ORDER

THIRU.S.KARUPPIAH, JUDICIAL MEMBER.

1. Aggrieved by the award passed by the District Consumer Disputes redressal Commission, Thanjavur, dated 27.08.2019 the appeal has been preferred by the opposite party/insurance company.

2. The facts The complainant insured his vehicle TN 49 BJ 0722 with the opposite party on 20.12.2016 the insurance coverage included own damages as well as Personal Accident coverage. The complainant on 11.09.2017 met with an accident and admitted in Theiva Hospital, Thanjavur on the same day, and discharged on 15.09.2017. Because of the accident his right hand wrist was fractured and plate was fixed in it. The medical expenses came to Rs.80,000/- and damage to the vehicle is Rs.5,000/- so the complainant made a claim for Rs.85,000/-. The opposite party/Insurance Company did not give any proper reply and the complainant suffered a lot of mental agony in approaching the opposite party. Finally, he sent a legal notice on 14.03.2018 which was received by the opposite party on 16.03.2018.

N o reply was sent subsequently by the insurance. Hence, this claim is filed alleging deficiency in service in not honoring the rightful claim and request the District Commission to direct the opposite party to pay Rs.85,000/- towards medical expenses and Rs.5000/- towards own damage claim and also Rs.1,00,000/- towards compensation for mental agony.

3. The opposite party filed their written version stating that, the complainant is not a consumer and the complaint is not maintainable. The allegations that he met with an accident and his vehicle sustained damage and he also sustained injuries are all not admitted. Similarly, the allegations that the complainant made a claim to the opposite party is also not admitted. The allegations that the complainant visited the opposite party many times is also not admitted. The claim for own damage is highly excessive and the medical expenses of Rs.80,000/- is not maintainable. Hence, the complaint is liable to be dismissed.

4. The District Commission after receiving the proof affidavits and documents Ex.A1 to Ex.A18, Ex.B1 allowed the claim by directing the opposite party to pay Rs.82,500/- towards medical expenses with interest at the rate of 9% from the date of complaint till its realization.

5. Aggrieved with the above order, the opposite party has . preferred the appeal on the following:

Grounds : That, the order of the District Commission is not sustainable in law. The District Commission failed to note that the policy did not cover reimbursement of medical expenses. As per the policy condition in Section III, which is a very restricted cover and the benefits are clearly defined under the policy, which are as under:

1. Death 100% of the Sum Insured

2. Loss of two limbs or sight of two eyes Or one limb and sight of one eye 100% of the Sum Insured 3. Loss of one limb or sight of one eye 50% of the Sum Insured

4. Permanent Total Disablement other from injuries other than named above 100% of the Sum Insured The personal Accident cover issued along with Motor Policy does not have a condition to reimburse or pay Medical expenses incurred by Insured/Owner/Driver arising out of an accident. Even as per the policy issued to the complainant there is no coverage for any medical reimbursement. Hence, they prayed to allow the appeal.

6. We heard both sides oral arguments and we perused both sides written arguments also. It is not disputed that the complainant insured his vehicle with the opposite party which is marked as Ex.A4. Similarly, which is also an admitted fact during the policy period the complainant met with an accident and he suffered medical expenses as well as damage to his vehicle. However, the disputed fact is as per the policy condition the complainant's entitlement to get reimbursement of medical expenses 7. Now the point for consideration is:

Whether the complainant i