THE PRESIDENT

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

WEST TRIPURA : AGARTALA

 

CASE No. CC-51 of 2021

 

Sri Hare Krishna Kuri,

S/O- Sri Jiba Ranjan Kuri,

East Majlishpur,

Mohanpur, P.S. Ranir Bazar,

District- West Tripura. ................Complainants.

 

-VERSUS-

 

ICICI Lombard General 

Insurance Company Ltd.

Divisional Manager,

Agartala Divisional Office,

2nd Floor, RMS Chowmuhani,

Agartala, District- West Tripura. ...............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 Tanmoy Chakraborty,

  Sri Bhushan Debnath,

  Learned Advocate.

  

For the O.P.  : Sri Utpal Das,

  Learned Advocate.

 

 

 

JUDGMENT  DELIVERED  ON :  08.07.2022

 

 

 

 

J U D G M E N T

The complainant filed this case U/S 35 of the C.P. Act, 2019 against the Opposite party(in short O.P) for deficiency in service on part of the O.P.

The Complainant's case in short is that on 30.08.2020 at about 6.30 PM, the complainant was proceeding from Mohanpur towards Jirania by riding his motor cycle bearing no. TR 01 AJ5889(Splendor). On the way at about 6.45 PM while he reached at Madhavbari Chowmuhani, suddenly a stray dog came infront of the motor cycle of the complainant and in order to save the said dog the complainant pressed break of the motor cycle tightly. But due to sudden press of break the complainant lost his control and collided with the dog and fallen down from the motor cycle. As a result of the said accident the complainant sustained grievous fracture injuries on his chest, head, brain injury, hands and both legs and other multiple injuries on his almost other organs of the body. He was taken to the Ranir Bazar PHC, but being serious condition he was referred to AGMC & GBP Hospital Agartala by the concerned doctors. After diagnosis the concerned doctors found that the complainant received severe traumatic brain injury. During treatment it was observed that there was no improvement rather it was deteriorating and on 01.09.2020 he was referred  to Peerless Hospital, Kolkata by the Medical Board, Govt. of Tripura for further treatment. Accordingly, he being a stretcher patient was taken to Kolkata along with escorts. The complainant took admission at Peerless Hospital. It was diagnosed that there were severe traumatic brain injury resulting in altered sensorium and ENT bleed and discharged on 24.09.2020. Thereafter, he returned to Agartala on 08.10.2020. A sum of 4,00,000/- was spent towards his treatment. It is also stated by the complainant that FIR was lodged by the mother of the complainant Smt. Gita Rani Kuri on 12.09.2090 which was registered as RNB P.S. G.D. Entry No.10 of 12.09.2020. Complainant has claimed for compensation before the Respondent by an Advocate Demand notice dated 25.11.2020 but they did not pay any heed thereto. At the time of accident the complainant had valid Insurance Policy vide No. 3005/43135790/10239/000 valid from 14.12.2018 to 13.12.2023. Hence the complainant approached before this Commission for getting relief. 

2 After receiving notice from this Commission the O.P. appeared and filed written statement denying the allegations made by the complainant in his complaint petition. It is stated in the W.S that the complaint is not maintainable and is liable to be dismissed as no cause of action as alleged or otherwise has ever existed in favour of the complainant and against the O.P. It is stated by the O.P that the complainant insured his vehicle being No. TR 01 AJ 5889(Engine No. JA05EGJ9K30921 and Chasis No. MBLJAR032J9K32581) with the O.P. Insurance Company being Certificate No.3005/43135790/1039/000 with policy period from 14th December, 2018 to 13th December, 2023 for own damage policy only i.e., for the accidental damage of the two wheeler bearing registration No. TR 01 AJ  5889 and the policy does not cover any medical reimbursement. The policy cover the risk of owner driver P.A. for amount of Rs.15,00,000/- form 14th December, 2018 to 13th December, 2019 for one year only. The insured policy was not covered personal accident of the insured on the date of accident as the policy for owner driver P.A. expired before the accident. The policy is not a mediclaim policy. So, the complainant is not entitled to reimbursement of his medical expenditure incurred for the treatment after the accident. As per  terms and conditions of the policy the claim amount would have been disbursed if there be ''100% of CSI for death, loss of two limbs or weight of  both eyes or one limb and sight of one eye.'' The insured can not get reimbursement of medical expenditure under the policy as mentioned provision of law (GR36 of IMT). The policy of the complainant did not cover the risk of owner driver under the head compulsory PA cover on the date of accident as mentioned on application. The claim of the complainant does not fall within the purview of coverage of policy and hence it could not been settled. There is no deficiency of service on the part of the O.P. and the O.P. is not liable for indemnify to the complainant. Hence, O.P. prayed for dismissal of the case  filed by the complainant with exemplary cost.

