THE PRESIDENT

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

WEST TRIPURA : AGARTALA

 

CASE No. CC- 55 of 2020

 

Smt. Rita Das,

W/O- Lt. Jantu Das,

R/O- Kamalnagar,

P.O. Totabari, P.S. Kalyanpur,

District- Khowai, Tripura- 799203.     …...................Complainant.

 

-VERSUS-

 

ICICI Lombard General Insurance Co. Ltd.,

RMS Chowmuhani, GRS Towers, 2nd Floor, 

Agartala, Tripura(West) Pin- 799001.     .....................Opposite Party.

 

 

     __________PRESENT__________

 

 SRI RUHIDAS PAL

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 Anirban Bhattacharjee,

  Sri Samrat Kar Bhowmik,

  Learned Advocates.

    

For the Opposite Party : Sri Utpal Das,

  Learned Advocate.

 

 

JUDGMENT  DELIVERED  ON : 13.12.2021

J U D G M E N T

This case has been filed by the complainant Smt. Rita Das of Kamalnagar, Khowai Tripura against the O.P namely ICICI Lombard General Insurance Co. Ltd. for deficiency of service on the part of the O.P. It is stated in the petition that the husband of the complainant was serving in 10th Bn TSR as a rifleman and on 24.01.2019 while he was travelling by his motorcycle bearing no-TR-06-9001 at about 9.00 hrs from Khowai TSR outpost to his house to North Kamalnagar met with an accident. The fact of accident was informed to Fire Service by local people and Kalyanpur Fire Service staffs shifted the husband of the complainant to Kalyanpur CHC. The husband of the complainant was treated there and after that he was treated in GPB Hospital, Agartala, subsequently referred to ILS hospital, Agartala  then again he was shifted to GBP Hospital, Agartala wherein on 04.03.2019 he expired from his injuries caused due to the said accident. From the postmortem report it was held that the cause of death was found to be septicemia from head injury. Written information was also given to Kalyanpur P.S. on 08.03.2019 and accordingly Kalyanpur P.S. U.D case no- 2019KLN006, U/S 174 Cr.P.C. Dated 08.03.2019 vide Kalyanpur P.S. G.D. Entry No- 27 dated 08.03.2019 was registered. Final report no- U.D. F.R. No.10/2019 dated 30.04.2019 was also submitted by the investigation authority. It is stated in the petition that the motorcycle of the deceased Lt. Jantu Das had valid registration from 28.10.2016 to 27.10.2023. Tax was paid upto 30.09.2031. PUC certificate was valid from 31.10.2018 to 30.04.2019. It was duly insured with ICICI Lombard General Insurance Co. Ltd. vide certificate no- 3005/42531025/40112/000 valid from 31.08.2018 to 30.10.2019. At the time of accident Lt. Jantu Das was holding a valid driving license bearing no-TR-0520160020981 issued on 09.06.2016 and valid upto 08.06.2036. The insurance policy had compulsory personal accident coverage covering the owner cum driver for Rs.15 lakhs as per terms and conditions of the policy and premium was duly paid for the said coverage as per the policy certificate. The nominee in the policy was the complainant. After death of the deceased, death certificate was duly issued by the registrar of birth and death, AGMC and GBP hospital, Agartala. Survival Certificate was also issued by SDM Office, Teliamura on 03.06.2019. On 27.09.2019 the complainant made a written claim to the O.P. Insurance company for settlement of the claim. But they did not disburse the insured amount nor made any sort of communication with the complainant till date. It is also stated in the petition that the O.P. intentionally and deliberately harassed the complainant being deficient of their service to its consumer, denying to settle the claim. Hence, the complainant filed this petition claiming Rs.15 lakh amount of the policy, Rs.1 lakh for mental agony and harassment, Rs.25,000/- as cost of the litigation along with 12% interest.

