Before the Motor Accidents Claims Tribunal (District
Judge)
Tirunelveli
M.C.O.P.N.O
/ 2022.
-------
Petitioners
VS
----- Respondents.
APPLICATION UNDER SECTION 166 OF THE MOTOR VEHICLES
ACT 54/94 AND FORM –II, SEE RULE 4 (1) AND (2) OF THE TAMILNADU MOTOR VEHICLE
ACCIDENTS CLAIMS TRIBUNAL RULES, 1989 AND MADE THEREUNDER IN G.O.Ms.1170 HOME
(TRANSPORT – VII) DATED 1.7.1989.
1. Address of the petitioner
The
address of service of all process and notices for the petitioners is as stated
above and that of their counsel
M.S. No. cell NO. Advocate, Number .
2. Address of the
Respondents.
3. I, the petitioner above named do hereby apply for
granting compensation on account of the injuries sustained by me in a motor
vehicle accident, which took place on
at about PM near in which a bearing regn.no. belonging to the 1st
respondent insured with the second respondent was involved. A criminal case was
registered in crime number / of
police station under section 279,337
IPC.
4. Necessary particulars in respect of the deceased, the
vehicle etc., are given below:
1. Name and Father’s name :
Of the person injured (Husband’s
Name in the case of married
woman and widow)
2. Full address of the person :
injured.
3. Age of the person injured :
4. Occupation of the person injured:
5. Name and address of the
Employer of injured
if any :
6. Monthly income of the person :
injured
7. Does the person in respect of :
Whom compensation is
claimed
Pay income tax? If
so state the
Amount of income tax
(to be
Supported by
documentary
Evidence)
8. Place, date and time of the :
Accident.
9. Name and address of the police : station in whose
jurisdiction the
accident took
place or was
registered.
10.Was the
person in :
respect of
Whom compensation
is claimed
Travelling in by the
vehicle
Involved in the accident?
If So give the
names of places
Of starting
of journey and
Destination.
11.Nature of injuries
sustained :
By the deceased.
12.Details of damages
caused :
To the property on
account
of the accident.
13. Period of treatment
and :
Expenditure if any,
incurred
There on (to be
supported by
Documentary evidence)
14. Registration number
and :
The type of the
vehicle
Involved in the
accident.
15. Name and address of
the :
Owner of the vehicle
16. Name and address of
the :
Insurer of the vehicle
16.(a) Name and address of
the :
Driver-in-charge of
the
Vehicle at the time
of accident.
17. Has any claim
been lodged :
With the owner/insurer?
If so with what result?
18. Name and
address of the :
Petitioner.
19. Relationship
with the : Petitioner himself is
the
Injured injured.
20. Title to the
property of the : Petitioner himself is
the
Injured injured
21. amount of
compensation :
Claimed.
21. (a)
Particulars of loss and
Expenses:
PART – I
a.
loss of earnings :
Rs.1,00,000/
For 5 months
b.
Partial loss of earnings :
Rs.
c.
Transport to hospital :
Rs. 25,000/
d.
Extra nourishment :
Rs. 50,000/
e.
Damage to Articles :
f.
Others:
1.
Medical attendants. :
Rs. 25,000/
2.
Medicines & : Rs. 1,00,000/
Medical charges
3.
Compensation for :
Rs. 2,00,000/
Shock & mental
agony
PART
– II
1.
Compensation for pain
and :
Rs. 2,00,000/
Sufferings.
2.
Compensation for
continuing : Rs. 2,00,000/
Permanent
disability
3.
Compensation for loss
of :
Rs. 2,00,000/
Earning power.
Total : Rs.
Claim restricted to Rs.
22. Whether the application is
:
Not made within six months
Of the occurrence of the
Accident, and the cause
thereof
a. Whether the deceased has been :
Involved in any other road
Accident earlier (in case how and
State details)
b. Whether the deceased has :
Preferred a claim for damages
In any case earlier and if so
With what result?
c. Whether the deceased has :
Preferred a claim with the owner
Of the vehicle and if so, how?
23. Any other information that may be necessary or helpful in the
disposal of the claim (here furnish a brief account of how the accident
occurred and state how the applicant is entitled to claim compensation and how
the respondents are liable to pay the compensation claimed)
1. On at
about the petitioner was , at that
time a bearing regn.no. belonging to the 1st respondent, insured
with the 2nd respondent driven by its driver in a high speed,
rashly, negligently and hit against the
As a result of which the petitioner sustained multiple injuries all over
the body in addition to fracture over .Immediately
after the accident the petitioner was taken to hospital and admitted a inpatient till
date. In the said hospital the petitioner underwent surgery and steel plates
and rods were inserted on the affected areas. A sum of more than Rs.1,00,000/
was incurred towards medicines and medical charges to this petitioner.
