Orissa

Cuttak

CC/28/2020

Nisant Kumar Mohapatra - Complainant(s)

Versus

Branch Manager,Liberty General Insurance Ltd - Opp.Party(s)

J R Jena & associates

13 Oct 2023

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL COMMISSION,CUTTACK.

C.C.No.28/2020

 

Nisant Kumar @ Nisant Mohapatra,

S/o: Nirmal Mohapatra,

Vill: Naruabaligoradi,

P.S:Gop,Dist:Puri,

At present C/o: K.C.Mohanty,

Plot No.871/2122,Canal Road,

P.S:Lingaraj,Dist:Khurda.                                                                   ... Complainant.

          Vrs.

 

Branch Manager,

Liberty General Insurance Ltd.,

Plot No.99,Mouza:Cuttack Sadar,

Unit No.37,Badambadi,Kathajodi Main Road,

              Null,Cuttack,Dkst:Cuttack-753012.                                                ...Opp.Party

 

Present:         Sri Debasish Nayak,President.

                      Sri Sibananda Mohanty,Member.

 

Date of filing:    28.02.2020

Date of Order:  13.10.2023

 

For the complainant:           Mr. J.R.Jena,Adv. & Associates.

For the O.P.                :             Mr. A.A.Khan,Adv. & Assciates.

         

Sri Debasish Nayak,President                                           

Case of the complainant as made out from the complaint petition in short is that he is the owner of a Bajaj Pulsar motorcycle vide Regd. No.OD-02AY-7366 which he had insured with O.P through policy no.201230110418701063700000 which was effective from 16.10.2018 to 15.10.2019.  The complainant had paid the premium of Rs.8294/- including a sum of Rs.750/- towards personal accident coverage with a condition to indemnify upto a sum of Rs.15,00,000/- in case of death or towards the medical treatment expenses arising out of accident.  During the midnight of 7/8.2.2019 the complainant had met with an accident while riding his said motorcycle and had thereby sustained grievous injuries on vital parts of his body including head.  The complainant had incurred medical expenses to the tune of Rs.6,00,000/-.  The matter was reported at Chauliaganj Police Station vide P.S. Case No.33/2019.  The O.P was also intimated immediately for necessary action.  But despite repeated approaches, the insurance claim of the complainant was not settled by the O.P even though he was fulfilling all the norms of M.V.Act.   It is for the said reason the complainant has approached this Commission claiming a sum of Rs.10,00,000/- from the O.P his medical treatment expenses including his mental agony, sufferings and towards loss of his income and also towards his litigation expenses.  He has also prayed for any other relief as deemed fit and proper.

          Together with his complaint petition, the complainant has filed copies of several documents in order to prove his case.

2.       The O.P has contested this case and has filed his written version wherein he has stated that the complainant has not lodged any claim regarding his personal accident coverage of the insurance policy before the O.P till the O.P had filed the written version in this Commission.   The O.P has thus prayed for dismissal of the complaint petition with cost.  According to the O.P, the complainant should have given notice in writing to the Insurance Company immediately after the occurrence but the complainant had not claimed any such insurance from him for which the O.P urges that the case of the complainant is not maintainable which is liable to be dismissed with cost.  The O.P admits to have issued two-wheeler insurance policy bearing No. 201230110418701063700000 in favour of the complainant covering risk of his Bajaj Pulsar 220 motorcycle having engine noDKYCJF16602 Chassis no.MD2A13EY9JCF76040 effective from,16.10.2019 till the midnight of 15.10.2020 subject to certain terms and conditions of the said policy.  It is submitted by the O.P through his written version that the injuries which are sustained by the complainant/insured do not fall within the scale provided in IMT-15.  As such, no amount is payable by the insurance company even if it will be established by the complainant that he had lodged the claim immediately as per the condition no.1 of the insurance policy.  The O.P also admits that the complainant/insured had paid Rs.750/- for his personal accident coverage and the sum assured was upto Rs.15,00,000/-.  The O.P ultimately has prayed to dismiss the complaint petition with cost since because the complainant do not fall under the category as stipulated by him and envisaged as IMT-15.

          The O.P has also filed copies of some documents in order to support his case.

          The complainant has filed his evidence affidavit which when perused, it is noticed that the same is only the reiteration of the averments of complaint petition and nothing else.

          The O.P has also filed his evidence affidavit through one Mr. P.G.Kinare, working as AVP & Corporate Legal Manager, Liberty General Insurance Ltd., on perusal of which it is noticed that the same is only the reiteration of the averments as made in the written version of O.P and nothing else.

3.       Keeping in mind the averments as made in the complaint petition and the contents of the written version of the O.P, this Commission thinks it proper to settle the following issues in order to arrive at a definite conclusion here in this case.

i.          Whether the case of the complainant is maintainable?

ii.         Whether there was any deficiency in service on the part of the O.P and if he had practised any unfair trade ?

iii.        Whether the complainant is entitled to the reliefs as claimed by him?

