DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

WEST TRIPURA :  AGARTALA

 

CASE   NO:   CC- 34 of  2022

 

Sri Samir Dey,

S/o- Late Ratneswar Dey,

Permanent Resident of 

East Gakulpur, P.O. Gakulpur,

P.S. - R.K. Pur, District- Gomati,

Tripura- 799 144. 

 

Presently residing at-

C/O- Ashish Malakar,

Kumari Tilla, P.O. Abhoynagar,

P.S.- N.C.C., District- West Tripura.

 

-VERSUS-

 

The Bajaj Allianz General Insurance Co. Ltd.,

Agartala Branch, Corporated House,

Metro Bazar, 3rd Floor,

Aitorma, Sentrum,

P.S. - West Agartala, 

West Tripura- 799 001. ...........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 Complainant : Sri Bijan Saha,

  Sri Partha Sarathi Chakraborty,

  Learned Advocates. 

 

For the O.P. No. : Sri Subhajit Chakraborty,

   Smt. Baisakhi Chakraborty,

   Learned Advocates.

 

ORDER  DELIVERED  ON:   22/02/2023.

F I N A L    O R D E R

Sri Samir Dey (here-in-after referred to as “the Complainant” has filed this complaint U/S 35 of the Consumer Protection Act, 2019 against the Bajaj Allianz General Insurance Company Ltd. here-n-after referred to as “the O.P.” alleging deficiency of service on the part of the O.P. The fact of the case in brief is that the complainant was/is the owner of the Suzuki Zeus-125 Motor Bike bearing No- TR-03/B-8386. He purchased the vehicle in the year 2021. The said motor vehicle was duly insured with the O.P.  vide policy no- OG-21-2001-1802-00018879 with validity effect from 30.10.2020 to 29.10.2021. On 08.10.2021 at about 09.30 A.M. while the complainant returning to his house situated at Gakulpur, Udaipur from Jagannath Chowmuhani, Udaipur, when he reached at Hatath Chowmuhani, Udaipur met with an accident as one lady came infront of his bike and to save the said lady he had to press the break of his bike hard. The complainant lost his control and fell down. As a result he sustained grievous bleeding injuries on various parts of his body and his right leg was broken into pieces. With the help of the local people the complainant was taken to Tepania Hospital and from there he was referred to A.G.M.C & G.B.P. Hospital  where he was admitted on 08.10.2021 and treated upto 30.11.2021. He was taken to Rabindranath Tagore Hospital, Kolkata and thereafter also at Genesis Hospital  and treated therein from 01.12.2021 to 05.12.2021 and operation was also done on his right leg in the said hospital. G.D. Entry vide G.D. Entry No. 28, dated 06.12.2021 was registered before the O/C, Radhakishore Pur, Police Station, Gomati District, Tripura. Thereafter the complainant informed the incident of accident to the  O.P. and made a claim for compensation for an amount of Rs.20,00,000/- with interest and other costs for the injuries sustained by him and also for the damage of the aforesaid Motor bike bearing registration no. TR-03-/B-8386. But the O.P. did not settle his claim and ultimately on 18.01.2022 informed the complainant that they will not settle the claim and the complainant is not entitled to get any compensation from the O.P. Hence, the complainant filed this petition before this Commission praying for compensation of Rs.20,00,000/-  along with up to date interest @ Rs.12% for his physical and mental agony, pain, anxiety and harassment with litigation cost and also for the damage of his motor bike. 

2. The O.P. resisted the claim by submitting Written objection stating that the complaint is wholly misconceive, groundless and unsustainable in law.  The complainant has no locus standi to file the complaint under the Consumer Protection Act, 2019 against the O.P. The complaint is barred by law of limitation and is liable to be dismissed in view of Section 69 of the C.P. Act, 2019. It is stated by the O.P that the complainant never gave any intimation of the alleged accident of the motor bike which is violation of the condition No.1 of terms and conditions of the policy. It was held by various courts in plethora of judgment that not informing the insurer about the accident, loss or damage immediately after the incident can be valid ground of repudiation as per terms and conditions of the insurance contract. Complainant filed this complaint petition before this Commission without lodging claim with the insurance company and therefore deserves to be rightly disposed off with cost. Since no accident occurred  on 08.10.2021  an imaginary G.,D. Entry was made to R.K. Pur Police Station, Udaipur quoting the narrative of this fake accident belatedly after 2 months on 06.12.2021 applying foul play. There is no deficiency of service on the part of the O.P.  and the present complaint is liable to be dismissed in limine.

3. The complainant submitted examination in chief as P.W. 1. One Narayan Choudhury submitted examination in chief as O.P.W. 1 on behalf of the O.P.

