THE PRESIDENT

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

WEST TRIPURA : AGARTALA

 

CASE No. CC- 166 of  2022

 

Sri Santanu Sabdakar,

S/O- Sri Rathindra Sabdakar,

West Jambura, Ganki,

P.O. Khowai, P.S. Khowai,

Khowai Tripura. ...............Complainant.

 

-VERSUS-

 

The National Insurance Company Ltd.,

(Represented by its Divisional Manager),

42, Akhaura Road, Agartala,

P.S. West Agartala, 

District- West Tripura. ..............Opposite party.

 

     __________PRESENT__________

 

 SRI RUHIDAS PAL

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,

  Smt. Dhitasree Debbarma,   

  Learned Advocates.

  

For the O.P. : Sri Sandip Dutta Chowdhuri,

   Learned Advocate.   

 

 

 

JUDGMENT  DELIVERED  ON : 09.12.2022.

 

J U D G M E N T

The case of the complainant in brief is that the complainant is the owner of the Hero Motor Bike, bearing No. TR-01-/C-7807. The said motor bike was duly insured  with the O.P. vide Policy no-20608431216260000586   valid for 5 years w.e.f. 16.08.2021 to 15.08.2026. On 05.02.2022 the motor bike met with an accident at about 3.00 PM  at Chakmaghat, Assam- Agartala Road. Due to the said accident the complainant sustained injuries and he was taken to Teliamura Hospital and then referred to AGMC & GBP Hospital, Agartala. That due to the said accident the complainant has become fully disabled and not in position to stand without the help of others since fact is that the complainant was a professional driver. G.D. Entry was also made with the Teliamura P.S. Vide G.D. Entry No. 017, dated 09.02.2022 with the O/C, Teliamura P.S., Teliamura, Khowai District, Tripura. The matter of incident of accident was also informed to the Agartala Divisional Office of the O.P. and also claimed for compensation for an amount of Rs.18,00,000/- with interest along with all relevant requisite documents and maintaining all formalities as the bike was duly insured with the O.P. Insurance company with validity up to 15.08.2026. Despite of requests and demand notice the O.P. did not agree to settle the claim and ultimately on 01.04.2022 O.P. informed the complainant that he is not entitled to get any compensation from the O.P. Till today the O.P. did not settle the claim of the complainant. Being aggrieved complainant filed this case before this Commission claiming Rs.18,00,000/- along with up to date interest @ Rs.12% P.A. and compensation and litigation cost.

2. After getting notice from this Commission the O.P. Insurance Company appeared and filed written statement denying the allegation made by the complainant in his complaint petition. It is stated by the O.P. that the complaint is not maintainable for breach of contract by the insured and liable to be dismissed. However, the O.P. admitted the averment made by the complainant at para 1 and 2 of his complaint petition though denied para 3 and 4. Denying para no. 5, the O.P. stated that they do not admit that due to the accident the complainant has become fully disabled and not in a position to move or walk even not in a position to stand without the help of the other cannot do day to day work and due to that accident the complainant become unemployed. It is also stated by the O.P. that the complainant did not cooperate with the O.Ps when the authorized officials of the O.P. visited the house of the complainant to pursue his condition and the condition of his bike, also did not supply the relevant documents and information, however allowed to have some situation so as to prove that he is not disabled after the accident. It is also stated that the G.D. No.17 dated 09.02.2022 is false and actual state of affairs was not produced before the police. The O.P. also denied what has been stated by the complainant in his petition at para 8, 9 & 10 that the demand notice dated 22.02.2022 was served upon the O.P.  and on 01.04.2022 O.P. refused to settle the claim rather reality is that the O.P. was asked to submit documents but the complainant failed to furnish the same as such the matter for claim is still pending. There is no negligence and deficiency of service on the part of the O.P. O.P. also denied averment made by the complainant in his complaint petition at para-11 and 12 and stated that the complaint  of the complainant claiming Rs.18 lakh from the O.P. is not tenable at law. The complainant is not entitled to get any compensation as he has not suffered any nature of injury as tabled therein. Thus, prayed for dismissal of the complaint petition.

3. EVIDENCE ADDUCED BY THE PARTIES:-

Complainant submitted his examination in chief by way of affidavit as P.W.1. The complainant submitted 12 documents which on identification marked as Exhibit- 1 Series.

On the other hand Sri Joydeep Ghosh, Manager of  O.P. Insurance Company submitted his examination in chief by way of affidavit. The documents submitted by the O.P. are marked as Exhibit- A Series.

4. POINTS  TO  BE  DECIDED:-

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

(ii) Whether the Complainant is entitled to get relief as being sought for? 

5. A R G U M E N T S:-

At the time of argument Learned Counsel Mr.Bijan Saha appearing for the complainant submitted that there is an insurance policy and also accident coverage. Due to the accident complainant has become disabled and percentage of disability was 15 % and the complainant by profession was a driver. Due to the disablement complainant now can not earn through his profession. So complainant is entitled to get compensation for the cause of disablement.

On the other hand Learned counsel Mr. Sandip Datta Choudhury submitted that the instant complaint is not maintainable for breach of contract as per policy document(Exhibit- A Series). Insurance company is not liable to make compensation as per condition of the policy that in case of death, loss of 2 limbs or sight of 2 eyes or one limb and sight of one eye and total disablement from injury other then named above is scale of compensation  100% and in case of loss of one limb or sight of one eye scale of compensation is 50%. He further submitted that in the instant case admittedly the disablement is 15% and it is temporary disablement and it will be reviewed after 5 years. So, condition of policy does not allow the complainant to get any compensation. He lastly submitted that the complaint is liable to be dismissed.

6. D E C I S I O N S:-

Both the points are taken up together for convenience. We have gone through the pleadings of both the parties as well as evidences adduced orally and documentary by them. The prospectus of the insurance policy which is marked as exhibit- A Series specifically  mentions the coverage. From the heading of the coverage we find that the company indicates to pay compensation as per the following scale for bodily injury/ death sustained by the owner driver of the vehicle in direct connection with the vehicle insured with any of the registered insurers transacting general insurance business in India, whilst mounting into/dismounting from or traveling in the insured vehicle as a co-driver, caused by violent accidental external and visible means which independent  of any other cause shall within six calender months of such injury result in:

Nature of injury Scale of Compensation

(i) Death 100.00%

(ii) Loss of two limbs or sight of two eyes or one limb and sight of one eye 100.00%

(iii) Loss of one limb or sight of one eye 50.00%

(iv) Permanent total disablement from injuries other than named above 100.00%

 

In the instant case from the Exhibit- 1 Series documents we find that admittedly the percentage of disablement is 15% and it is a temporary disablement and it is  a case of locomotor disablement. Disablement certificate speaks that it recommended for 5 years and it is valid till 10.08.2027. The photographs taken upon the complainant is also submitted by the O.P. and it is also marked as Exhibit- A Series. And the photographs show that there is no such disability for which the Insurance company is liable to pay any compensation. Apparently it is shown that now complainant is fully well. During enquiry the photographs were taken by the officer of the insurance company.

8. On appreciation of the evidences of both sides, we are in the opinion that there are much force in the submission of Learned Counsel Mr. Datta Choudhury and as per terms and condition of the policy the complainant is not entitled to get any compensation. Hence, complaint is dismissed. No costs.

9. All the points are, accordingly, decided. Hence, the case is disposed of. Supply copy of this judgment to both the parties free of cost.

    

Announced.

 

 

SRI R. PAL

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.