Order-6.

Date-13/07/2015.

Complainant Abhijit Chattapadhyay by filing this complaint submitted that he has his Personal Accident Policy bearing No. 510603/42/11/0100000161 for a Sum Assured of Rs. 3,00,000/- in the name of Abhijit Chattapadhyay for the period of 23.02.2012 to 22.03.2013 under the New India Assurance Co. Ltd. and the date of inception of this policy was 23.03.2000 and the complainant is renewing the said policy regularly without any break or interruption till date.

Fact remains that Policy Holder Abhijit Chattapadhyay faced an accident on 02.01.2013 at about 04:45 P.M. at Shyampur, Goshpara near about his residence and the complainant has been treated by Dr. A.K. Khanra continuously until his fitness and according to the advice of the treating doctor, complainant has taken medicines and bed rest for one month for which complainant has filed the claim application.

After submission of the claim application by the complainant along with claim form including documents, op did not dispose of the same and not disburse the amount as per Policy condition and repeatedly requested to dispose of the claim but ultimately on 25.04.2013, complainant sent Lawyer’s letter for a claim of Rs. 14,097/- along with interests and for negligent and deficient manner of service, complainant filed this complaint praying for redressal.

On the other hand op nos. 1 & 2 by filing written statement submitted that no doubt complainant filed a claim.But peculiar fact is that complainant did not file any medical report to show any major injury as alleged by the complainant in the complaint.But the x-ray report of the complainant dated 04.01.2013 clearly showed that ‘no definite evidence of recent injury is seen in the bones of right foot’.

So, the case of the complainant that complainant faced an accident on 02.02.2013 is false and concocted and in fact for non filing of the materials documents in support of his treatment, the claim of the complainant was correctly closed as ‘no claim’ as the claim lodged by the complainant did not result in Temporary Disablement as covered under Table A of Personal Accident Policy.

So, the complainant is not entitled to any claim and there was no negligence and deficiency on the part of the op.The closure of the claim was communicated the same to the complainant through letter dated 25.04.2015 and thereafter complainant obtained a doctor’s report on 27.04.2015 to influence the claim illegally and that document dated 27.04.2015 was not filed along with the claim form which was submitted to the Insurance Company on 05.02.2013 by the complainant for which the present complaint should be dismissed and in fact with some ill purpose, complainant filed this case for grabbing some money.

                                                 Decision with reasons

On careful consideration of the complaint and the written version and also considering the materials on record, it is clear that complainant is the holder of Personal Accident Policy (Individual Policy) being Policy No. 510603/42/11/0100000161 having its validity period from 23.03.2012 to 22.03.2013 and as per policy condition, the policy provides for the payment of certain amount for death or disablement of insured due to sum insured.But no benefit is available to the insured in case of any treatment or treatment for any accidental.

If we consider the policy condition and risk as covered by the policy, it is clear that complainant must have to prove at first that complainant due to said accident, as per disablement in any nature.But peculiar factor is that complainant has filed or produced any document that due to alleged accident, he suffered any disablement and in such disablement certificate is produced by the complainant, no such treatment documents are produced by the complainant to show that he suffered any disablement due to alleged accident.

On the contrary complainant’s own documents simply prove that even the complainant collected of one certificate from Dr. A.K. Khanra on 27.04.2015 wherefrom it is found that doctor submitted that on 02.11.2013 when he examined the patient, he found that no bone injury has been in the x-ray report and doctor has not stated any that complainant has been suffering any temporary disablement due to such accident and considering that fact, it is clear that complainant with some ulterior motive to grab some money collected the said certificate and submitted the said certificate before this Forum on 27.04.2015.

But even then complainant has failed to prove that as per policy condition, he is entitled to get such benefit and in fact complainant failed to prove that any treatment cost of such period must be paid as per policy condition of Personal Accident Insurance Policy.But after proper consideration of the Clause of the policy, it is clear that this present policy provides a certain amount for death or disablement of insured due to accident and in case of disablement, it must be permanent partial disablement or temporary total disablement.

In the present case complainant has failed to prove any sort of disablement either permanent partial disablement or temporary disablement due to alleged accident and truth is that x-ray report supports that there is no accidental disablement.

In the result, the complaint bears no merit in the eye of law, but considering the complainant’s attitude and manner of filing the complaint knowing fully well the condition even after consultation with the Ld. Lawyer, we are convinced to hold that the entire claim is false and fake and only for the purpose of grabbing more money and in fact op has brought this that without any reason and no doubt for filing such vexatious complaint, complaint should be dismissed with penal cost against the complainant.

Hence, it is

                                                       ORDERED

That the complaint be and the same is dismissed on contest against the ops by imposing the penal cost and complainant shall have to pay penal cost of Rs. 5,000/- to this Forum within one month from the date of this order, failing which penal action u/s 25/27 of C.P. Act 1986 shall be started against the complainant for realizing the same and further penalty and fine may be imposed for non compliance of the Forum’s order.