 

 

3. EVIDENCE ADDUCED BY THE COMPLAINANT:-

Complainant adduced evidence by way of filing examination in chief on affidavit. He also submitted 14 nos. of documents vide firisti dated 20.07.2021.

 

On the other hand O.P. also adduced evidence by filing examination in chief on affidavit of one Bitopan Gogoi, Legal Manager of ICICI Lombard General Insurance Company Ltd., Guwahati, Assam.  

  

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. ARGUMENT:-

Learned Counsel Mr. Tanmoy Chakraborty at the time of argument submitted that on 30.08.2020 at about 6.30 P.M. complainant was proceeding from Mohanpur towards Jirania by riding his motor cycle TR O1 AJ5889(Splendor) and on the way about  6.45  P.M. while he reached at Madhavbari Chowmuhani all on a  sudden a street dog came infront of the motor cycle. The complainant pressed the break of the motor cycle tightly but due to sudden press of break the complainant lost his control and collided with the dog and fallen down from the motor cycle. As a result of the accident, complainant sustained grievous injuries, fracture, injuries on his chest, head, brain, injury on hands and both legs and other multiple injuries on his almost other organs of the body. He was taken to the Ranir Bazar PHC with the aid of fire service  person then he was referred to AGMC and GBP Hospital, Agartala and was shifted there by ambulance but there was no improvement and medical board of Govt. of Tripura referred him for his further treatment as a stretcher case. Thereafter, complainant was shifted to Kolkata and he was admitted in the National Neuroscience Centre and he was undergone treatment there. After partial recovery he returned to Agartala on 08.10.2020. During treatment period he spent total sum of Rs.4 lacs. Learned Counsel further submitted that Insurance company is fully liable to pay the amount of compensation as there was an Insurance Policy of the vehicle for covering 5 years. On the other hand Learned counsel of the O.P. Mr. Utpal Das submitted that there is no dispute in respect of the accident and sustaining of injuries as well as treatment but the Insurance company is not liable to pay any compensation as there is no compulsory P.A. coverage on the date of accident. The policy period was 14.12.2018 to 13.12.2023 which does not mean that P.A coverage was for 5 years. Policy documents speaks that CPA was Rs.15 Lacs for the period from 14.12.20218 to 13.12.2019 and thereafter CPA was shown Nil. Mr. Das further submits that as per complaint petition as well as evidence of the complainant it is crystal clear that accident was occurred on 30.08.2020 and P.A. coverage was up to 13.12.2019. So, as per terms and conditions of the Insurance Policy complainant is not entitled to get any compensation for his personal injuries and treatment cost incurred by him. Therefore, complaint is liable to be dismissed. 

       

6. DECISION AND REASONS THEREOF:-  

We have gone through the pleadings of both parties as well as evidences submitted by them. From the oral evidence of the complainant we find that the Road Traffic Accident took place on 30.08.2020 and due to that accident complainant sustained various multiple injuries and he was taken to Ranir Bazar PHC and thereafter AGMC and GBP Hospital and thereafter Kolkata Peerless Hospital and ultimately he was admitted as indoor patient at National Neuroscience Centre and was under treatment of Dr. Ashis Kr. Bhattacharya, Neurosurgeon. He spent a lot of money for the purpose of his treatment. He deposed that his Insurance Policy No. 3005/43135790/10239/000 valid from 14.12.2018 to 13.12.2023. He has submitted various documents including the copy of the policy. 

 

7. On the other hand, one Bitopan Gogoi Legal Manager of ICICI Lombard General Insurance Company Ltd. submitted his examination in chief on affidavit and at Para-4, he deposed that the policy period was from 14th December,  2018 to 13th December, 2023 for 3rd party risk and not for own damage. Policy does not cover any medical reimbursement. At Para-5, he stated that the policy covered the risk of the owner driver P.A. for an amount of Rs.15 lacs from 14th December, 2018 to 13th December, 2019 only for one year. At Para-6, OPW stated that the Insured policy was not covering personal accident of the insured on the date of accident and policy for owner driver P.A. expired before the accident.

 

8. We have seen the unexhibited documents submitted from the side of the complainant including Insurance policy. In the instant case the insurance policy is the vital document and if the policy does not support the claim of the complainant then this Commission is undone. Insurance Policy clearly shows that CPA for 15 Lacs was valid during the period of 14.12.2018 to 13.12.2019 and thereafter no premium was given  for continuation of the PA coverage for owner driver. As per terms and conditions of the policy complainant is not entitled to get any medical reimbursement.

 

9. On overall appreciation of the entire evidence, we are in the opinion that complainant has failed to prove the deficiency of service on the part of the O.P. Accordingly, complaint is dismissed. Supply copy of this 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.