West Bengal

Paschim Midnapore

CC/90/2015

Diptendu Hazra - Complainant(s)

Versus

Reliance General Insurance Co.Ltd. - Opp.Party(s)

12 Apr 2016

ORDER

                                                             DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

                             

Bibekananda Pramanik, President,

Mrs. Debi Sengupta, Member

and 

Kapot Chattopadhyay, Member.

   

Complaint Case No.  90/2015

                                                        

                                        Sri Diptendu Hazra………………..…..….……Complainant.

Versus

 

1)Reliance General Insurance Co. Ltd, Kharagpur Branch Office,

2) Reliance General Insurance Co. Ltd, Wadala (W).....…..Opp. Parties.

 

              For the Complainant: Mr. Asim Kumar Dutta, Advocate.

              For the O.P.               : Mr. Pinaki Sengupta, Advocate.

 

Decided on: - 12/04/2016

                               

ORDER

                          Bibekananda Pramanik, President – Facts of the case, in a nutshell, is that the complainant is the owner of a motor cycle bearing no.WB 34AB/0153 and he insured his said vehicle with the opposite party-Insurance Company under a policy being no.1516422312006152 covering the period from 22/08/2012 to 21/08/2013.  The complainant has his valid driving license.  Unfortunately,  on 07/12/12, the complainant met with an accident while he was riding his said motor cycle and sustained grievous injuries on head and body.  After long treatment,  the complainant became 100% disabled and a disablement certificate was also issued by the proper authority.  Complainant intimated about such road traffic accident in the office of the opposite party and submitted all relevant papers, handicapped certificate including driving license.  The opposite party issued the said insurance policy against the motor cycle and as per condition of that policy,

Contd………………P/2

 

 

 

 

(2)

insurance PA coverage and owner cum driver under section III C.S.I. Rs.1,00,000/- and the complainant is entitled to get the said sum as per policy terms and conditions but the opposite party intentionally withheld the claim and did not settle the claim as per law.  Therefore, there is deficiency in service on the part of the opposite party.  Hence this complaint praying for directing the opposite party to make payment of compensation of Rs.1,00,000/- as per policy condition and for other reliefs as may be found fit and proper.

                  The opposite party- Insurance Company has contested this case by filling a written objection. Denying and disputing the case of the complainant, it is the specific case of the opposite party-Insurance Company that as per claim petition as well as documents, it was found by them that the present complainant is not permanent or partial disabled person and he failed to produce disablement certificate mentioning the nature of disablement.  It is also stated by the opposite party that the complainant intimated the occurrence of accident to the opposite party after lapse of 222 days on 17/07/2013 although the incident took place on 07/12/2012 for which the opposite party repudiated the claim on the ground of violation of policy terms and conditions no.1.  The opposite party, therefore, claims dismissal of the complaint with cost.

Point for decision

                      Is the complainant entitled to get the reliefs, as sought for?    

                   

Decision with reasons

At the very outset, it is to be mentioned here that in this case neither the complainant nor the opposite party adduced any sort of evidence, either oral or documentary but they have relied upon some documents,  so filed by them.

From the respective cases of the parties, we find that it is not denied and disputed that the complainant is the owner of a motor cycle bearing no. WB 34AB/0153 and he got his said motor cycle insured with the opposite party-Insurance Company covering the period from 22/08/2012 to 21/08/2013.  In their written objection in paragraphs 7 and 8,  opposite party-Insurance Company has admitted that the policy benefit of the policy in question is given for permanent or partial disablement and also for death and the policy is covered for Rs.1,00,000/-.  It is the case of the complainant that during the policy period, he met with an road traffic accident on 07/12/2012 as a driver of the said motor cycle and he sustained grievous injuries on head and body and after long treatment,  he became 100% disabled.   In support of his said case, the complainant has filed a copy of FIR regarding the said occurrence of accident apart from producing medical papers regarding his treatment after

Contd………………P/3

 

 

 

 

 

(3)

such accident.  Admittedly, the complainant filed an application before the opposite party-Insurance Company claiming assured money under that policy on the ground of his 100% disability and along with that application, he submitted disablement certificate along with the copy of policy,  FIR etc.   From the written  objection of the opposite party we find that they repudiated the claim of policy on the ground of policy terms and conditions no.1 i.e. “Notice shall be given to the company immediately upon the occurrence of any accident loss of damage in the event of any claim”.  The opposite party has stated that the said occurrence was intimated to them after lapse of 222 days after the date of accident and as such they repudiated the claim for violation the policy terms and conditions no.1 as stated above.  Regarding the said ground of refusal of the claim, we find that in his claim petition, the complainant specifically stated that after the accident he became 100% disabled and for long treatment of his injuries,  he lost his mental balance for which he could not intimate the opposite party – Insurance Company regarding the said occurrence of accident in time.  The cause shown for such long delay in lodging the claim by the complainant is sufficient enough for condonation of delay but instead of  considering the said cause of delay  the opposite party-Insurance Company straightway repudiated the claim of insurance.  Another objection has been raised by the opposite party – Insurance Company that the complainant is not entitled to benefit of personal accident policy as because the issuing disablement certificate is not issued according to Government prescribed formula and without mentioning the medical data and the percentage of disablement is not proper.  On this score, we find from the disablement certificate dated 16/07/2013 that this certificate was issued as per rules in Government prescribed form and it was issued as per order no. HF/OPHP/292/HAD/9M-57-2002 (Pt I) , dated 8^th May 2003 and it was issued by the Medical Superintendent cum Vice Principal and Chairman,  Handicapped  Board,  Medinipur Medical College and Hospital , Paschim Medinipur showing 100% permanent disability of the complainant.  So considering the said certificate, it cannot be said that this certificate is not issued according to Government prescribed form as claimed by the opposite party-Insurance Company.  Under the above facts and circumstances  and considering the said disablement certificate, we are of the view that the opposite party-Insurance Company was not at all justified in repudiating the claim under the policy in question and therefore the complainant is entitled to an order of compensation under that policy,  as claimed.  The petition of complaint is therefore deserve to be allowed.

   Contd………………P/4

 

 

 

 

 

 

(4)                         

 

                              Hence, it is,

                                                               Ordered,

                                   that the complaint case no.90/2015  is allowed on contest with cost.  Opposite party-Insurance Company is directed  to pay Rs.1,00,000/- (One lakh) to the complainant  towards the sum assured of the policy in question with interest @ 9% p.a. w.e.f. the date of filing of this complaint till payment within a month from this date of order. O.P. is also directed to pay Rs.2,000/- as litigation cost to the complainant within a month from this date of order.

                               Let plain copy of this order be given to the parties free of cost.

               Dictated & Corrected by me

                              Sd/-                              Sd/-                          Sd/-                              Sd/-

                          President                      Member                   Member                        President

                                                                                                                                 District Forum

                                                                                                                             Paschim Medinipur