 

2. ` The Opposite party appeared and filed their written statement denying the allegation made by the complainant in her complaint petition. In their written statement O.P. stated that instant claim petition is not maintainable in its present form and nature as well as in law and the petition is baseless so far the O.P. ICICI Lombard General Insurance Co. Ltd. is concerned. That the complainant has not come with clean hands before this Commission and concealed various material particulars. It is also stated in the written statement that the complainant suppressed material facts. It is clearly written on their every policy paper that 'in case of buy/renewal/ service/ claim related queries log on to www.icicilombard.com or call Toll free number-18002666. complainant never intimated about the claim till now and the present O.P. is totally in dark about this claim of the complainant. O.P. first came to know the fact by receiving notice from this Commission. However receiving notice the O.P. for further processing  issued reminder letter dated 17th December, 2020 to the insured but till date requisite documents not submitted. O.P. admitted that the vehicle of the deceased was insured with their company. In regard to the para no. 2, 3 and 4 of the complaint of the complainant it is submitted that those are matter of record.  O.P. denied the contention made by the complainant in his complaint at para no-6, 7 & 8 and O.P. stated that there is no question of harassment and deficiency in service and also compensation to the complainant. Hence the O.P. prayed for dismissal of the complaint petition made by the complainant before this Commission.

 

3. EVIDENCE ADDUCED BY THE PARTIES:-

Complainant submitted examination in chief on affidavit and also examination in chief of another witness namely Nakul Das, brother in law of the complainant.  She also produced 12 documents containing 15 sheets which on admission were marked as Exhibit- 1 Series.

On the other hand, O.P. namely Dibakar Gupta, Insurance Investigator of ICICI Lombard General Insurance Company Ltd. submitted examination in chief on affidavit and one document(6 sheets) which on admission marked as Exhibit- A Series.

 

4. POINTS TO BE DETERMINED: - 

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

  (ii)Whether the complainant is entitled to get compensation/ relief as prayed for?

 

5. ARGUMENTS: - 

Heard argument of both sides at length. Learned Advocate appearing for the complainant submitted that there is dispute about compulsory personal accident coverage amounting  to Rs.15 lakhs as per terms and conditions of the policy but the O.P. denied to settle the claim and most illegally did not honour the terms of Insurance policy. As a result O.P. caused immense mental agony and hardship to the complainant which the complainant is required to be compensated. It is further submitted that complainant was compelled to file this complaint unnecessarily and so complainant is entitled to get Rs.15 lakhs as Personal Accident Coverage and Rs.1 lakh for mental agony and harassment Rs.5,000/- as cost of notice and Rs.20,000/- as litigation cost along with interest @ 12% P.A. w.e.f. the date of cause of action.

 

On the other hand Learned Advocate Mr. Utpal Das appearing on behalf of the O.P. fairly submitted that there is not dispute about the compulsory Personal Accident coverage amounting to Rs.15 lakhs but it was not disbursed on genuine grounds such as non filing of requisite documents. Mr.Das submitted that the insurance policy was subject to the terms, conditions, exceptions and limitations there of and the confirmation of the compliance of Section-64 VB of the Insurance Act, 1938. So, it was justified on the part of the O.P. not to disburse the policy amount. He further submitted that personal accident claim was never intimated to the O.P. to arise any cause of action against the O.P. However, after receiving this case notice from DCDRC, West Tripura, Agartala claim was initiated and required documents were asked to submit for further proceeding. Reminder was also sent to the insured but no requisite documents  were submitted.  

 

6. DECISION AND REASONS THEREOF:-

                    Both the points are taken up together for convenience. We have gone through the pleadings as well as evidences, both oral and documentary adduced by the parties. 

