Gulam vs ORIENTAL INSURANCE CO. LTD

REVISION Petition No. 2910 OF 2013 has been filed by the petitioner/complainant against the order dated 28.3.2012, passed by Madhya Pradesh State Consumer Disputes Redressal Commission, Bhopal (short, "State Commission") in First Appeal No. 1296 of 2011.

BRIEF facts of the case as per petitioner/complainant are that the petitioner/complainant had purchased one insurance policy from the office of the respondent/insurance company, under which there was personal accident policy also. The number of this policy was 122701/07 which was valid from 20.12.2006 to 19.12.2007. After that till date, the above policy was valid and effective. Along with the policy premium Rs. 442/ -, the petitioner had paid premium for accident Rs. 50/ - to the insurance company, under which risk for Rs. 1 lakh was covered. The petitioner was seriously injured in an accident in 3.1.2007. He was admitted and treated in Arihant Hospital. The petitioner remained in Life Line Hospital from 3.1.2007 to 5.1.2007 and from 6.1.2007 to 16.1.2007, he remained admitted in Arihant Hospital.

THE petitioner got injuries in head, mouth and back and fracture in back bone and 8 teeth broke in the accident. After treatment from the doctor, 75% disability certificate was issued. The applicant under personal accident policy has filed case no. 374 of 2008 for compensation in District Consumer Forum in which was dismissed by the District Forum on 25.8.2009.

IN compliance with the order given by the District Forum, the petitioner submitted an application in the office of the insurance company which was dismissed by the opposite party on the basis of false facts. Therefore, the complaint was again filed before the District Forum. Respondent in its reply before the District Consumer Disputes Redressal Forum, Indore (short, ''District Forum'') has stated that; "The complainant in connection with the above accident, had submitted one complaint earlier also before the Hon''ble Forum, which the Hon''ble Court has disposed of on 28.8.2000, giving this order that the opponent should dispose of the claim, within two months from the date of submission of the claim by the complainant.

The complainant, alongwith his complaint letter has submitted the certificate of permanent disability, who is not of the complainant but any other person Gul Mohammad father Kadar Khan, aged 54 years. The complainant, with the intention to get false claim has submitted the certificate of permanent disability in the case. The complaint letter of the complainant is fit to be dismissed on this very basis. The above certificate, is submitted along with this rejoinder and exhibit D -1 has been mentioned on it

The claim form that has been submitted by the complainant alongwith the complaint, in that the date of accident has been mentioned as 3.1.2007. Along with in this claim form, the date of admission for treatment in Arihant Hospital and Research Centre has been mentioned for the period dated 23.10.2006 to 26.10.2006. It is clear that the complainant wants to submit the false claim on false basis through the medium of Hon''ble Forum. In this very claim form, this is also mentioned that the treatment of the complainant has been done in the M.Y. Hospital but in this connection, no document has been submitted by the complainant in the case.

The complainant, in his complaint has written his name in the complaint letter as Gulam Mohammad and address 735, Nanda Nagar, Indore and the complainant himself in the above claim form, exhibit D -3, has mentioned his name as Gulam Hussain, 735, Chandan Nagar, age 62 years. There being disparities between alongwith the complaint by the complainant, the case being doubtful, is fit to be dismissed.

The complainant alongwith his complainant letter, has submitted the discharge card of Arihant Hospital, which is of any other person Gul Mohammad, father Chajju Shah, age 54 years in which there is no mention of injuries caused to the complainant in the accident. In the above discharge card, in the diagnosis column, it is clearly mentioned whiplash injury. The above discharge card has been submitted in the case and exhibit D -3 has been mentioned.

The complainant, in the description in his complaint, at para 2 mentioned that he got his treatment done by admitting himself in Life Line and Arihant Hospital, Indore but in the claim form, exhibit D -2, has mentioned treatment in M.Y. and Lifeline Hospital, Indore but has not submitted any document concerning treatment at M.Y.

If the complainant has met with any vehicle accident and in that he had received injuries, then its MLC would have been made, the complainant has not submitted any MLC alongwith his complaint Clearly, the complaint of the complainant is suspicious.

