Tripura

West Tripura

CC/33/2016

Shri Biman Shyam Chowdhury. - Complainant(s)

Versus

The Divisional Manager, The National Insurance Company Ltd. - Opp.Party(s)

Mr.A.De, Mr.P.R.Sarkar, Miss.M.Bhattacharjee, Mr.K.Bhattacharjee.

14 Sep 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
WEST TRIPURA :  AGARTALA

CASE   NO:   CC- 33 of 2016

Biman Shyam Chowdhury,
S/O- Late Gouranga Shyam Chowdhury,
West Pratapgarh,
P.O. A.D. Nagar, P.S. A.D. Nagar,
Agartala, West Tripura.                 ..…..…...Complainant.

          VERSUS

The Divisional Manager,
The National Insurance Company Ltd.,
Agartala Divisional Office,
42, Akhaura Road, Agartala,
Tripura West – 799001.

      __________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 Ashutosh De,
                          Sri Partha Rn. Sarkar,
                           Sri Kingshuk Bhattacharjee,
                          Miss Mridula Bhattacharjee,
                           Sri Champak Kr. Sen Biswas,
                          Advocates.

For the O.P.                 : Sri P. Goutam,
                      Advocate.

 

        JUDGMENT  DELIVERED  ON:    14.09.2016

J U D G M E N T

        This case arises on the petition filed by one Biman Shyam Chowdhury U/S 12 of the Consumer Protection Act. Petitioner's case in short is that on 01.03.15 when the petitioner was going towards Madhupur by Motor Bike  bearing registration no- TR01R 9643 the bike met with accident. Petitioner fell on the road side, suffered multiple grievous injury and become permanent disabled. He was treated at Tripura Medical College, Ambedkar Hospital. Thereafter he was admitted to ILS hospital. He spent huge amount for treatment near about Rs.3 lakhs. Petitioner claimed total amount of Rs.18 lakhs as compensation. Insurance company refused to pay the amount and repudiated the claim. Being aggrieved he filed this prayer before this Forum for getting redress and compensation Rs.18 lakhs.
    
O.P. the Insurance company appeared, filed W.S. denying the claim. It is stated that policy was effective from 22.02.2015 to 21.02.2016. The claim is totally baseless. There was no deficiency of service by the insurance company.

3.        On the basis of contention raised by the parties following points cropped up for determination.
        (I) Whether  the petitioner was covered by the policy certificate and entitled to get compensation?
4.        Petitioner produced xerox copy of G.D. Entry,  Discharge summary of ILS Hospital, B.R. Ambedkar  Hospital, Insurance Policy certificate, registration, driving license, tax token, advocate's notice etc. Petitioner also produced the statement on affidavit of one witness i.e., the complainant, Biman Shyam Chowdhury.

5.        O.P. Insurance Company on the other hand produced the statement on affidavit of Snehasish Das, Administrative Officer of National Insurance Company. Insurance Policy schedule and Standard Form For Two Wheeler Package Policy also produced. 
6.        On the basis of all these evidence we shall now determine the above points:
        Findings and decision;
7.         In this case is it admitted and established fact that petitioner suffered accidental injury and underwent treatment. It is also admitted fact that the petitioner Purchased the certificate of Insurance Policy effective from 22.02.2015 to 21.02.16. Within the policy period the accident occurred on 01.03.15. It also admitted position that the petitioner was the owner cum driver at  the time of accident and petitioner paid the premium covering personal accident up to Rs.1 lakh. In this case main contention of the O.P. Insurance company is that as per Standard Form For Two Wheeler Package Policy personal accident coverage is covered for death, loss of limbs, loss of sight, permanent disablement not for any injury. In this case petitioner failed to produce any disablement certificate to support that his injury caused any disablement. We have gone through the certificate of Insurance and also Standard Form  for Two Wheeler Package Policy. In the Insurance Policy nothing written to support that form for Two Wheeler package Policy  was part of the policy.     
Learned advocate for the Insurance company placed his reliance  on the decision of the Supreme Court (2004)8 SCC 644 and argued that the terms and conditions is to be strictly followed relying on the decision of Supreme Court and argued that the terms and conditions learned advocate argued that no aid outside the contract should be sought unless the meaning is ambiguous. But in this case the question is whether the two Wheeler package policy was part of the policy or not. This part is not reflected in the policy.
9.            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 the judgment dated 15.03.13 rendered by the Madras High Court 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, recognised by the Motor Tariff Committee.  As stated supra, when the policies issued under the Insurance Act, are recognised 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.''
        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.''   
10.            In this case petitioner was treated in the Ambedkar Hospital and also ILS Hospital. Some vouchers, prescriptions are produced to support the treatment cost. We have scrutinized all the vouchers of the ILS Hospital. It is found that Rs.70,657/- was spent from 05.03.2015 to 09.03.2015 in the ILS Hospital. Thereafter again Rs.30,250/- spent. So treatment cost was more than Rs.1 lakh. But as per policy certificate P.A. coverage was Rs.1 lakh and for that P.A. coverage for owner cum driver Rs.50/- was paid as premium. In the W.S. O.P. Insurance Company did not tell anything about the construction of policy agreement but in the argument  the point was raised. But nothing shown to support that terms and conditions was projected before the petitioner before signing the agreement. Admittedly, injury sustained by the complainant does not fall within the category as shown in the Package Policy.  But petitioner is definitely entitled to get cost of treatment as per decision of the Madras High Court discussed by us.
As a result, we hold that petitioner is entitled to get Personal Accident benefit and O.P. Insurance company is liable to indemnify the complainant towards expenditure of the treatment. But the Insurance company  failed to do so. It is deficiency of service. Petitioner is entitled to get the compensation. Treatment expenditure is more than Rs.1 lakh but his coverage was up to Rs.1 lakh. He is entitled to get only Rs.1 lakh as per policy certificate. We therefore, direct the O.P. Insurance company to pay Rs.1 lakh to the petitioner and also pay Rs.5,000/-(Rupees Five Thousand) for cost of the litigation total Rs.1,05,000/(Rupees One Lakh Five Thousand). The amount is to be paid within a period of 2(two) months. If the amount is not paid it will carry interest @9% P.A. till the amount is paid.

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.