In  the  Court  of  the

Consumer Disputes Redressal Forum, Unit -I, Kolkata,

8B, Nelie Sengupta Sarani, Kolkata-700087.

CDF/Unit-I/Case No.  258 / 2008.

1)                   Sri Ashoke Mondal,

20E, Talpukur Road, Kolkata-700058.                                                     ---------- Complainant

---Versus---

1)                   ICICI Lombard General Insurance Co. Ltd.,

Apeejay House, Block-‘B’, 7^th Floor,

15, Park Street, Kolkata-700015.                                                             ---------- Opposite Party

Present :           Sri Sankar Nath Das, President.

                        Dr. A. B. Chakraborty, Member

Order No.   3 3    Dated  1 3 / 0 3 / 2 0 1 2 .

The petition of complaint u/s 12 of the C.P. Act, 1986 has been filed by the complainant Ashoke Mondal against the o.ps. ICICI Lombard General Insurance Co. Ltd. The case of the complainant in short is that he insured his vehicle with the o.p. covering the risk and interest under scheme Private Car Package Policy covering loss of damage and 3^rd party liability along with the liability of personal accident for owner driver. On 12.8.06 the car met with an accident near Shyambazar and it was duly recorded at Cossipore P.S. vide M.C.R. No.90/06 dt.12.8.06. Due to the accident complainant received severe multiple injuries and was admitted to R.G. Kar Medical College and Hospital, Kolkata wherefrom he was transferred to Ekbalpur Nursing Home Pvt. Ltd. and treated there upto 22.8.06 and complainant was declared by the attending Orthopaedic Specialist at 45% permanently disabled. On 24.5.07 complainant preferred a claim of insurance amount of Rs.2 lakhs and o.ps. repudiated the same in their letter dt.9.1.08 on the ground that the temporary disablement does not come within the purview of the terms and conditions of the present insurance policy. Thereafter complainant made several correspondences with the o.p. for his claim but of futile exercise. Hence the instant case.

          O.p. had entered its appearance in this case by filing w/v denying all the material allegations labeled against it and prayed for dismissal of the case.

Decision with reasons:   

          We have gone through the pleadings of the parties, evidence and documents in particular. From the record we find that complainant was never declared defaulter by o.p. Fact remains that complainant had to incur a sum of Rs.1,10,000/- for his medical treatment owing to aforesaid accident. Receipt of premium cannot the sole criterion of the insurance company in a welfare state like us and mere clause of the provisions of he terms and conditions retain in a microscopic script cannot stand in the way for repudiating such type of accident oriental claim. The case law referred to by o.p. published in 2008 (3) CPR 214 (NC) hardly applies her since it relates to life insurance policy, not policy like instant one. O.p. while repudiating the claim did not take steps for ascertainment of the disablement. From the record we find no step was taken by o.p. prior to repudiating the claim of the complainant by Competent Authority for ascertainment exact extent of disablement challenging the veracity of the attending Orthopaedic Surgeon and his certificate and this action on the part of o.p. leaves room for doubt as to the very stand of repudiation  and o.ps. nowhere denied that complainant did not have to incur Rs.1,10,000/- for his treatment as medical expenses owing to the aforesaid accident in question caused to the complainant.

          In view of the above findings and on careful judicial application of the entire materials on record we are of the view that o.p. had sufficient deficiency repudiating the justified claim of the complainant being a service provider to its consumer / complainant and complainant is entitled to relief as prayed for.

          Hence, ordered,

          That the petition of complaint is allowed on contest against the o.p. with cost. O.p. is directed to pay Rs.1,10,000/- (Rupees one lakh ten thousand) only together with interest @ 9% p.a. from the date of claim till the date of realization. O.p. is further directed to pay compensation of Rs.25,000/- (Rupees twenty five thousand) only for harassment and mental agony and litigation cost of Rs.5000/- (Rupees five thousand) only within 45 days from the date of communication of this order, i.d. an interest @ 9% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.

          Supply certified copy of this order to the parties.

   _____Sd-______                                             _________Sd-_________

     MEMBER                                                           PRESIDENT