C.F. CASE No.          : CC/09/11                                                                                                         

 

COMPLAINANT             :  Sajal Saha

S/o Sri Bimal Saha

Vill. Khidirpur (Madhyapara)

P.O. Bethuadahari, 

P.S. Nakashipara, Dist. Nadia 

Panchayat Area, Pin. 741126

 

 

       –  Vs  – 

 

 

OPPOSITE PARTIES/OPs   : 1. The Divisional Manager,

The New India Assurance Co. Ltd.,

Barasat Divisional Office,

68, K.N.C. Road, P.O. Barasat,

24-Parganas (North).

 

             : 2. The Branch Manager,

The New India Assurance Co. Ltd.,

L.M. Ghosh Road, Bus Stand

P.O. Krishnagar, Dist. Nadia.  

 

 

PRESENT              :  SHRI DILIP KUMAR BASU                     PRESIDENT

             :  KUMAR MUKHOPADHYAY              MEMBER

       

DATE OF DELIVERY             

OF  JUDGMENT               :    26th June, 2009.

 

 

:    J U D G M E N T    :

 

The fact of the complainant's case, in a nutshell, is as follows. 

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The complainant, Sajal Saha has filed this case against the OPs viz., OP No. 1, The Divisional Manager, New India Assurance Co. Ltd., Barasat Divisional Office, 68, K.N.C. Road, Barasat and the OP No. 2, The Branch Manager, New India Assurance Co Ltd., L.M. Ghosh Road, Krishnagar, Nadia alleging that he is the nominee of deceased Nilu @ Mahananda Saha who was covered under the Janata Personal Accident (JPA) Policy No. 4751240308000, valid from 14.07.99 to 13.07.04 for the sum of Rs. 1,00,000/-.    On 14.04.04, over NH34 near Bholadanga Culvert while he was travelling by his matador No. WB/51/2270, along with the driver of the said vehicle met an accident.  At first, he was shifted to Bethuadahari B.P.H.C. and thereafter to Shaktinagar Hospital.  On the same day, he was taken to Woodland, Nursing Home, Kolkata and finally he was taken to Apollo Hospital, Chennai.  On 01.06.04, Nilu @ Mahananda claimed the insurance amount being disabled due to that accident.  On 23.06.04 he submitted complete filled up claimed form along with all documents but no receipt was given from the office.  Superintendent District Hospital, Krishnagar, Nadia issued a disable-certificate in his favour to the tune of 90%.  Subsequently on 18.03.05 he expired.  On several attendance by the complainant to the office of OP No. 2 as to settlement of the claim he was orally assured for quick settlement, but no fruitful result was cropped up.  On 09.08.07 he issued reminder to OP No. 2.  On 26.10.07 the OP No. 2 sent one claim form along with letter bearing No. 512403/JPA Claim/2007 dtd. 26.10.07.  He sent all the papers along with the filled up form on 15.02.08 for settlement of the claim.   Thereafter, OP No. 2 demanded all documents of Woodland Nursing Home and Apollo Hospital.  Thereafter, the OP No. 2 issued a no claim letter vide No. 512403 /JPA – N.CI/SA/613 dtd. 20.10.08 stating that the proximate cause of death was not accident.   By filing this complaint he has prayed for an order for making payment of Rs. 1,00,000/-, compensation of Rs. 1,00,000/- for mental pain and agony, cost, and other relief.

The Ld. Lawyer of the New India Assurance Co. Ltd.  by filing a written 

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version has contested this case contending, inter alia, that all the facts stated in the complaint are false.  They have admitted that Nilu Saha had the JPA Policy vide policy No. 4751240308000 for the period from 14.07.99 to 13.07.2004 covering the accident loss / injury or death as per terms and conditions of the policy.  He has denied the filing of the claim by Nilu Saha who did not die due to the accident and the case is liable to be dismissed.

 

In view of the above facts and circumstances the following points are taken for proper adjudication.

Point No.1:        Whether there cause any deficiency in service on the part of the OPs?

Point No.2:        Whether the complainant is entitled to get relief as prayed for?

 

 

FINDING WITH REASONS

 

Both the points are taken together for sake of convenience and for the purpose of avoiding needless repetitions. 

The Ld. Lawyer of the OPs has argued that Nilu Saha has never claimed the insured money.  No document has been filed by the complainant to show that Nilu Saha preferred the claim.  Furthermore, he has added that according to the condition of the policy Nilu Saha had to suffer by total disablement.  In the instant case the complainant has stated that he suffered disablement to the tune of 90%.  According to the clause a – d of the condition of the policy the complainant will not get any relief.   The death certificate does not disclose that Nilu Saha died due that accident; as such the complainant is not entitled to get relief.