4. On the basis of pleadings and evidence the following points emerge for discussion and decision:-

  (i) Whether there is any deficiency in service on the part of the O.P. ?

  (ii) Whether the complainant is entitled to get the reliefs as sought for within the scope of the P.A coverage as per the policy  of insurance?

 

5. DECISION AND REASONS FOR DECISION:-

For convenience both the points are taken up together for discussion, decision and reasons. The main contention of the O.P. Insurance company for rejecting the claim was that the complainant did not inform the O.P. Insurance Company the fact of accident in time and for that reason the complainant could not lodge G.D. Entry also in time. 

6. During the course of argument Learned Counsel of the complainant had drawn a series of incidents and argued that the complainant had no chance to intimate the Insurance company as he was under treatment outside the state of Tripura.

7. Per contra, Learned Counsel of the O.P. Insurance Company argued that the case of the complainant was rightly repudiated because of non intimation on time.

8. On perusal of the pleadings and documents of the parties, we find that  Khama Das, the wife of the complainant explained in her intimation to the O/C, R.K. Pur P.S. that since the complainant was admitted in hospital and they were busy with the treatment of the complainant and there was none competent to lodge such information with the police, there was delay in lodging information. Hence, on 06.12.2021 such information was lodged.

9. On perusal of the medical documents we find that the complainant was admitted in Tepania Hospital and on 08.10.2020 i.e., the day of accident and was referred to AGMC and GBP Hospital, Agartala. The discharge summary of AGMC and GBP Hospital, Agartala proves that the complainant was admitted on 08.10.2021 and was discharged on 30.11.2021. The discharge summary of Genesis Hospital, Kolkata shows that the complainant was admitted in that hospital on 01.12.2021 that is on the next day of his discharge from G.B. Hospital, Agartala and the complainant was discharged from Genesis Hospital on 05.12.2021 and for that reason the G.D. Entry was made on 06.12.2021.

10. In United India Insurance Company Ltd. and Others Vs. Rahul Kadian reported in 2018(3CLT)(1), Hon'ble National commission was pleased to consider IRDA circular No. IRDA/ HLTH/ Misc/ CIR/ 2016/ 09/ 2011 dated September 20,  2011. That circular is clear that to reject a claim on the ground of delayed intimation, the decision shall be based on sound logic and valid grounds. Such intimation clause does not work in isolation and is not absolute. It is the liability of the Insurance Company to ascertain the reasons of delay and should be satisfied that delayed claims was deliberate and would have been rejected even if reported in time.

11. In the case on hand, the complainant by submitting all relevant documents has proved the dates chronologically from where it is luminous that the delay in lodging the G.D. Entry and delay in giving intimation to the Insurance company were not deliberate and were not for any vexatious reasons.

12. The Policy of Insurance proved that covering the date of accident the complainant insured had valid policy covering P.A. coverage for owner driver for Rs.15 lakhs.

As per the terms and conditions of the policy. 

(i) The policy holder is entitled to the entire amount that is 100% in case of death. (ii) again 100%  in case of loss of 2 limbs or sight of 2 eyes or 1 limb and sight of 1 eye (iii) loss of 1 limb or sight  of 1 eye in that case 50% of the total sum and (iv) permanent total disablement from injuries other then named in the 3 cases above. 

13. Be that as it may, there is no scope for giving any compensation for the injuries sustained by the complainant. In fact, this compulsory personal accident covering to the tune of 15 lakhs has come into force by dint of a judgment of Hon'ble Supreme Court in IRDA based regulation with effect from 1st September, 2018. Therefore, it is evident that in the case at hand the complainant is not entitled to any compensation for his injuries.

14. The complainant has proved discharged summary FIR and other medical documents including vouchers for the purpose of proving the expenses incurred for his treatment in the hospital. The complainant has also submitted the discharge certificate showing  70% temporary disablement   of his right leg and deformity following both bone fracture. This disablement certificate has been recommended for 5 years valid till 19.07.2027. 

15. Therefore, as per the scope of the policy of personal accident coverage the complainant has not suffered any permanent disability either 100% or 50% in terms of clause (ii) or clause (iii) or either permanent total disablement  with in the meaning of 'clause 4' of the policy. Be it made clear that under P.A. coverage,  insured is not entitled to any compensation either under pecuniary loss or non pecuniary loss as in the case of 3rd party insurance policy under the Motor Vehicle Act, 1988. 

16. In the result, we do not find any deficiency of service on the part of the O.P. Insurance Co. as the claim of the complainant is not legally maintainable.

The case stands disposed off. 

Supply a copy of this Final Order free of cost to the complainant and the Opposite party.

 

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.