Issue no.II.

              Out of the three issues, issue no.ii  being the pertinent issue is taken up  first for consideration here in this case.

               After going through the averments of the complaint petition, the written version, copies of documents as filed, the evidence affidavits from either sides so also the written notes of submissions, it is noticed that admittedly, the complainant had obtained one insurance policy towards his Bajaj Pulsar motorcycle bearing Regd. No.OD-02-AY-7366 which was effective from 16.10.2018 to 15.10.2019.  It is also not in dispute that the complainant had paid premium for the said policy to the tune of Rs.8294/- which includes a sum of Rs.750/- towards Personal Accident coverage.  The said insurance coverage was for an assured sum upto Rs.15,00,000/- in case of death or expenditure for medical treatment.  There was FIR lodged I n this case by one A.K.Mohanta who had submitted his written report before the IIC,Choudwar police station on 8.2.2019 mentioning that his deceased son Amit Kumar Mohanta was travelling alongwith his friend in a Bajaj Pulsar motorcycle bearing Regd. No.OD-02-AY-7366 which had met with an accident on the road near Tarini Temple at Biribati area as a result of which his son had died.  The said motorcycle was seized and was later handed over on Zima to father of the complainant.  As per the copy of the medical examination report, it is noticed that the complainant had indeed sustained injuries on his person due to such accident and he was blood vomiting.  The C T Scan showed Plax Cerebral bleeding for which he was admitted under the Neuro Surgeon.  The plea of the O.P is that the complainant had never put forth any claim till the O.P had submitted his written version before this Commission and also the complainant is not entitled for any claim since because he does not fall within the category of IMT-15.  The O.P has taken the plea that the complainant has not filed any claim before him but the complainant has filed his complaint petition before this Commission mentioning therein that since because his claim was not settled by the O.P, he had filed this case.  In his complaint petition he has mentioned at para-5 that as per condition, the matter was also intimated to the O.P immediately for taking necessary action at their end.  At para-6, it is alleged by the complainant that despite repeated approaches, the O.P has not shown any positive attitude towards settlement rather had misbehaved him.  No prudence person would come up with a case building stories in this sky.  The complainant after being harassed had approached this Commission definitely.  The contention thus raised by the O.P that no claim was made by the complainant does not hold good.  The O.P has taken the plea that as per the condition of IMT-15, the complainant is not entitled to any claim even though he had sustained injuries on his person since because the injuries of the complainant do not fall within the purview of the table as provided by the O.P.  Admittedly here in this case, the complainant had obtained insurance towards his Bajaj Pulsar motorcycle bearing Regd. No.OD-02-AY-7366 vide Policy No. 201230110418701063700000 which was valid from 16.10.2018 to 15.10.2019.  It is also admitted that out of the premium amount of Rs.8249/-, an amount of Rs.750/- was paid by the complainant towards Personal Accident Coverage with a condition to indemnify the assured sum of Rs.15,00,000/-. The O.P together with his written version has filed copies of certain documents in order to prove his stand.  The said documents of the O.P when scrutinized minutely, it is noticed that Annexure-A is the certificate of insurance policy schedule as issued by the O.P in favour of the complainant.  Exhibit-B is the copy of the policy terms and conditions as filed by the O.P. But the O.P has not filed any scrap of document in order to apprise this Commission that if while entering into the said policy proposal the complainant/insured was made aware about such terms and conditions as envisaged at IMT-15 that only for those terms and conditions, the complainant/insured will be entitled to get his claim otherwise not.  Thus, the complainant is not aware about such hidden terms and conditions of the O.P. The policy agreement as entered into in between the complainant/insured and the O.P/insurer appears to be unilateral, arbitrary and not in consonance in the eye of law.  Accordingly, by denying to settle the claim and taking a ridiculous excuse that the complainant had not made any claim, the act of the O.P imbibes us for an irresistible conclusion that infact the O.P is deficient in his service and has practised unfair trade also here in this case.  Accordingly, this issue goes in favour of the complainant.

Issues no.i & iii.

From the discussions as made above, the case of the complainant is maintainable and the complainant is entitled to the reliefs as claimed by him.  Hence, it is so ordered;

                                              ORDER

Case is allowed on contest against both the O.P. Thus, the O.P is directed to pay the complainant a sum of Rs.10,00,000/- towards medicinal and treatment expenses, mental agony and sufferings alongwith litigation expenses together with interest thereon @ 9% per annum from the date of filing of this case till the total amount is quantified.     This order is to be carried out within a period of 30 days from the date of receipt of copy of this order.

Order pronounced in the open court on the 13^th day of October,2023 under the seal and signature of this Commission.         

                                                                                                                                                                                            

                                                                                  Sri Debasish Nayak

                                                                                           President

                                                                                         Sri Sibananda Mohanty

                                                                                                   Member