, R/a H.No.149, Math Galli, Kedur village, Belagavi Tq & dist. Karnataka ...........Respondent(s) BEFORE: HON'BLE MR. Ravishankar PRESIDING MEMBER HON'BLE MRS. Smt.Sunita Channabasappa Bagewadi MEMBER PRESENT: Dated : 02 Aug 2022 Final Order / Judgement THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BANGALORE. (ADDL. BENCH) DATED THIS THE 2nd DAY OF AUGUST, 2022 PRESENT SRI RAVI SHANKAR - JUDICIAL MEMBER SMT. SUNITA C.BAGEWADI - MEMBER APPEAL NO. 172/2020 National Insurance Limited, Divisional Office, No.1732, 2nd Floor, Prabhu Building, Ramadev Galli, Belagavi, Rept. By its Regional Manager, ....Appellant/s. (By Sri.Janardhan Reddy, Adv.,) -Versus- Bhartesh S/o Shivagonda Sambhaji, Aged about 26 years, R/atH.No.149, Math Galli, Kedur Village, Belagavi Taluk & District (By Sri.Lingraj.M, Adv.,) ........... Respondent/s :ORDER:
BY SRI. RAVISHANKAR, JUDICIAL MEMBER.
The Opposite Party in complaint No.545/2018 has preferred this appeal against the order passed by the Additional District Consumer Commission, Belagavi dated 21-1-2020, which directed this appellant/Opposite Party to pay personal accident benefit of Rs.1,00,000-00 to the complainant along with Rs.15,000-00 compensation and Rs.3,000-00 litigation expenses.
2. The brief facts of the complaint is that, the complainant is the owner of Hero MHF Deluxe Motor Cycle bearing Reg. No.KA-22/EV-2780 and insured with the Opposite Party vide policy bearing no.39010231166201026704 which is valid from 6-6-2016 to 5-6-2017. The complainant paid Rs.50-00 towards personal accident benefits coverage such being the case on 21-5-2017 he met with an accident and suffered grievous injury immediately admitted to Vijay Ortho & Trauma Center as inpatient from 21-5-2017 to 1-6-2017 and spent nearly Rs.3,00,000-00 towards treatment. Subsequently, by virtue of the personal accident benefit coverage, the complainant claimed compensation to the tune of Rs.1,00,000-00 as he suffered permanent disability, but the Opposite Party has repudiated the claim without any reason. Subsequently, the complainant issued a legal notice and called upon the Opposite Party to pay personal accident benefit, in spite of service of legal notice the Opposite Party neither complied nor replied. Hence, the complainant filed this complaint before the District Commission at Belagavi alleging deficiency of service and prayed for payment of compensation to the tune of Rs.1,00,000-00 under personal accident benefit coverage.
3. After service of notice, the Opposite Party appeared through his counsel and filed version contended that they issued the policy to the vehicle bearing Reg. No.KA-22/EV-2780 in favour of complainant and they have also covered the personal accident risk of owner/driver of the vehicle, the terms and conditions of the policy binding and as per the terms and conditions the claim is not payable to the complainant as the claim not fall within the clause mentioned in the terms and conditions of the policy. Hence, they have repudiated the claim and submitted no deficiency of service.
4. After trial, the District Commission allowed the complaint and directed the Opposite Party to pay Rs.1,00,000-00 along with other relief as above against which the appellant before this Commission.
5. On perusal of the certified copy of the order and the memorandum of appeal, there is no dispute that as on the date of accident i.e. on 21-5-2017 the vehicle of the complainant is covered under policy for personal accident benefit. As per the evidence of complainant, we noticed here that, he suffered a permanent disability to the extent of 60%, in that regard one Dr.Siddappa Rachappa Angadi has given evidence as PW-2. Considering the said evidence the District Commission allowed the complaint and directed the Opposite Party to pay Rs.1,00,000-00 whereas on going through the policy terms and conditions, we noticed here that, the personal accident benefits are payable only when the owner/driver suffered, the following;
"Subject otherwise to the terms exceptions conditions and limitations of the policy, the Company undertakes to pay compensation as per the following scale for bodily injury/death sustained by the owner-driver of the vehicle, indirect connection with the vehicle insured whilst mounting into/dismounting from or travelling in the insured vehicle as a co-driver, caused by violent accidental external and visible means which independent of any other cause shall within six calendar months of such injury results in."
Provided always that:
Death 100% Loss of two limbs or sight of two eyes or one limb and sight of one eye 50% Loss of one limb or sight of one eye 100% Permanent total disablement from injuries other than named above 100% Hereby we noticed the complaint has not fall under any category as shown in the above table. The terms and conditions of the policy on binding both parties and the premium amount paid by the complainant only Rs.50-00 for which the Opposite Party have under taken to pay Rs.1,00,000-00 towards personal accident when he suffered any 100% permanent total disablement whereas in this case the complainant has not suffered any 100% permanent disability is only 60% partial disability hence, the claim is not eligible under personal accident coverage. The District Commission made error in allowing the complaint without considering the policy terms and conditions.
6. We are of the opinion that, the very intention of the policy is to provide an additional benefit to owner/driver if he suffered any disability as shown in the above table. The District Commission/Forum ought not to overtake the terms and conditions of the policy and over write them. Hence, the order passed by the District Commission is liable to set aside. The repudiation of the claim is in accordance with law and he is in accordance with the terms and conditions of the policy and there is no any deficiency of service on the part of Opposite Party in repudiating the claim, as such the appeal is allowed and complaint is hereby dismissed. Hence, the following;
:ORDER:
The appeal is allowed and consequently the complaint is dismissed. No costs.
The amount deposited before this Commission is payable to the appellant.
Send a copy of this order to both parties as well as Concerned District Commission.
Member. Judicial Member. [HON'BLE MR. Ravishankar] PRESIDING MEMBER [HON'BLE MRS. Smt.Sunita Channabasappa Bagewadi] MEMBER