The vehicle mentioned by the complainant, the vehicle motor cycle no. MP 09 JT 3006 is registered in RTO Indore in the name of Gulam Mohammad, father Chajju Shah, resident 142, Nandan Nagar, Indore. And in the insurance policy of the above vehicle, the name of the complainant has been mentioned as Gulam Mohammad, 735, Nanadan Nagar, Indore. And in the complaint letter, the name is written as Gulam Mohammad father Sajju Shah alias Gul Mohammad, resident 735, Nandan Nagar. The letter to lodge no claim case, letter that was sent by the opponent insurance company to the complainant through registered AD on dated 5.11.2009, having been returned without discharge, then the above letter without discharge was again received back on 10.11.2009. Then the complainant received the above letter of no claim by coming in the office of the opponent on 30.11.2009. In this way, due to considerable disparities being in the documents submitted by the complainant, the complaint letter of the complainant is suspicious. The above both the registered letters envelopes have been marked as exhibit D -4 and exhibit D -5. On vehicle registration and insurance policy, exhibit D -6 and exhibit D -7 has been mentioned.

The complainant with the intention to obtain false claim, submitted one MST case one false basis before the Third Party Motor Accident Claim Authority, which has been dismissed by the Authority. The above facts not having been mentioned in the complaint, the actual facts having been hidden, false affidavit has been submitted along with the complaint letter.

On the above primary objections being there, without accepting any responsibility by the opponent, this is also requested that in the policy issued by the opponent for vehicle no. MP 09 JT 3006, in the personal accident risks, the injuries caused to the complainant do not come under the vehicle accident, the claim is not fit to be paid.

In the claim letter dated 5.11.2009 given to the complainant under the personal accident section, the risks covered have been mentioned. The injuries suffered by the complainant not coming under the category of the described risks in the personal accident section, the claim of the complainant having been do ne no claim by the opponent, there has not been any dereliction of services by the opponent The complainant received the above letter of no claim by coming in the office of the opponent on 30.11.2009.

The complainant on false basis, thoughtfully with the intention to get false compensation amount, reported to the police about the injuries caused in the vehicle accident, on 23.1.2007, that is delay of 20 days after the accident on 3.1.2007, the complainant not being eligible to receive compensation amount of any type, the complaint of the complainant be dismissed alongwith expenses.

The complaint has not met with vehicle accident on 3.1.2007. The injuries have been caused to the complainant have been caused by jerk due to fastness and carelessness of the driver of the complainant vehicle no. MP 09. JT 3006. The complainant having got the case registered against unknown vehicle on false basis, the complainant not being eligible to receive any compensation amount of any type, the complaint of the complainant on this very basis is fit to be dismissed.

From the perusal of the documents submitted by the complainant alongwith his complaint, it is clear that there being significant difference between the different names of the complainant, the complaint of the complainant being significant difference between the different names of the complainant, the complaint of the complainant being doubtful, the complainant, under the provisions of the policy, is not fit to receive any compensation amount from the complainant, the complaint against this opponent is fit to be dismissed."

DISTRICT Forum vide order dated 3.12.2009 while dismissing the complaint observed that: - "11. Deliberations were done on the arguments of both the parties. Perusal was done of the claim dismissal letter and the insurance policy. On perusal of the conditions of the insurance policy, it is clear that there is provision of giving 100% amount of compensation in death due to accident and on mutilation of two parts, eye sight of both the eyes or on mutilation of one limb and one eye, there is provision of giving 50% compensation and on being permanent disable, there is provision of giving 100% amount of compensation. In the case, the certificate that has been submitted by the complainant with respect to disability, the injuries described in that do not come in the conditions of the policy.

The conditions of the policy are as below: -

From the above deliberations, this is clear that the injuries received by the complainant, not being under the conditions of the policy, the opponent has not committed any dereliction of services by not making the payment.

From the above deliberation, it is clear that dereliction of services by the opponent has not been proved.

Deliberation point no. 2 -Asa resultant, the complainant not being eligible to receive any help, the complaint is dismissed."

