Shri Ravindra Anandrao Sonavane Vs. the Oriental Insurance Co. Ltd., Thane - Court Judgment

Per Shri S.R. Khanzode, Honble Presiding Judicial Member.

This appeal is preferred by the Original Complainant challenging the impugned order/award dated 22nd August, 2005, dismissing the consumer complaint bearing No.376/2004, Shri Ravindra Anandrao Sonavane V/s. The Oriental Insurance Co. Ltd.

The undisputed facts are that appellant/original Complainant (hereinafter referred to as the Complainant) has taken an Insurance Policy, the copy of which is produced on record along with Annexure-A, titled as “Liability Only Policy for Zone-B Private Car”, covering the period from 17.12.2002 to 16.12.2003. Under said Policy charging extra premium, Personal Accident cover under section III for Owner-Driver was extended upto Rs.2,00,000/-. Complainant met with an accident on his way to Satara from Thane on Panvel - Pune Express Highway on 19.07.2003 and suffered personal injuries besides the damage to the Car other occupants of the car at the time of accident were his wife and son. Complainant himself suffered jaw fracture and fracture to left shoulder i.e. mandible fracture and was treated at the Lokmanya Hospital at Chimchwad, Pune. He made insurance claim under the Policy, supra, which stood repudiated on the ground that 30% disability suffered by the Complainant is not covered under the policy. Feeling aggrieved thereby, this consumer complaint was filed inter-alia claiming reliefs as under:

1. Compensation for 30% disablement and loss of earning due to motor vehicle accident on 19.07.2003, risk of which is covered by O.P. Insurance Co.

Rs.75,000/-

2. Compensation for pain and suffering caused due to injury in said accident.

Rs.25,000/-

3. Compensation for mental agony and hardship caused due to said accident.

Rs.25,000/-

4. Medical Bills paid to Hospital for treatment of injury caused due to accident

Rs.41,166/-

5. Compensation for future medical treatment expenses, post operation treatment.

Rs.5,000/-

6. Compensation for special diet during the period of recuperation from injury.

Rs.5,000/-

7. Compensation for conveyance/traveling to and fro to hospital at Pimpri Chinchwad and other misc. expenses.

Rs.5,000/-

Total

Rs.1,81,166/-

Respondent, Original Opposite Party (hereinafter referred to as Insurance Company) resisted the consumer complaint in tune with their cause mentioned for the repudiation, supra. They have also relied upon standard form for ‘Liability Only Policy produced on record (Page Nos. 71 to 74 of the paper book in appeal), particularly, its contents under sub-head “Personal Accident Cover for Owner-Driver”. Upholding the contentions of the Insurance Company, Forum below dismissed the complaint.

We heard both sides, Mr. S.S. Bondre, Advocate for the Appellant and Mr. Sanjay Mhatre, Advocate for the Respondent, considered written arguments produced on record.

Forum below in the impugned order mentioned that issue as to non-supply of documents, i.e. standard form for Liability Only Policy, supra, was raised by the Complainant for the first time at the time of arguments before it. Such statement is a departure from the factual situation. Such statement about non-receipt of standard form for Liability Only Policy which is relied by the Insurance Company is made by the Complainant in the Rejoinder-cum-Affidavit dated 9th June, 2005, filed by him. In case of repudiation, it is for the Insurance Company to justify the same. The initial policy document issued to the Complainant is as per Exhibit-A, supra. Along with it the document of ‘standard form for Liability Only Policy, being not supplied, the Insurance Company cannot sheltered itself behind it to repudiate the claim. Insurance Company miserably failed to show that such standard form for Liability Only Policy was supplied to the Complainant along with the Policy.

Under the circumstances, one has to go as per the insurance liability spelled out from the original policy – Annexure-A and it offered a personal accident cover for Owner-Driver to the extent of Rs.2,00,000/- without any further limitation. It may not be out of place to mention here that the Complainant had paid extra premium to extend the scope of insurance coverage under the said policy. Complainant has produced the certificate that he has suffered 30% permanent disability due to his jaw fracture and another fracture to his shoulder. He has also produced from record the treatment papers as well as the expenses incurred by him during the hospitalization and the treatment he was required to take. He has, in all incurred expenses of Rs.41,166/- during his hospitalization. He has claimed the same under Prayer clause no.18, Sr. No.4, supra. We find that under the insurance cover, he is entitled for the same. He has claimed Rs.75,000/- towards the compensation for 30% disablement and loss of earning during the period as a result of an accident and similarly, for alleged loss of provisional income. The complainant miserably failed to establish his claim on the ground of alleged loss of income from the profession. Also such claim would not fall within the ambit of consumer complaint. Therefore, the claim made on this count stands rejected. We also find it just and proper to award him compensation, for legal injury caused to him due to unjust repudiation he was driven to file this consumer complaint and had to suffer mental agony. Accordingly, we quantify the compensation on this count at Rs.25,000/-. We further find that Complainant is not entitled to separate compensation on any other count, as claimed. Thus, we find that it would be just and proper to award the compensation for deficiency in service to the extent of Rs.41,166/- plus Rs.25,000/-, total amounting to Rs.66,166/-. In addition to it, we award cost to the Complainant as per the following order:

Order:

(1) Appeal is partly allowed.

(2) Impugned order/award dated 22/08/2005 is set aside.

(3) Respondent/Insurance Company do pay Rs.66,166/- to the Appellant/Complainant within 45 days from the date of service of the copy of this order/award on it and failing which, it shall carry interest @ 9% per annum from the date of this order till its realization.

(4) Respondent/Insurance Company to bear its own costs and pay Rs.5,000/- as costs to the Appellant/Complainant.

(5) Appeal stands disposed of accordingly.

(6) Copy of the order be sent to both the parties.