MRS S.TRIPATHY, MEMBER:-This case is filed by one Sonu Agrawal alleging unfair trade practice against Branch Manager, National Insurance Company Ltd., Sambalpur. Brief fact of the case is that, the petitioner is the owner-driver of the private vehicle bearing Regd.No.OR-15-Q-4963 and insured his vehicle with the O.Ps Company vide Policy Certificate No.120628339 covering the period from dt.21.12.2010 to dt.20.12.2011. The said insurance was covered with the personal insurance/bodily injury of the owner-driver, for which he has paid additional P.A. cover premium, U/s.11-1-owner-driver against death or bodily injury to an extent of Rs.2,00,000/-.
2. On dt.05.3.2011 at about 6 A.M., the said vehicle met with an accident and in the said accident the vehicle was badly damaged and the matter was reported at Sadar Police Station, Sambalpur vide P.S.Case No.35. Due to the accident, the right leg of the petitioner was fractured as well as bone of right hand was dislocated. For treatment, operation, imputation of steel rod in right leg, the petitioner spent about a sum of Rs.1,00,000/-. After the aforesaid operation, the petitioner was again required to be admitted for another operation and treatment, but not fully recovered as yet.
3. In the aforesaid accident, the petitioner got permanent injury in his right leg and became disable. He spent a huge amount in his treatment, but he could not be cured. For such bodily injury, he is entitled to receive an amount of Rs.2,00,000/-, U/s.11(10 under the limit of the liability clause towards compensation. Accordingly he preferred a claim and submitted all the necessary documents in support of that for early sanction of the compensation amount, but his claim has been illegally and unlawfully repudiated by the O.P. and the O.P. harassed the petitioner intentionally. The avoidance of the payment of the legitimate claim of the petitioner by the O.P. amounts to unfair trade practice and also the O.P. Insurance Company is deficient in giving service to its insured.
4. The petitioner prays for the following reliefs to this Forum
(1) O.P. be directed to pay an amount of Rs.2,00,000/-as compensation .
(2) to pay a sum of Rs.50,000/- towards harassment and mental agony suffered by him.
(3) to pay a sum of Rs.5,000/- towards cost of litigation.
Documents filed by the complainant are Xerox copies of
- Certificate of Insurance (2) Advocate’s Notice dt.8.10.2011 (3) Reply to Advocates notice
5. After service of notice from this Forum, the O.P. Insurance Company filed its written version. It is not disputed by the O.P. that the complainant had taken an insurance policy covering the period from 21.12.2010 to 20.12.2011 and after the accident; the complainant in the capacity of the owner/insured of the vehicle lodged a claim before the o.p. for compensation in terms of the policy. It is stated by the O.P. in its written version that, Sec.11 (1) of the policy refers to the limits of liability clause of the policy. This clause deals with three kinds of peril i.e. (i) Death or bodily injury of third party- the compensation admissible is as per the M.V.Act, 1988, (ii) Damage to vehicle- on actual basis subject to the condition and exception of clause of the policy and (iiii) P.A.(Personal Accident) cover under Section-III for owner-driver is fixed for a sum of Rs.2,00,000/-.
6. The O.P. Insurance Company described the terms and conditions itemized in IMT-15 under the heading Accident to the Insured other than paid driver or cleaner in a form of table. This section/clause of the policy has made a specific provision regarding the amount of compensation to be paid to the owner-driver in the event of a contingency of such nature.
7. The claim of the complainant was disallowed by the O.P. as the reported injury allegedly sustained by the complainant depicted in his claim intimation letter covers neither of the contingency allowed under the policy. On the aboveground it is submitted by the O.P. that, it was never negligent or deficient in rendering effective services, and the personal injury claim of the complainant was repudiated under a valid and proper ground which is permissible under the policy so also the law governing the field. So, there is no deficiency in service of any nature of the O.P. in this case.
8. We heard both learned counsels on behalf of the parties and also gone through the record and documents filed therein.
9. It is submitted by the complainant that, due to the accident, his right leg was fractured and after operation also he was in disable condition. He spent a huge sum of money in his treatment and for such bodily injury he is entitled to get an amount of Rs.2,00,000/-U/s. ii(i) under the limit of liability clause of the O.P. Insurance Company towards compensation.
10. It is also not denied from the side of the O.P. that due to the accident, the right leg of the complainant got injury and permanently became disable. The O.P. Insurance Company described about the amount of compensation to be paid to the owner/driver in the event of a contingency of such nature. The learned counsel on behalf of the O.P. vehemently protested in this regard and submitted that, the O.P. Insurance Company is no way liable to pay any amount to the complainant.
11.In our view, in the present case, the second provision that is Loss of one limb or sight of one eye for which scale of compensation is 50%, is applicable to the complainant’s claim and repudiation of claim of the complainant by the O.P. Insurance company is not justifiable.
12. Keeping in view the facts and circumstances, the case of the complainant is allowed against the O.P. on contest. O.P. is directed to pay to the complainant 50% of the insured amount i.e. Rs.1,00,000/-(Rupees One Lakh) along with Rs.3,000/-(Rupees Three thousand) towards cost of the proceeding within one month of the order, failing which the O.P. will pay interest 9% per annum on the awarded amount from the date of order till the date of payment.