Admitted fact that Nilu Saha @ Mahananda had the valid insurance 

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policy at the time of alleged commission of accident.  The xerox copy of the F.I.R. lodged by one Manik Kumar Chandra of Mujaffar Colony P.O. Bethuadahari reveals that Mahananda Saha, the owner of the vehicle No. WB/51/2270 received severe injuries on 14.04.04 due to the accident of the above vehicle.  The xerox copy of the certificate issued from the office of the Superintendent District Hospital, Krishnagar, Nadia vide memo No. 451 dtd. 10.02.05 transpires that Nilu Saha aged about 29 years was permanent disable to the tune of 90%.   

The xerox copy of the certificate issued by Dr. Hari Narayan Saha, MBBS (Cal) vide Registration No. 18596 reveals that Dr. Saha issued a certificate on 18.03.05 that Mahananda Saha aged about 29 years had suffered from bedsore on the different parts of the body.  He was in a run down condition and ultimately he expired on 18.03.05 at 4.05 pm.......... . 

The xerox copy of the document filed by the OP transpires that Mr. Mahananda Saha was admitted at Apollo Hospitals, 21, Greams Lane, Chennai, 600006 on 18.04.04 and discharged from that Hospital on 04.05.04.  In that document  it is stated “Course in the Hospital: 29 year old male patient with inability to walk and stand following road traffic accident sustained on 13.04.04 was evaluated for the injuries and diagnosed to have Fracture Dislocation with instability C7 – D1 and Fracture D3, D4, D5 vertebra after through pre-operative evaluation including fitness for surgery and after prior consent on 22.04.04 under general anaesthesia, Posterior Spinal Stabilization with instrumentation using rods, supra laminar hooks and pedicle screws done.”

The Ld. Lawyer of the OP has contended that the said report transpires that at the time of discharge patient was comfortable, as such the complainant is not entitled to get relief as Nilu Saha did not die consequence to that accident.

It is admitted fact that Nilu Saha went to Apollo Hospital, Chennai for his treatment.  Thus, it is established fact that he met an accident.

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Perused the condition of JPAIP whereon the conditions are laid in clauses (a) to (e).   The clause (a) provides as follows “If such injury shall within twelve (12) calendar months of its occurrence be the sole and direct cause of the death of the insured the capital sum insured stated in the Schedule and the amount payable under this clause shall be paid to the nominee shown in the Schedule.”

We have come into conclusion that Nilu @ Mahananda Saha met an accident on 14.04.04.   According to the certificate issue by Sub-Registrar, Death and Birth, Bethudahari 1, GP, Nelu Saha @ Mahananda died on 18.03.05 i.e., within 12 calender months from the date of his accident.  The xerox copy of the certificate issued by Dr. Hari Narayan Saha clearly divulges that Nilu Saha suffered by bedsore on different parts of his body at the time of his death.  Obviously, it supports that he was unable to move after his accident and due to constant lying on the bed he suffered bedsore.   Thus, the argument of the Ld. Lawyer of the OP that he was comfortable does not mean that he was recovered from his ailment.  In our considered view the death of Nilu @ Mahananda Saha was the resultant affect of the accident for which he had to accrue bedsore for continuous and long lying on the bed. 

In view of the above facts rejection of the claim of the complainant by the OPs on the ground of no claim obviously tantamounts to deficiency in service.

Considering the facts and circumstances of this case we can easily realize the mental agony and harassment of the complainant and the members of his family.  In our considered view if Rs. 40,000/- (Rupees forty thousand) only is awarded as compensation then that may alleviate the grievance of the complainant.

In view of the above discussion the case succeeds.

Hence,

Ordered,

That the instant case is allowed on contest with cost of Rs. 5,000/- (Rupees 

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five thousand) only against the OPs.  

The OPs are directed to pay the complainant either jointly or severally the insured amount of Rs. 1,00,000/- (Rupees one lakh) with interest @ 10% per annum from 25.02.09 i.e., the date of filing of this case till disposal of this case i.e., on 26.06.09.   

The OPs to pay either jointly or severally the sum of Rs. 1,00,000/- the insured amount and interest @ 10% per annum upon that amount and compensation of Rs. 40,000/- (Rupees  forty thousand) only and Rs. 5,000/- (Rupees five thousand) only as cost within 40 days from the date of this order failing which the entire amount will accrue interest @ 10% per annum from this day till making payment to the complainant the entire amount.  

The complainant do get the above cited sum from the OP No. 1 & 2 either jointly or severally within the stipulated period.   

Hand over a copy of this order to the parties free of cost.

The case is disposed of by 2 months 13 days.

 

 

Dictated & corrected by me.

 

 

  (D.K. Basu)

    President         

C.D.R.F., Nadia

        (K. Mukhopadhyay)           (D.K. Basu)

Member             President            

           C.D.R.F., Nadia      C.D.R.F., Nadia