Tripura

West Tripura

CC/57/2016

Sri Jayanta Majumder. - Complainant(s)

Versus

The Chief Manager, SBI General Insurance Ltd. - Opp.Party(s)

Mr.U.K.Majumder.

22 Feb 2017

ORDER

DISTRICT CONSUMER DISPUTES REDRESSSAL FORUM
WEST TRIPURA : AGARTALA

CASE NO:  CC-  57   of  2016

Sri Jayanta Majumdar,
S/O- Sri Parimal Chandra Majumdar,
16 Office Lane, Agartala,
West Tripura.                 ..........Complainant.

             ___VERSUS___

The Chief Manager/ Manager,
S.B.I. General Insurance Co. Ltd.,
2nd Floor, Lakshmi Darshan G.S. Road,
Opp. Bora Service, Ulubari,
Guwahati, Kamrup,
Assam.                         ........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.

SRI U. DAS
MEMBER,
  DISTRICT CONSUMER 
DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

 

C O U N S E L

For the complainant    : Sri Uttam Kumar Majumdar, 
                  Advocates.

For the O.P.             : Sri Tanmay Chaudhari
                   Advocates.    

 

                                               
        JUDGMENT  DELIVERED  ON: 22.02.2017

J U D G M E N T
        This case arises on the petition filed by one Jayanta Majumdar U/S 12 of the Consumer Protection Act. He filed the case against the Chief Manager/ Manager, S.B.I. General Insurance Ltd.  alleging deficiency of service. 
        
2.        The fact of the case in short is that the petitioner met vehicle accident on 23.06.13 near Milan Sangha, Agartala. He suffered fracture injury in the right leg and other parts of the body. He was shifted to Medical College and GBP Hospital. Thereafter he was treated in the Bhaumik Nursing Home. In total he had to spend Rs. 2,50,000/- because he was treated out side. Petitioner claimed the amount from the Insurance company as it was covered. But the Insurance company refused to pay the same. So, this case is filed for redress.
        
3.        O.P. S.B.I. General Insurance Co. Ltd. appeared, filed Written statement denying the claim. It is stated that the claim  is barred by limitation and disability certificate and other papers not submitted. He is therefore not entitled to get any benefit. 

4.        On the basis of contention raised by the parties following points cropped up for determination;
        (I) Whether the petitioner suffered injury and had to spend huge amount for treatment which was covered by the policy certificate?
        (II) Whether the O.P. Insurance company was negligent and had deficiency of service?
5.        Petitioner side submitted the FIR, Final Report, Registration of the Vehicle, Insurance Policy Certificate, Driving license along with admit Card and Adhar Card all photocopies.  Also produced discharge certificate, Cash Memo, Money Receipt, Copy of Tax Token, doctors slip. 
6.        Petitioner side also produced the statement on affidavit of one witness i.e., Jayanta Majumdar.

7.        O.P. Insurance company produced related policy details, correspondence letters in support of the contention.
8.        On the basis of all these evidence we shall now determine the above points.

        Findings and decision;

9.        We have gone through the FIR. From the FIR and final report of police investigation. It is found that the incident occurred on 23.06.13. Matter was investigated by the police and charge sheet submitted on 31.08.13. After filing the charge sheet petitioner placed the claim  before the O.P. O.P. finally repudiated the claim. So, the cause of action arose from the date of final repudiation not from the date of accident. We have gone through the policy certificate. Policy was issued on 26.11.12 in the name of the petitioner, Insurance cover P.A. cum owner driver is  from 25/11/2012 to 24/11/2013. So, admittedly accident occurred within the policy coverage for the period. From the FIR, Charge sheet and Final Report it is found that the accident occurred and petitioner got injury in his right leg. The fact of injury also supported by discharge certificate, Prescription and other medical report of the GBP Hospital and Bhaumik Nursing Home. Insurance Certificate also proves that the vehicle was insured and coverage extended to driver cum owner of the vehicle. Petitioner was not owner of the vehicle. It is true that for the damage of the insured vehicle compensation was given as per terms of the policy. In the limits of liability portion it is written that in case of death or bodily injury of any person in coverage is up to 2 lacs. Petitioner produced the medical certificate, expenditure report of Bhaumik Nursing Home. 

10.        We have gone through the Bhaumik Nursing Home certificate and found that Rs.37,000/- was spent there. There was other prescriptions. On scrutiny of the vouchers it is found that  another Rs.50,000/- was spent. Treatment outside Tripura not supported by any documentary evidence. As per Package Policy terms and conditions only in case of permanent disablement, death petitioner is entitled to get compensation. On this point the matter is reflected in the Private Car Package Policy.

11.        On this point we have to rely upon the decision of the Madras High Court in the CMA No. 306 of 2012 National Insurance Co. Ltd. Vrs. Krishnan wherein it has be held that ''The contention that the Insurance Company need not pay any compensation to any grievous injury or permanent disablement,  arising out of the injuries, except for Items 1 to 4, specified in the Personal Accident Cover Policy, cannot be accepted, as the contract of  insurance, viz., Personal Accident Cover Policy for the owner-cum-driver, is also a Motor Transport Policy, under IMT 15, recognized by the Motor Tariff Committee.  As stated supra, when the policies issued under the Insurance Act, are recognized by the Committee, subject to the regulations and instructions, issued by the Committee, it is not open to the Insurance Companies to disown, their liability to pay compensation, in respect of other bodily injuries, wherein, scales of compensation are not specifically provided. There is no negative covenant in the policy, that no compensation would be paid, in respect of other bodily injuries. It is well settled that the Motor Vehicles Act is a beneficial legislation.  Reference can be made to a decision of the Apex Court in Smt. Rita Devi and others v. New India Assurance Co. Ltd., reported in AIR 2000 SC 1930, wherein, in construing the provisions of the Act, the Supreme Court held that it is to advance the beneficial purpose underlying the enactment in preference to a construction, which tends to deviate the purpose.''

12.        It has been further held that'' such a narrow construction of the terms of the policy proposed by the Insurance company, would run to the purpose of the beneficial legislation. For the above said reasons, this court is not inclined to deny the benefit of Personal Accident Cover to the respondent/claimant, who is the owner-cum driver of the vehicle involved in the accident.'' 
   
13.        In our considered opinion the ratio of the law laid down by the Madras High Court is applicable in the present case. So, we hold that the complainant is entitled to get compensation  though the injury sustained by the claimant does not fall within the category of death or permanent disablement. 

14.        The treatment papers produced before us supports that the treatment cost was Rs.85,000/-. The coverage is extended to Rs.2 lakhs though it is not a case of permanent disablement but the petitioner suffered grievous injury and he had to spend Rs.85,000/- for treatment. Petitioner is entitled to get this amount. But the claim was denied by the O.P. SBI General Insurance. For this deficiency of service O.P. is to pay Rs.10,000/- and for litigation cost another Rs.5,000/- is awarded. In total Rs.1 Lac is awarded. Both the points are decided accordingly.
    
15.        In view of our above findings over the two points the petitioner is entitled to get Rs. 1 lac as compensation. We direct the  O.P., Manager, S.B.I. Insurance Co. Ltd. to pay the aforesaid amount within 2(two) months if not paid it will carry interest @ 9% P.A.  

                     Announced.

 

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    SRI U. DAS
MEMBER,
  DISTRICT CONSUMER 
DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.