From the evidence of the complainant we find that P.W.1 Smt. Rita Das in her examination in chief on affidavit stated that her husband was served in 10th Bn. TSR as a rifleman. On 24.10.2019  at about 19hrs her husband was traveling by his motor cycle bearing registration no- TR0696001 from Khowai TSR outpost to North Kamalnagar and when he reached at Amar colony on Khowai-Teliamura Road, he lost control over the motor cycle and met with an accident. The local people informed the matter to the fire service station, Kalyanpur who shifted him to Kalyanpur CHC without any delay. Thereafter, her husband was referred to GBP Hospital, Agartala for better treatment. Thereafter her husband was shifted to ILS Hospital, Agartala where he was treated up to 03.03.2019. But ultimately on 04.03.2019 her husband expired due to injuries caused by the said accident. P.W.1 further deposed that the motor cycle was duly insured with ICICI Lombard General Insurance Co. Ltd. at the relevant time. Her husband was holding a valid driving license at the time of accident. The insurance policy had Compulsory Personal Accident Coverage covering the owner cum driver for Rs.15 lakhs as per terms and conditions of the policy and premium was duly paid for the said coverage. Being wife and the nominee of the said policy she claimed the insurance coverage amount. She further stated that on 27.09.2019 she made a written claim along with relevant documents for settlement of the claim with the O.P. Insurance company and requested to disburse the insurance amount at the earliest but till date the O.P. did not disburse the insured amount nor made any sort of communication with her. P.W.2 Sri Nakul Das stated that he is the brother in law of the complainant and elder brother of the deceased Jantu Das. He almost repeated the facts of accident narrated by P.W. 1. 

On the other hand, D.W. 1, namely Sri Dibakar Gupta in his examination in chef on affidavit stated that he is fully aware of the facts and circumstances of the case. He stated that he was the insurance investigator and he admitted that there was a bike accident by the husband of the complainant and due to that accident husband of the complainant expired on 04.03.2019. D.W.1 at para 4 of his examination in chief stated that in order to settle the claim of the complainant he asked for required documents from the complainant but the complainant did not provide the required documents. Therefore the O.P. was unable to settle the accident claim. 

Complainant exhibited the copy of written claim dated 27th September, 2019 (Exhibit-1 Series). On perusal of the  written claim dated 27th September 2019, we find that copy of Insurance Policy, copy of FIR  in UD Case no- 6/19 dated 08.03.2019, copy of death certificate of late Jantu Das, copy of Survival Certificate was annexed with the claim petition. From the oral evidence of D.W. 1 we find that he himself investigated the claim incident and he found the fact of the incident was true. So, we do not find any reason not to settle the claim or not to disburse the insured amount. Moreover, we find that there is no dispute in respect of the insurance policy and the coverage. At the time of argument Learned Counsel of the O.P. fairly submitted that claimant is entitled to get Rs.15 lakhs as Compulsory Personal Accident Coverage. 

 

7. From the evidence of the complainant side we find that the husband of the complainant expired on 04.03.2019 due to injuries caused by the bike accident. We also found that the written claim was filed by the complainant on 27.09.2019 but it was not settled by the O.P. and matter was kept pending for long. No doubt the conduct and activity of the O.P. amounts to deficiency in service. So we hold that complainant is entitled to get Rs.15 lakhs as Compulsory Personal Accident Coverage as well as Rs.50,000/- for mental agony and sufferings. Further complainant is entitled to get Rs.10,000/- as litigation cost. In total complainant is entitled to get Rs.15,60,000/-. Moreover complainant is entitled to get interest @ 9% P.A. w.e.f. 10.08.2020 that is the filing date of the complaint petition before this Commission till realization. O.P. is directed to made the payment within one month from the date of judgment and in case of failure the rate of interest will carry @ 12% P.A. till the payment is made. 

Thus, the complaint petition is partly allowed. 

Supply a certified copy of the judgment to both the parties free of costs.

 

 

Announced.

 

 

SRI R. PAL

PRESIDENT, 

DISTRICT CONSUMER  

DISPUTES REDRESSAL COMMISSION,

WEST TRIPURA, AGARTALA. 

 

 

 

Dr (SMT) B. PAL

MEMBER,

  DISTRICT CONSUMER 

DISPUTES REDRESSAL COMMISSION, 

  WEST TRIPURA,  AGARTALA.

 

SRI SAMIR GUPTA,

MEMBER,

  DISTRICT CONSUMER 

DISPUTES REDRESSAL COMMISSION

  WEST TRIPURA,  AGARTALA.