Decided on January 03,2014

Satish Goel Appellant


Sham Sunder, J. (President) - (1.) THIS appeal is directed against the order dated 26.11.2013, rendered by the District Consumer Disputes Redressal Forum -I, UT, Chandigarh (hereinafter to be called as the District Forum only) vide which, it dismissed the complaint, filed by the complainant (now appellant). The facts, in brief, are that the complainant obtained a Personal Accident Insurance Policy, from the Opposite Party, valid for the period from 18.3.2011 to midnight of 17.3.2012, for the capital sum risk, to the tune of Rs. 5 lacs, on payment of premium, to the tune of Rs. 993. During the currency of the said Insurance Policy, the complainant met with an accident, on 19.3.2011, while walking, whereafter he was taken to Apollo Clinic, Chandigarh. The Doctors of the said Hospital advised the complainant, complete bed rest. Thereafter, the complainant filed a claim, with the Opposite Party, along with all the requisite documents, vide AnnexureC -3, followed by reminders dated 28.7.2011 Annexure C -4 and 31.8.2011, Annexure C -5. However, the Opposite Party, disowned its liability, on the ground, that no such claim was reported to its office. It was stated that the claim was duly intimated to the office of the Opposite Party and the same was acknowledged by it. It was further stated that the complainant spent approximately, a sum of Rs. 15,000, for treatment of the injuries suffered by him, in the said accident. It was further stated that the Opposite Party, was requested to pay the amount of claim, but to no avail. It was further stated that the aforesaid acts of the Opposite Party, amounted to deficiency, in rendering service, as also indulgence into unfair trade practice. When the grievance of the complainant, was not redressed, left with no alternative, a complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter to be called as the Act only), was filed, directing the Opposite Party, to reimburse, the amount of Rs. 15,000, spent by him, on his treatment; pay compensation to the tune of Rs. 20,000, for mental agony and physical harassment; cost of litigation, to the tune of Rs. 10,000; and interest on the aforesaid amounts @ 12% P.A., till realization.
(2.) THE Opposite Party, in its written version, admitted the issuance of Personal Accident Insurance (Individual) Policy, to the complainant. According to the Opposite Party, the said Policy was valid, for the period from 18.3.2010 to 17.3.2011. It was stated that the complainant met with an accident, on 19.3.2011, and, on the said date, the Policy was not in force. It was further stated that the details of accident were not mentioned by the complainant, in the complaint. It was further stated that according to the Personal Accident Insurance Policy, the claim was payable only if the insured sustained any bodily injury, resulting solely and directly, from the accident caused by external violent and visible means, and if the injury resulted into disability of any part of the body. It was further stated that though the alleged accident, which took place on 19.3.2011, was not covered under the said Insurance Policy, and no liability was admitted, yet the medical certificate dated 19.3.2011, submitted by the complainant, did not show that he was totally and permanently disabled, in any way, and, as such, his case did not fall, under the provisions of the same (Insurance Policy), even if the same was in force. It was denied that the complainant had submitted any letter dated 2.4.2011, to the office of the Opposite Party, or it acknowledged the same. It was further stated that the complainant did not intimate the Opposite Party, about any such accident, immediately, as required under Condition No. 1 of the Insurance Policy. It was further stated that neither there was any deficiency, in rendering service, on the part of the Opposite Party, nor it indulged into unfair trade practice. The remaining averments, were denied, being wrong. The Parties led evidence, in support of their case.
(3.) AFTER hearing the Counsel for the parties, and, on going through the evidence, and record of the case, the District Forum, dismissed the complaint, as stated above.;

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