DATE OF FILING : 12-09-2014.
DATE OF S/R : 05-12-2014.
DATE OF FINAL ORDER : 12-08-2015.
Sri Joydeep Kar,
son of Sri Subrata Kar,
residing at Dharsa Govt. Colony ( Nityananda Pally ), P.S. Jagacha,
District Howrah……………………………………………………… COMPLAINANT.
Versus -
1. ICICI Lombard General Insurance Company Limited,
ICICI Lombard House,
414, Veer Savarkar Marg, near Siddhi Vinayak Temple,
Prabha Devi, Mumbai 400025.
2. ICICI Lombard General Insurance Company Limited,
7th Floor, Apeejay House, 15 Park Street,
Kolkata 700 016.………………………………………….OPPOSITE PARTIES.
P R E S E N T
Hon’ble President : Shri B. D. Nanda, M.A. ( double ), L.L.M., WBHJS.
Hon’ble Member : Smt. Jhumki Saha.
Hon’ble Member : Shri A.K. Pathak.
F I N A L O R D E R
- Complainant namely, Sri Joydeep Kar,by filing a petition U/S 12 of the C. P. Act, 1986 ( as amended up to date ) has prayed for a direction to be given upon the o.ps. to pay the balance amount being Rs. 5,314/- as cost of repairing charges of damaged motor cycle, to pay Rs. 2,00,000/- as compensation and litigation costs , to pay Rs. 1,00,000/- towards the ‘Owner driver risk coverage’ as per the policy in question along with other relief or reliefs as the Forum may deem fit and proper.
- Brief fact of the case is that complainant insured his motor cycle with the o.p. no. 1 company being certificate no. 3005/2010653710/0000014413 on payment of Rs. 2,683/- as premium with a policy period from 02.09.2013 to 01.09.2014 mid night. The policy also covered the risk of ‘Owner Driver’ for Rs. 1,00,000/-. On 03.11.2013 at about 7.40 p.m. complainant was passing through Kona Express High Way at that time a vehicle hit the complainant from behind and as a result complainant fell down and was injured seriously and also the motor cycle got damaged. Complainant was admitted at CMRI, Alipore, Kolkata. The damaged motor cycle was seized by the Jagacha P.S. and a case has been started on the basis of GDE No. 163 of 03.11.2013. The complainant was under treatment at CMRI from 03.11.2013 to 19.11.2013 and incurred Rs. 2,30,000/- for the treatment of the complainant in addition to that Rs. 1,00,000/- was spent for the treatment of the complainant till date. The damaged motor cycle was placed to Aradhana Distributors Pvt. Ltd. and they sent a quotation amounting to Rs. 17,874/- butdue tonon availability of spare parts, Rs. 13,314/- was charged. Thereafter complainant submitted claim form along with the requisite documents before o.p. no. 1 vide Claim No. MOTO 3492075 dated 21.12.2013. And o.p. no. 1 released Rs. 8,163/- which was credited to the complainant’s bank account vide Annexures bank statement dated 13.5.2014. But they did not release the insurance claim meant for covering ‘Owner Driver risk’ and the rest amount of the actual bill charged for repairing of the vehicle in question being ( Rs. 13,314 –Rs. 8,168/-) Rs. 5,314/-. Complainant sent many letters to the o.ps. with a request to release the same but no fruitful result came out. Being frustrated and finding no other alternative, complainant filed this instant case with the aforesaid prayers.Hence the complaint.
- Notices were served. O.ps. appeared and filed written version. Accordingly, case was heard on contest.
- Upon pleadings of both parties two points arose for determination :
i) Is there any deficiency in service on the part of the O.Ps. ?
- Whether the complainant is entitled to get any relief as prayed for ?
DECISION WITH REASONS :
- Both the points are taken up together for consideration. We have carefully gone through the complaint petition along with the annexures filed by the complainant and W/V filed by the o.ps. along with the annexures and noted their contents. It is the specific plea of the o.ps. that the insurance policy in question is nota medi claim policy so that the complainant is not entitled to reimbursement of his medical expenditure incurred for his treatment after the accident. Moreover,the criteria for the release of claim amount with respect to ‘owner driver risk’ is not being fulfilled in this particular case. Because as per the terms and conditions of the policy in question the claim amount would have been disbursed if there be “100% of CSI for Death, Loss of Two Limbs or sight of both eyes or one limb and sight of one eye.” On perusal of the certificate cum policy schedule, under the headings ‘limits of liability’ it is clear that there is personal accident coverage to the owner driver for both death or bodily injury. And for aman of common prudence, it is very well understood that a person who was hospitalized for 03.11.2013 to 19.11.2013 after accident, he must have severe bodily injury. O.ps. also took premium for that purpose. Again o.p. submitted the copy of surveyor’s report showing the total payable amount of Rs. 9,300/- but o.ps. paid the complainant only Rs. 8,168/-, the reason which is best known to them. Complainant also submitted the quotation for repairing the vehicle in question as well as he also submitted the actual bill for repairing his vehicle showing the amount of Rs. 13,314/-. So it is very much clear that o.ps. have released the amount of Rs. 8,168/- arbitrarily which caused severe mental agony and pain to the complainant which should not be allowed to be perpetuated. Under the above circumstances, we are of the candid opinion that the o.ps. adopted unfair trade practice with respect to the policy in question. Accordingly the case succeeds on merit.
Hence,
O R D E R E D
That the C. C. Case No. 499 of 2014 ( HDF 499 of 2014 ) be allowed on contest with costs against the O.Ps.
That the O.Ps. are jointly and severally directed to release Rs. 1,05,314/- to the complainant .
The complainant do get an award of Rs. 3,000/- as compensation and Rs. 2,000/- as litigation cost and o.ps. are directed to pay the entire decreetal amount of Rs. 1,10,314/- within one month from this order i.d. amount shall carry an interest @ 9% p.a. till actual payment
The complainant is at liberty to put the decree into execution after expiry of the appeal period.
Supply the copies of the order to the parties, as per rule.
DICTATED & CORRECTED
BY ME.
( Jhumki Saha)
Member, C.D.R.F., Howrah.
