DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: WEST TRIPURA : AGARTALA

 

CASE   NO:   CC- 61 of  2023

 

Smt. Purnima Paul,

W/O- Late Pankaj Sarkar,

Kashinagar, P.O. Ishan Chandra Nagar,

P.S. Amtali, District- West Tripura,

Pin- 799003. ...........Complainant.

 

-VERSUS-

 

ICICI Lombard General Insurance Company Limited,

2nd Floor, GRS Tower, RMS Chowmuhani,

Akahuara Road, Agartala,

P.O. Agartala, P.S. West Agartala,

District- West Tripura, 799001.

To be represented by 

the Divisional Manager. ..........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  O.P. : Sri Sampad Choudhury, 

 

 

F I N A L    O R D E R

1. This case is filed U/S 35 of the Consumer Protection Act, 2019 by Smt. Purnima Paul of Kashinagar, Amtali, West Tripura here-in-after called the “complainant” against the ICICI Lombard General Insurance Company Limited, RMS Chowmuhani, Agartala, West Tripura, here-in-after called the “O.P.” alleging deficiency in service on the part of the O.P.

1.1 The case of the complainant in short is that the husband of the complainant, Pankaj Sarkar, since deceased, while returning to home from his working place riding his motor bike bearing no. TR 07 E 4808 met with an accident at Gurogabari, near Amtali P.S with collision with a Maruti Dzire bearing no. TR 07 E 0708 which was running infront of the motor cycle of the deceased Pankaj Sarkar and dashed his vehicle. As a result of which he sustained severe bleeding injuries on his head and other portions of the body. Immediately he was shifted to Tripura Medical College and Dr. B.R. Amdbedkar Memorial Teaching Hospital, Agartala and the attending doctors after examination declared him brought dead.  Post mortem was conducted  on the same date as per requisition of Amtali P.S. GDE No.27 dated 05.07.2022. 

1.2 Written Ejahar was lodged by the brother of the victim on 05.07.2022 to Amtali Police Station vide no. 2022AMT104 under Section 279/304(A) of IPC read with 184 of Motor Vehicle Act, 1988. After investigation charge sheet was filed against the driver of the offending vehicle. 

1.3 The said motor vehicle was insured with the ICICI Lombard General Insurance Company Ltd. Vide Policy No. 3005/48857461/63260/000 covering period from 16.09.2020 to 15.09.2025. 

1.4 The complainant approached the O.P. Insurance company with all relevant documents claiming the benefit of Compulsory Personal Accident but the claim was not settled by the O.P. on the ground that Compulsory Personal Accident benefit was not subscribed under the insurance policy. 

1.5 Hence, this complaint.

 

2. The O.P. Insurance Company submitted written objection denying all the allegations made by the complainant in her complaint petition. It is stated by the O.P. that the alleged incident of accident occurred due to own fault as there was gross negligence on the of the deceased. However, the O.P. admitted that the motor vehicle of the deceased was insured with the O.P. Insurance company. It is further stated by the O.P. that  the complainant never approached to the O.P. claiming for the Compulsory Personal Accident benefit of her deceased husband. 

 

Both the parties submitted evidence on affidavit with documents.

 

 

4. Hearing argument following points are taken up for discussion and decision:-

 

Decision and reasons for decision:-

5. Both the points are taken up together for discussion and decision.

 

5.1 The petitioner has successfully proved the accident and consequent death of Pankaj Sarkar by submitting the death Certificate, copy of Post Mortem Certificate and copy of FIR lodged with the O/C, Amtali P.S. 

 

5.2 On perusal of the policy schedule of Insurance, we find that no premium was paid for the P.A coverage. Means at the time of taking the Policy of Insurance Pankaj Sarkar, since deceased, did not enter into a contract with the Insurance company for P.A. coverage and for that reason no premium was paid under this head.

5.3 As per IRDA Rules from the month of September, 2018 P.A. Coverage, Insurance is mandatory.

 

5.4 Learned Counsel of the complainant by referring an order of Hon'ble Karnataka Consumer Disputes Commission submits that it is the duty of the Insurance company to inform the insured regarding P.A coverage. On perusal of the order of the Hon'ble Karnataka State Commission we find that the proposal form in that case was incomplete as there is no clause for P.A coverage and on that ground only Hon'ble Karnataka State Commission directed the Insurance Company to pay compensation.

5.5 In the case at hand, the O.P. Insurance company was directed to submit the proposal form but today Learned counsel of the O.P. submits that the proposal form is not there. So,  in absence of the  proposal form it can neither be decided that the insurance company informed the insured regarding P.A coverage as per the guideline of IRDA nor can it be decided that it is the insured who refused to pay premium for P.A coverage. Therefore, the benefit of  doubt must go in favour of the complainant because as per IRDA notification, taking P.A coverage while taking policy the Insurance is a must. Further, not maintaining the proposal form itself is deficiency in service and illegal trade practice. Hence, we decide the case in favour of the complainant.

 

6. In the result, it is ordered that the O.P. Insurance Company shall pay the amount of P.A. Coverage of Rs.15 lakhs in favour of the complainant with interest @ 7.5% P.A. from 12.09.2022 i.e., the date of lodging claim with the Insurance Company till the date of actual payment with a compensation of Rs.5,000/- inclusive of litigation cost.

 

7. The case stands disposed off. 

8. Supply copy of this Final Order free of cost to the parties.

 

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.