2. A case under section 279,337 IPC has been
registered by the police station in
crime number / against the first respondent driver which is
now pending before the judicial magistrate court at .
3. The petitioner was aged 28 years at the time of
accident and he was active. Due to the fractures over the right leg, the
petitioner is not able to walk without the help of the others or stick. The
petitioner’s entire right leg movement was completely restricted. The
petitioner is not able to stand for a long time. Sitting and squatting is not
at all possible for the petitioner. Due to the fracture over the left leg the
petitioner’s left leg movement also completely restricted. Due to the injury
the petitioner is permanent is permanently disabled. The petitioner was
doing work and thereby earning a sum of Rs. /pm which has been now deprived off. The
petitioner is not able to continue his profession as before. Hence he is
undergoing mental agony and physical sufferings. As the petitioner become
disabled, his functional disability would be total and in future he would not
be able to do any work and the loss of income would be total.
4. The petitioner herein, due to the injuries
sustained in the accident, sustained partial loss of earnings to the tune of
Rs.1,00,000/, he spent a sum of Rs.25,000/ towards transport to hospital,
Rs.50,000/ towards extra nourishments; Rs.25,000/towards expenses on person
attending on him while under treatment and Rs.1,00,000/ towards the cost of the
medicines and medical charges. However a sum of Rs.2,00,000/ has been claimed a
sum of Rs.2,00,000/ towards compensation for pain and sufferings. The
petitioner has claimed a sum of Rs.2,00,000/ towards compensation for
continuing permanent disability and that for loss of earning power he claims a sum
of Rs.2,00,000/. I total the petitioner herein estimates the loss and expenses
at Rs.11,00,000/ However, he restricts the claim to the tune of Rs.10,00,000/
only since the petitioner herein in the event of award of compensation by this
hon’ble tribunal, will get a lumpsum payment.
5. The 1st respondent is the owner of the
tractor bearing regn.no. which was
involved in the accident. The 2nd respondent is the insurer of the
said vehicle. The 3rd respondent is the divisional office of the2nd
respondent. The accident had occurred only due to rash and negligent driving of
the driver of the 1st respondent. Hence the respondents are jointly
and severally liable to pay compensation as claimed by the petitioners herein.
6. The petitioners have claimed a sum of R. /(Rs.
Only) towards compensation award amount and the court fees comes to
Rs. Under rule 24(1) of MV claim
rules. The petitioners have filed a separate application for the grant of
exemption from paying the court fees of Rs.
/. Hence a nominal court fee of Rs.200/ is paid in the main claim
petition.
7. The insurer, the 2nd respondent office,
policy issuing office is at . But the 3rd respondent,
divisional office of 2nd respondent is situated at , within the jurisdiction of the motor
accidents claims tribunal (District judge)
. Hence the claim has been preferred by the petitioners before this
hon’ble tribunal.
8. The petitioners have not preferred any claim
petition before any other forum for the grant of compensation in respect of
this accident.
It is therefore prayed that this hon’ble court may be
pleased to pass an order:-
a.
Directing the respondents
to pay the petitioners a sum of Rs. /
(Rs. Ony) towards the compensation
with future interest at 12% p.a. from the date of petition till payment;
b.
Directing the respondents
to pay the cost of this petition; and
c.
Granting such other
relief as this hon’ble court may deem fit and proper in the circumstances of
the above case and thus render justice.
Advocate for the petitioners Petitioners
I, the petitioner herein do hereby declare that the
facts stated above are true to our knowledge and belief and we sign this on
the day of 20
at .
Petitioners
LIST OF DOCUMENTS:
1.
Xerox copy of the first
information report.
2.
Xerox copy of the
insurance policy.
3.
Xerox copy of the Discharge
summary.
4.
Xerox copy of the Aadhaar
card of the petitioners ( numbers)
Advocate.
BEFORE THE MOTOR
ACCIDENTS
CLAIMS
TRIBUNAL (DISTRICT JUDGE)
MCOP / 21
==========================
Application under section 166 of
the motor
vehicles amended Act
54/94 of the Tamilnadu motor
Vehicles Accidents claims
Tribunal rules 1989 and made
There unde G.O.Ms.No.1170
Home (Transport VII dated
1.7.1989)
=========================
& others
--- Petitioners
By Advocate
MS.NO. /
Cell NO
And others
--- Respondents
Enclosures:
Vakalath
Batta memo
Documents
Affidavits
Petition & Affidavit
------------------------------------------
Total
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Presented on :
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