DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

WEST TRIPURA :  AGARTALA

 

 

CASE   NO:   CC- 175 of 2022

 

Sri Asim Kuki,

S/O- Sri Ananda Kr. Kuki,

Chhanlog Para, P.O.- Hawaibari, 

P.S. Teliamura, District- Khowai, 

Tripura- 799205. ...........Complainant.

 

 

-VERSUS-

 

 

H.D.F.C. ERGO General Insurance Co. Ltd.,

(Represented by its Branch Manager)

2nd Floor, Techno Building, Sardar- 1,

Mantribari Road, P.S. West Agartala, 

District- - West Tripura- 799001.   ..........Opposite Party.

 

 

 

    __________PRESENT__________

 

 SRI GOUTAM DEBNATH

PRESIDENT,

  DISTRICT CONSUMER  

DISPUTES REDRESSAL COMMISSION,

      WEST TRIPURA, AGARTALA. 

 

DR (SMT) BINDU PAL

MEMBER,

  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 Complainant : Sri Bijan Saha,

         Miss Dhitashree Debbarman

         Learned Advocates.

 

For the O.P.   : Sri Sampad Chowdhury,

    Smt. Rinku Shil, 

            Learned Advocates.

 

 

ORDER  DELIVERED  ON:   26.04.2023.

 

F I N A L    O R D E R

1. This complaint U/S 35 of the Consumer Protection Act, 2019 has been filed by the complainant Sri Asim Kuki of Teliamura, Khowai District (in short 'the complainant') against the Branch Manager, HDFC ERGO General Insurance Co. Ltd., Agartala, West Tripura (in short 'O.P.') alleging deficiency in service on the part of the O.Ps. 

1.1 The fact of the case in brief is that the complainant is the owner of the registered bike bearing registration no. TR 01/R-9062. The said bike was insured with the O.P. Insurance company vide Policy No. 2320101132405400000 valid for one year w.e.f. 27.11.2021 to 26.11.2022. 

 

1.2 On 20.03.2022 at about 6.30 P.M. at Pal Para, Assam – Agartala Road the complainant met with an accident while he was coming from Teliamura to his house at Hawaibari riding the said bike bearing no. TR 01/R- 9062.  As a result of which he sustained grievous injuries on various parts of his body particularly in face.

1.3 He was taken to Teliamura Hospital and then referred to AGMC & GBP hospital, Agartala  where he was admitted and treated from 20.02.2022 to 28.02.2022.  

1.4 Due to the accident complainant also suffering disfiguration and became fully disabled, fully unemployed and became totally dependent upon on others in all respects. 

1.5 Complaint was lodged before the O/C, Teliamura, Khowai District, Tripura which was registered as Teliamura P.S. G.D. Entry No. 18 dated 04.03.2022.

1.6 Thereafter the made oral claim before the Agartala Branch Office of the O.P.,  for an amount of Rs.18 lakhs with interest and other costs along with all relevant documents but with no result.

1.7 Lastly on 07.03.2022 he issued a Demand Notice to the O.P. to settle his claim. 

1.8 On 05.04.2022 the O.P. verbally informed the complainant that they will not settle his claim and he is not entitled to any compensation from the O.P.

1.9. Till today the O.P. did not settle the claim of the complainant.

1.10 Hence, the complainant filed this case before this Commission for getting relief claiming compensation of Rs.18 lakhs with up to date interest @ 12 %. 

 

2. The contested the case of the complainant by filing written version denying all the allegations made by the complainant in his complaint petition. 

2.1 It is stated by the O.P. that according to the terms and conditions of the policy the information should be given to the company via claim intimation. It is also contended by the O.Ps that they did not receive claim of the complainant nor even they received any document about the accident. Thus, the O.P. payed for dismissal of the complaint.  

 

3. The complainant filed his evidence on affidavit along with documents.      

4. On the basis of evidence submitted by the complainant along with documents and pleadings as well as arguments advanced by the parties the following points are taken up together for discussion and decision:- 

(i) Whether there is any deficiency in service on the part of the O.P. ?

  (ii) Whether the complainant is entitled to get the reliefs as sought for within the scope of the P.A coverage as per the policy of insurance?

 

DISCUSSION AND REASONS FOR DECISION:-

5. For convenience both the points are taken up together for discussion & decision. 

5.1 We have gone through the documents submitted by the complainant as well as the copy of policy submitted by the O.P. 

5.2 On perusal of the medical documents we find that the complainant was admitted in Agartala Govt. Medical College & GBP Hospital, Agartala on 20.02.2022 i.e., the day of accident and was discharged on 28.02.2022. G.D. Entry was also made on 04.03.2022.

5.3 We have also perused other medical documents including vouchers for the purpose of proving the expenses incurred for his treatment in the hospital. 

5.4 As per Section III of the terms and conditions of the policy the Personal Accident Cover for Owner-Driver is as under :-  

(i) The policy holder is entitled to the entire amount that is 100% in case of death. (ii) again 100%  in case of loss of 2 limbs or sight of 2 eyes or 1 limb and sight of 1 eye (iii) loss of 1 limb or sight  of 1 eye in that case 50% of the total sum and (iv) permanent total disablement from injuries other then named in the 3 cases above. 

5.5 Therefore, there is no scope for giving any compensation for the injuries sustained by the complainant.

5.6 Therefore, as per the scope of the policy of personal accident coverage the complainant has not suffered any permanent disability either 100% or 50% in terms of clause (ii) or clause (iii) or either permanent total disablement. Be it made clear that under P.A. coverage,  insured is not entitled to any compensation either under pecuniary loss or non pecuniary loss as in the case of 3rd party insurance policy under the Motor Vehicle Act, 1988.

6. In the result, we do not find any deficiency of service on the part of the O.P. Insurance Co. as the claim of the complainant is not legally maintainable.

7. All the points are decided accordingly in negative.

8. Hence, the case is disposed of. Supply copy of this final order to the parties free of cost.       

Announced.

 

 

 

SRI  GOUTAM DEBNATH

PRESIDENT,

DISTRICT CONSUMER  DISPUTES 

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA

 

 

 

 

DR (SMT)  BINDU  PAL

MEMBER, 

DISTRICT CONSUMER DISPUTES 

REDRESSAL COMMISSION, 

WEST TRIPURA,AGARTALA

 

 

 

SRI SAMIR  GUPTA

MEMBER,

 DISTRICT CONSUMER DISPUTES  

REDRESSAL COMMISSION,

WEST TRIPURA,AGARTALA.