DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: WEST TRIPURA : AGARTALA

 

 

CASE   NO:   CC- 70 of  2023

 

Smt. Shilpi Deb,

W/O- Late Paritosh Deb,

Deb Para, West Masli, Karamcherra,

Manughat, Longtharai Valley,

District- Dhalai Tripura,

Pin- 799275. …................Complainant.

 

 

-VERSUS-

 

 

Mantri Bari Road, Old RMS Chowmuhani, 

Agartala, P.O. Agartala, P.S. West Agartala.

District-  West Tripura, Pin- 799001.

(To be represented by 

The Branch Manager). .......Opposite Party.

 

 

 

 

   ________PRESENT__________

 

 SRI GOUTAM DEBNATH

PRESIDENT,

  DISTRICT CONSUMER  

DISPUTES REDRESSAL COMMISSION,

      WEST TRIPURA, AGARTALA. 

 

 

SRI SAMIR GUPTA

MEMBER,

  DISTRICT CONSUMER  DISPUTES  

REDRESSAL COMMISSION,

WEST TRIPURA, AGARTALA. 

 

 

 

C O U N S E L

 

 

For  the  O.P. : Sri Subhajit Chakraborty,

 

 

 

F I N A L    O R D E R

1. Smt. Shilpi Deb here-in-after called the “complainant” has filed this complaint against the Chola Mandalam MS General Insurance Co. Ltd. here-in-after called the “O.P” alleging deficiency in service on the part of the O.P.

1.1 The case of the complainant in short is that the husband of the complainant Paritosh Deb, since deceased was registered Owner Cum Driver of the auto rickshaw vide registration No-TR 02 4296 which was insured with the O.P. Insurance company vide policy No. 3368/01231524/000/00 covering period from 25.06.2019 to 24.06.2020 having valid Driving license vide no. DL No. TRA0220050009035.

 

1.2 On 04.01.2020 at about 1350 hours the auto rickshaw of the husband of the complainant met with an accident at Masli Bye-pass at NH -08 with tipper Truck vide registration no. TR01 V 1736 due to rash and negligent driving by the driver of the truck. 

 

1.3 As a result Paritosh Deb sustained severe injuries  and the auto rickshaw was also badly damaged. He was shifted to Manu CHC but  died during the course of treatment on 04.01.2020. 

 

1.4 Written Ezahar was lodged before Manu Police Station vide Manu Police Station Case No.2020MNU001, dated 04.01.2020 U/S 279/304A/437 of IPC read with Sections 184/187 of M.V. Act, 1988.

 

1.5 The complainant approached before the O.P. Insurance company claiming for Compulsory Personal Accident (CPA) cover and also Motor Accident claim for the damaged auto rickshaw.

1.6 The O.P. vide letter dated 06.02.2020   asked the complainant to justify as to why there was delay of 27 days to intimate the O.P. Again by 2 nos. of letters dated 14.02.2020 and 21.02.2020 the O.P. demanded various vehicular document but as the auto rickshaw was seized by the Manu P.S. the complainant was unable to submit those documents. 

 

1.7 On 10.03.2020 the complainant came to know that her claim was closed due to non-cooperation.  Thereafter, the complainant again filed another application along with all vehicular documents and requested the O.P. to re-open her claim.

 

1.8 The O.P. vide letter dated 08.05.2020, 22.05.2020 and 29.05.2020 asked the complainant to submit documents including Post Mortem Report of Paritosh Deb. The complainant submitted all other documents but as the investigation  was not completed and charge sheet was not filed by Manu P.S. she could not submit the post mortem report.

 

1.9 Finally vide letter dated 13.09.2022 the O.P. without settling closed the claim of the complainant.

1.10 Hence, this case. 

 

2. The O.P. filed written objection denying all the allegations made by the complainant in her complaint petition. The main contention of the O.P. Insurance company is that the deceased i.e., Owner-cum Driver did not pay any premium for P.A. Coverage as such there was no P.A. Coverage. Hence, not entitled to compensation.

 

3. Hearing argument the following points are taken up for discussion and decision:-

 

 

 

Decision and reasons for decision:-

4. As per IRDA guidelines from the month of September, 2018, P.A. Coverage is must and the amount is Rs.15 lakhs. Whether the owner has any other P.A coverage otherwise the Insurance Company shall refuse to issue Policy of Insurance. From the policy of Insurance, we find that premium was paid for Paid Driver which tantamount to P.A. Coverage as Paritosh Deb, since deceased was driver-cum-owner of the Auto rickshaw. Premium was also paid for own damage as per the policy of insurance. 

From the complaint we find that Rs.34,000/- was estimated for the damage of the auto rickshaw. From the documents we find that the complainant has submitted estimate of Manoj Auto Mobiles for repairing of the auto rickshaw, however, glass item and rubber items are to be deducted.

4.2 As per order dated 06.08.2024 Learned Counsel of the O.P. Insurance Company has submitted Blank Proposal form without any signature of the insured but in fact this is a Model Proposal Form. In this proposal form there is no column whether the insured opted for CPA or not.

4.3 Learned counsel refers the circular of IRDA dated 11th December, 2018 wherein it is mentioned that “After the detailed examination of issues, it has been decided, in terms of Section 14(2)(i) IRDA Act, 1999, to unbundle the Compulsory Personal Accident cover and permit the issuance of a stand-alone CPA cover for owner driver. However, if a policy holder chooses to opt for the CPA cover as part of the Liability Only Policy  or the Package Policy as it exists today, he/she can continue to do so. In the event the policy holder chooses to take a stand-alone CPA Policy, the CPA cover offered as part of Liability Only or Package policy shall be deleted.”

4.4 This guideline of the IRDA only means that where the policy holder has otherwise P.A coverage he may not pay further premium for cover of personal accident. In such eventuality, in the proposal form there has to be a column that the insured opted not to take such policy and pay premium for that. Therefore, it must bear signature of the insured, otherwise the policy purpose of IRDA guideline for taking personal accident policy becomes frustrated and meaningless.

4.5 In the case at hand, the Model Proposal Form of the Insurance Company does not bear such column and the Insurance Co. has also failed to submit any such proposal form of the disease insured having his signature on such proposal form.

4.6 Therefore, we are of the clear opinion that this policy of Insurance is a clear violence of the IRDA guidelines and the Insurance company has to change the Model Proposal Form in terms of the order passed today.

5.    Hence, it is ordered that the O.P. Insurance Company shall pay the P.A. Coverage  of Rs.15 lakhs to the complainant with interest @ 7.5% P.A. from 23.08.2023 till the date of actual payment and pay a lump sum amount of Rs.25,000/- to the complainant for damage of the auto rickshaw and shall also pay further compensation of Rs.25,000/- which is inclusive of litigation cost.  

6. The case stands disposed off.

7. Supply copy of this order free of cost to both the parties and we find it appropriate to send a copy of this order to the IRDA authority, Govt. of India for kind perusal and for giving necessary direction to all the Insurance Company in this matter.

 

Announced.

 

 

 

SRI  GOUTAM DEBNATH

PRESIDENT,

DISTRICT CONSUMER  DISPUTES 

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA

 

 

 

 

 

SRI SAMIR  GUPTA

MEMBER,

DISTRICT CONSUMER DISPUTES

REDRESSAL COMMISSION,

WEST TRIPURA, AGARTALA.