Tripura

West Tripura

CC/84/2015

Sri Debasish Das. - Complainant(s)

Versus

The Branch Manager, Oriental Insurance Company Ltd. - Opp.Party(s)

Self

01 Apr 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSSAL FORUM
WEST TRIPURA : AGARTALA

CASE NO:  CC-   84  of   2015

Sri Debashis Das,
Late Dinesh Ch. Das,
Bhattapukur, Near Suktara Club,
P.O. + P.S. A.D. Nagar,
District- West Tripura.                ...........Complainant.
    
             ___VERSUS___
             
The Branch Manager,
Oriental Insurance Co. Ltd.,
Central Road, Kaman Chowmuhani,
Agartala,  West Tripura.               .........Opposite parties.
    

      __________PRESENT__________

 SRI A. PAL,
PRESIDENT,
  DISTRICT CONSUMER  DISPUTES REDRESSAL FORUM,
      WEST TRIPURA, AGARTALA. 

SMT. Dr. G. DEBNATH
MEMBER,
  DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

SHR. B. BHATTACHARYA,
MEMBER,
  DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

 

C O U N S E L

For the Complainant        :  Sri Swarup Pandit
                       Advocate.

For the Opposite Parties        :  Sri Basudev Chakraborty,
                       Advocate.                                       
    

          
        JUDGMENT  DELIVERED  ON:  01.04.2016

 

J U D G M E N T

        This case was filed by one Debashis Das alleging deficiency of service by O.P. Oriental Insurance Co. Ltd. It is alleged that the petitioner suffered injury while handling the Ice Crasher Machine. He was operating it on 19.05.14 at 8 P.M. The ice crasher machine caused injury and he lost his two fingers. He was admitted to the I G.M. Hospital, treated in the Apollo Hospital, Chennai, spent 5 lacs, but the insurance company only sanctioned Rs.52,000/-. Therefore, he pray for compensation for deficiency of service.

O.P. Insurance company appeared and contended that it was not a motor accident at all. So, coverage of motor insurance certificate shown by him is not admissible. Petitioner was covered by Nagarik Suraksha Individual Policy for the period from 15.11.13 to 14.11.14. According to the terms and condition of the policy the amount was paid to him as per Nagarik Suraksha Individual Policy coverage was for an amount of Rs.80,000/- and hospitalization section another Rs.20,000/-.

3.        On the basis of contention raised by both the parties following points cropped for determination.
        (I) Whether the petitioner was covered by Motor Accident Claim Policy or Nagarik Suraksha policy?
        (II) Whether the petitioner is entitled to get compensation for deficiency of service of the O.P.?
        
4.        Petitioner side produced the photocopy of Apollo hospital medical report, expenditure, statement of Motor Insurance Certificate Cum Policy Schedule. Petitioner side also examined one witness i.e., the petitioner himself.

5.        O.P. on the other hand produced Nagarik Susraksha Policy, medical bill, discharge summary, disablement certificate, copy of discharge voucher, copy of investigation report. 
        O.P. also examined one witness, Goutam Banik, Administrative officer of the Oriental Insurance Co. Ltd. 

We have gone through all the documents and evidence produced by the parties. From the evidence on record we shall now determine the above points.

    Findings:-
7.        It is admitted fact that he already get the compensation Rs.52,000/- under Nagarik Surksha Policy Schedule. The policy covered period is from 15.11.13 to 14.11.14. the accident took place in the ice crasher machine on 19.05.14 i.e., within the policy period. Petitioner claimed compensation under Motor Insurance Certificate Scheme Policy. We have gone through the certificate. The policy certificate is in the name of Debashis Das, petitioner. Policy covered period is from 15.11.13 to 14.11.14. Particulars of the insured vehicle is given there. Its number is TR01- F- 7934, Bajaj CT 100 with seating capacity 2. But the petitioner clearly stated that while he was operating the ice crasher machine the accident occurred & lost his thumb. So, ice crasher machine is not the vehicle as  described in the motor Insurance Certificate vide no. TR 01 F 7934. So, it was not a motor accident but the accident of the ice crasher machine. For the accident in the ice crasher machine petitioner is not entitled to get any benefit under motor insurance policy certificate. So, claim of the petitioner under motor insurance policy certificate is baseless and we can not consider his claim on motor insurance policy. But his claim under Nagarik Suraksha Policy was justified. We have gone through the Nagarik Suraksha policy as produced by the petitioner. On the vouchers it is found that under that policy petitioner received Rs.52,000/- from Oriental Insurance Co. Ltd. His disablement was 40% as per disablement certificate. We do not understand when 2 finger were amputated then how the doctors issued disablement certificate for 40% disablement. 

8.        We have gone through the Nagarik Suraksha Individual Policy. Sum insured was Rs.80,000/- for hospitalization 20%. How the Insurance company calculated the damage for Rs.52,000/- not clear. When the policy coverage is for Rs.1 lac and the petitioner spent huge amount for his treatment then it was not proper for insurance company to pay only Rs.52,000/-. The assessment done by the Insurance company in respect of loss and damage not proper. We have gone through the treatment papers. Petitioner was treated in the Apollo Hospital for a longer period. He lost his 2 fingers which were amputated so under Nagarik Suraksha Policy he was entitled to get full compensation of insurance of Rs.1 lac but it was denied. This is deficiency of service by the Insurance company. The evidence on record clearly proves that the petitioner suffered and he was hospitalized. The compensation as assessed on the basis of 40% disablement. But when the disablement was full amputation of 2 fingers then petitioner is entitled to get Rs.80,000/- + Rs.20,000/- = Rs.1 lac. 

9.        We therefore direct the Insurance company to pay Rs.1 lac to the petitioner as compensation, also pay Rs.5000/- for deficiency of service as compensation, Rs.2000/- for the cost of litigation. Total Rs.1,07000/-. Both the two points are decided accordingly.

In view of the above 2 points this case is partly allowed. Petitioner is not entitle to get benefits under motor vehicle accident but he is entitled to get benefit under Nagarik Suraksha Policy. We direct the O.P. to pay compensation amounting to Rs.1,07000/- _    Rs.52,000/- = Rs.55,000/-. We direct the O.P. Insurance company to pay Rs.55,000/- to the petitioner within 2 months if it is not paid it will carry interest @ 9% P.A. Supply copy of the judgment.

                     Announced.

 

SRI A. PAL
PRESIDENT,
DISTRICT CONSUMER  DISPUTES 
REDRESSAL FORUM,
WEST TRIPURA,  AGARTALA.

SMT. DR. G. DEBNATH,
MEMBER,
 DISTRICT CONSUMER DISPUTES 
REDRESSAL FORUM,  AGARTALA, 
WEST TRIPURA.    SHRI. B. BHATTACHARYA,
MEMBER,
 DISTRICT CONSUMER DISPUTES 
REDRESSAL FORUM,  AGARTALA,
WEST TRIPURA.