Order No. 16 Dt. 19.05.2015
The fact of the case in short is that the petitioner is a permanent resident of Vill: Shyampur, P.S. Manikchak, within the District of Malda and he obtained one individual Personal Accident Policy from National Insurance Company on 06.02.2012 and the premium was Rs. 240/- and Policy Certificate No. was 150700/47/11/9600000327 and the maturity date was 05.02.2017. Kannur Bibi was the nominee of the said policy. On 06.06.2012 he went to Uttar Dinajpur and met with an accident at Dalkhola. He went to nature’s call and one lorry being No. WB-59A/5277 coming from Raiganj dashed him and he sustained severe injuries and he was shifted to Dalkhola Primary Health Centre. He was also treated by doctors and he sustained fractured injuries. He was also treated at Malda Medical College and also treated at Orthopedic Centre of Bihar and Musura Vidya Memorial Hospital of Dist. Coachbihar. Due to the said accident he gradually lost his eye sight and became a disable person and lost her eye sight totally. He obtained his handicapped certificate from the competent authority. He, thereafter, sent all papers to the Insurance Company but the Insurance Company repudiated their claim. So he filed this case in this Forum claiming compensation of Rs.100000/- and mental agony and sufferings.
On the basis of the said claim summons were served upon the O.Ps and the O.Ps appeared in this case and filed written statement. The allegation raised by the petitioner is denied to the effect that the damage of eye sight is not due to the road traffic accident. They also admit that they received the petition of the complainant but his claim was repudiated.
On the basis of the same following issues are framed:-
- Whether the case is maintainable?
- Whether there is any cause of action to file this case?
- Whether there has been any deficiency in service on the part of the ops?
- Whether the complainant is entitled to get the relieves as prayed for?
:DECISION WITH REASONS:
Issue Nos. 1,2,3 and 4
All the issues are taken up together for the sake of brevity and convenience of discussion.
The petitioner filed documents i.e. Certified Copy of FIR marked (Ext.-1), Certified Copy of Seizure List marked (Ext.-2), Voter Identity Card marked (Ext.-3), Copy of disability certificate marked (Ext.-4), xerox copy of policy marked (Ext.-5), xerox copy of letter signed by the O.P., Insurance Company dt. 25.11.2013 marked (Ext.-6), xerox copy of letter signed by the O.P. Insurance Company signed by the O.P. marked (Ext.-7), xerox copy of discharge certificate of Dalkhola Primary Health Care dt. 06.06.2012 marked (Ext.-8), xerox copy of outdoor sheet of Dr. Roushan Kumar marked (Ext.-9), prescription of Musuru Vidya Memorial Hospital marked (Ext.–10), prescription of Astha Neuro Research and Rehabilitation Centre marked (Ext.-11), Outdoor Ticket District Hospital Malda marked (Ext.-12) and another Outdoor Certificate of Treatment of Malda Government Hospital marked (Ext.-13).
P.W.-1 stated in his evidence that for his livelihood he went to Dalkhola within the district of Uttar Dinajpur on 06.06.2012. He further stated that when he proceeded to his nature’s call at about 06-00 A.M, one lorry being No. WB-59A/5277 which was coming from Raiganj side towards Dalkhola dashed him and he sustained severe injuries and he was shifted to nearby Primary Health Centre and he was treated there and thereafter he was shifted to another doctor. He sustained severe fractured injuries. His treatment is going on till now. His eye sight is gradually deteriorating and ultimately he totally lost his eye sight. He was treated at Coach Bihar, Malda and in the district of Bihar also. His witness is cross-examined and he admits in his cross-examination that he sustained injuries on his eyes but he had no deficiency of his eye sight for about one year after the accident.
From the exhibited documents it is established that a road traffic accident took place on 06.06.2012 and police started criminal case against the offending vehicle. Police seized the offending vehicle. The treatment certificate and the Ext.-8 Medical Officer of Dalkhola Primary Health Care found fracture on left upper libia and cut injuries and fracture on his body. Outdoor sheet of the O.P.D Center also speaks Dr. Roushan Kumar, Orthopedic Surgeon treated Noor Islam, petitioner on 06.06.2012 and the diagnosis and prescription speaks that the petitioner sustained knee injury and other fractured injuries on his body due to the said accident. It is also relevant that the said Nur Islam admitted on 12.06.2012 in Nur Vidyalaya Memorial Hospital and stayed there as indoor patient till 16.08.2012. This document i.e. Ext.-10 corroborates the facts of treatment regarding the fracture in the R.T.A. He was also treated at Malda Medical College Hospital and the doctor also advised the patient to visit the Eye Department for problem. All this prescription sufficiently proved that this petitioner sustained injuries in the accident and lastly the Malda Medical College Hospital issued a total disability certificate regarding the loss of eye sight.
Now the question arises whether the Insurance Company properly repudiated the claim of the petitioner? It is evident from the evidence of record that the petitioner purchased one policy of individual Janata Personal Accidental Policy and he paid the premium i.e. Ext.-5 and the premium was Rs. 240/-. The Insurance categorically stated in Ext.-7 and in Ext.-6 regarding the receiving of letter of the petitioner dt. 28.10.2013. So the petitioner sent letter to the Insurance Company along with papers but most funny thing is this i.e. the Insurance Company stated in their letter that the loss of eye sight is not directly related with the accident and it was damaged due to the side effect of medicine.
From the very outset it is crystal clear that eye sight was diminishing gradually and when the said poor person who is a day labourer tried his level best to recover injuries and when he totally lost his eye sight he then with a clean hand approached the Forum to get the minimum money of Rs. 100000/-for which he opened the said insurance policy.
It is true that the petitioner filed the claim of the O.P. after about 15 months after the accident when he was totally invalid person and like a dead man he sent the letter claiming to give the insurance amount to pass his days and the Insurance Company repudiated the claim on the ground that due to the effect of the medicine he became blind. As per the law the onus shifted upon the Insurance Company but the O.P. did not adduce any evidence to justify their case. On the other hand it is duty bound as per the policy terms that the O.P. must pay the amount as per the insurance policy.
In the result, the claim case succeeds.
Proper fee paid.
Hence, ordered
that the D.F.C Case No. 33/2014 be and the same is hereby allowed on contest against the O.P. Insurance Company with cost. The Petitioner, Nur Islam do get an award of Rs. 100000/- towards the claim amount and Rs. 10000 as cost of suit and mental pain and agony totaling Rs.110000 (Rupees One Lakh Ten Thousand Only). The O.P. Nos. 1 and 2 jointly and severally liable to pay the amount within 60 days from the date of this order failing the amount would carry interest @ 9% p.a. from the date of filing till recovery and the petitioner will be at liberty to put the decree in execution.
A copy of this order be supplied to each of the parties free of cost.