AGGRIEVED by the order of the District Forum, petitioner filed an appeal before the State Commission. The State Commission in its impugned order dated 28.3.2012 while also dismissing the appeal observed as under : - "In the reply submitted before the District Forum, the defendant appellant insurance company has given this statement that the certificate of permanent disability that has been submitted by the appellant alongwith his application, is of other person, Gul Mohammad, father Kadar Khan. Whereas in the application, the complainant has mentioned his name as Gulam Mohammad and address 735, Nandan Nagar, whereas in the claim form, name Gulam Hussain is mentioned. In Arihant Hospital, in the discharge card, name Gul Mohammad, father Chaggu Shah is mentioned. Due to disparities in the document, the complaint letter is doubtful. The defendant appellant insurance company has given this statement also that the injuries that have been received by the appellant, that being not due to vehicle accident, the insurance amount is not fit to be paid. It has been requested to dismiss the complaint.

In the documents submitted in the file, many disparities were found in the name of the appellant/applicant. In the disability certificate submitted by the appellant in the file, the described injuries are does not appear to be in the ambit of conditions of the insurance policy. From the perusal of conditions of the insurance policy, this is clear that in case of death in accident, 100% compensation and disability in two parts eye sight in both the eyes or for one limb and one eye, there is provision of providing 100% compensation. Whereas for disability in one limb and one eye, there is provision of giving 50% compensation and for permanent disability, there is mention of giving 100% amount. Whereas, in the above case, the applicant has not submitted any such certificate from which it can be established that he has got any permanent disability of this type. Accordingly to the certificate given by the District Medical Board, Indore, the applicant has suffered 45% disability.

On the basis of perusal of the above, we find that the injuries got by the appellant are not fit to for payment under the policy. In our opinion, the order passed by the District Forum is appropriate and according to law.

As a resultant, the appeal submitted is dismissed."

Hence, the revision petition.

WE have heard the Amicus Curiae appointed on behalf of the petitioner and carefully gone through the record. The petitioner was also present in person.

LEARNED counsel argued that the petitioner was aggrieved as the respondent had not honoured his claim inspite of the fact that he had suffered 75% disability in the accident. Ongoing through the record, we see there is disability certificate on record from District Medical Board, Indore which mentions the name of the petitioner and his address. The rest of the columns in the form are blank. The certificate does not mention what the petitioner was suffering from and what was the percentage of his disability. It appears that the petitioner has somehow obtained a blank form of the District Medical Board and after affixing his photograph has filled in some details. The said medical certificate has also not been signed by any Member of the Board as such no reliance can be placed on the certificate. The petitioner has failed to prove that he suffered any injury resulting a in disability which is covered by the conditions of the policy. The policy was issued by the respondent for vehicle No. MP 09 JT 3006. Hence, we do not find any error in the orders passed by both the foras below as they have rightly dismissed the complaint. Hon''ble Supreme Court in Mrs. Rubi Chandra Dutta Vs. M/s. United India Insurance Co. Ltd., : 2011 (3) Scale 654 has observed; "Also, it is to be noted that the revisional powers of the National Commission are derived from Section 21(b) of the Act, under which the said power can be exercised only if there is some prima facie jurisdictional error appearing in the impugned order, and only then, may the same be set aside. In our considered opinion there was no jurisdictional error or miscarriage of justice, which could have warranted the National Commission to have taken a different view than what was taken by the two Forums. The decision of the National Commission rests not on the basis of some legal principle that was ignored by the Courts below, but on a different (and in our opinion, an erroneous) interpretation of the same set of facts. This is not the manner in which revisional powers should be invoked. In this view of the matter, we are of the considered opinion that the jurisdiction conferred on the National Commission under Section 21(b) of the Act has been transgressed. It was not a case where such a view could have been taken by setting aside the concurrent findings of two fora."

THUS , no jurisdictional or legal error has been shown to us to call for interference in the exercise of powers under Section 21(b) of Act. Since, the both the foras below have given detailed and reasoned order which do not call for any interference nor they suffer from any infirmity or erroneous exercise of jurisdiction or material irregularity. Thus, the present revision petition is hereby dismissed.

NO order as to cost.