JUDGEMENT

Mr. Purna Chandra Mishra, President.

      Complainant Durlabha Charan Behera, has filed this case u/s 35 of the CP Act-2019 alleging deficiency of service and unfair trade practice on the part of the Opposite Parties for not paying him the insurance claim as per the policy condition and praying therein for direction to the Opposite Parties to release a sum of Rs. 2,00000/- with interest @ 18% per annum and pay a sum of Rs. 1,00000/- towards harassment, deficiency of service and unfair trade practice and a sum of Rs. 25000/- towards cost of litigation.

1.               Brief fact leading to the case is that the complainant is working as a Reader in National College, Nuapada. He had insured his life with SBI General Insurance Company Ltd. and the premium was paid for the year 2020. On 13.12.2018 at about at about 6 PM, while he was returning from college with his colleague, he mate with an accident and he was admitted in District Headquarters Hospital , Nuapada at about 6 PM vide OPD Regn. No. 23786 dt. 13.12.2018. No FIR was lodged in Police as his family members were engaged in his treatment. The Complainant was referred to VIMSAR, Burla, as his condition deteriorated, he was shifted to AIMS, Bhubaneswar on 14.12.2018 by ambulance and got admitted there on 15.12.2018 where he was admitted as an indoor patient and was finally discharged on 31.12.2018. After his release from AIMS, he lodged his claim before the OP No. 2. But, they did not respond to his claim and the OP No. 3 who is a stranger asked him to submit his entire document for settlement of his claim. Even after submission of documents, his claim was not settled and was kept hanging. It is pleaded that the complainant has spent Rs. 2,00000/- since 13.12.2018 and as the OP No. 2 and has harassed him &  finding no other alternative, has filed this case before this Commission for reliefs discussed in the preceding paragraphs.
2.               After receipt of notice, the OP No. 2 appeared through his Advocate and filed his show-cause. Other Opposite Parties did not appear.
3.               The OP No. 2 pleaded in his written statement that the period of meeting accident and admission in the District Hospital, Nuapada is at the exact same time and same date. Even though, they plead that both of them got physical injuries and immediately, shifted and admitted in the nearby District Hospital the complainant has failed to produce the admission ticket of the co-rider. No police FIR has been lodged by either of them and the complainant failed to produce the receipt bill of his shifting to VIMSAR, Burla on 13.12.2018 and the AIMS, Bhubaneswar on 14.12.2018. He has not produced the x-ray plate as he had got severe head injuries. The complainant has not filed separate petition to condone  the delay of filing the case  after lapse of limitation period and therefore, they pray for dismissal of the case as the complainant could not provide the required documents to them for settlement of the claim.
4.               It is clear from the written statement of the OP No. 2 and 3 that   they have not yet repudiated the claim of the complainant. It is their specific case that neither the complainant nor the co-rider lodged their FIR before police and the complainant has not filed any treatment document of the co-rider and he has failed to produce the bills relating to transportation by Ambulance from Nuapada to Burla and from Burla to AIMS, Bhubaneswar. Nowhere in the written statement, the OP No. 2 and 3 deny the accident and the treatment availed by the complainant in different hospitals. The OP No. 2 and 3 have not mentioned anything regarding the documents which they have received and which are lacking for process of the claim.
5.               The first objection raised by the OP No. 2 is that the time of accident and the time of admission is almost the same. Nuapada is a very small place and it will not take much time to shift a person to the District Headquarter Hospital from National College, Nuapada. Besides, a person while meeting with an accident and receiving grievous injury does not look to his watches to record the exact time of accident and also to record the exact time of the admission. So such a plea is complete a vague and the Insurance Company should have deputed one of his officers or investigator/surveyor to take verify t   he spot of the accident and the distance thereof from the hospital. Such a plea is complete absurd and is only designed to harass the complainant.
6.               The next objection raised by the OP is that the complainant or his co-rider has not lodged any FIR before police. It is seen from the documents filed by the complainant that the bed-head ticket, it has been mentioned in the bed-head ticket of the complainant that “case of R/M brought by police S to H” meaning thereby that it is a case of road accident and the victim has been brought by police from the spot to hospital. So, it is crystal clear from the bed-head ticket of the complainant that the complainant has been removed from the accident site to the hospital by police. Had it been a cognizable case, police should have registered a case and as police found that the case is not a cognizable case or worth not recording, they might not have recorded it. The complaint petition has clearly stated that since his family members were busy in his treatment , they have not lodged any FIR. It is very much clear from the bed-head ticket that there was an accident in which the complainant was injured and he has been removed from the accident spot to the hospital by police. So, there is no point in suspecting regarding the knowledge of police about the incident.
7.               It is seen from the bed-head ticket that the complainant was referred to VIMSAR, Burla where from he was subsequently, referred to AIMS, Bhubaneswar. The MRI report conducted on the body of the victim complainant clearly goes to show that he had been to Burla and the subsequent document goes to show that he was treated at AIMS, Bhubaneswar. There is a connecting link of his treatment from District Headquarters Hospital, Nuapada and subsequent treatment at Burla and final treatment at Bhubaneswar. So, it is as clear as anything that the complainant met with an accident on 13.12.2018, was taken to Nuapada District Headquarters Hospital, admitted there as Indoor Patient with Head Injury, referred to VIMSAR, Burla where MRI was conducted and subsequently, his admission and treatment at AIMS, Bhubaneswar. The Insurance Company has made all attempts to block the payment of the genuine claim by raising flimsy and vague grounds which is unacceptable on the eye of law.

8. The OP.No.2 has raised a technical point regarding limitation, it is stated by OP No.2 that the case has been filed beyond the limitation period and no application has been filed to condone delay, it is settled principle of law that limitation in an insurance case runs from the date of repudiation of the claim. In the instant case the claim is yet to be repudiated. Besides since the claim is pending with OP No.2 it gives rise to continued cause of action. So the claim of the OP No.2 on this point stands rejected.        
9.     Since the accident and treatment of the complainant is well-established beyond any reasonable doubt, the OP No. 2 by not paying the genuine claim of the complainant has caused deficiency in service, practicing the unfair trade practice and caused harassment to him.

10.               As a case of deficiency of service, unfair trade practice and harassment is clearly made out against the OP No. 2 is liable to compensate the petitioner for loss and harassment sustained by him and hence the order.

O R D E R

The complaint petition is allowed on contest against the OP No. 2 and 3 and dismissed against OP No. 1. The OP No. 2 and 3 are made jointly and severally liable for causing deficiency in service, practicing unfair trade practice and for causing harassment to the complainant. The OP No. 2 is directed to pay a sum of Rs. 2,00000/- (Two Lakhs Only) to the complainant with interest @ 12% per annum till it is actually paid to the complainant. The OP No. 2 and 3 is further directed to pay compensation of Rs. 50,000/-(Fifty Thousand only) each for causing deficiency in service, unfair trade practice and harassment to the petitioner and a sum of Rs. 25,000/- (Twenty Five Thousand Only). The order is to be complied within a period of 30 days from the date of receipt of order failing which the entire amount shall carry interest @ 12% from the date of order till it is paid to the complainant.