Tripura

West Tripura

CC/50/2015

Sri Kunal Debnath. - Complainant(s)

Versus

The Divisional Officer, The Oriental Insurance Co. Ltd. - Opp.Party(s)

S.Chowdhuri.

02 Mar 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSSAL FORUM
WEST TRIPURA : AGARTALA

    CASE NO:  CC-  50   of   2015

Kunal Debnath,
S/O- Sri Jyoti Ranjan Debnath,
Dhaleswar Road No.9,
Agartala, West Tripura.    ........Complainant.
    
                 ______VERSUS______

The Divisional Officer,
The Oriental Insurance Company Ltd.,
44/2  Central Road,
Agartala, Tripura West.    ..........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        : Smt. Shilpi Choudhury,
                      Advocate.                       

For the Opposite Parties        : Sri Basudev Chakraborty,                                 Advocate.
        
              

        JUDGMENT  DELIVERED  ON:  02.03.2016

J U D G M E N T
        This case arises from the application filed by Kunal Debnath U/S 12 of the Consumer Protection Act. Kunal Debanth met with  an accident on 12.03.2009. He was admitted in the GB Hospital and AMRI Hospital, spent an amount of Rs.5 lac for his treatment and he became disabled & handicapped to the extent of 75%. He filed the claim petition before the MAC Tribunal. But 2 times his claim was rejected. The tribunal suggested to appear before the Consumer Forum by the judgment on 17.06.14 in the case no. TS(MAC) 366/12. Thereafter he filed this case before this Forum. He claimed amounting to Rs.1,50,000/- as Personal Accident Benefit, Rs.50,000/-for harassment and mental agony and Rs.5,000/- for cost of the proceeding.

2.        Opposite party Oriental Insurance Company appeared, filed W/S denying the claim. It is stated by the Oriental Insurance Company that the claim is barred by limitation. Its personal Accident coverage is applicable in case of permanent disablement and death.  So, as per Two wheeler package policy condition, petitioner is not entitled to get any amount.

3.        On the basis of assertion denial made by the parties following points up for determination:
        (I) Whether the claim is justified and not barred by any law?
        (II) Whether the petitioner is entitled to get compensation as per terms and conditions of the policy?

Claimant petitioner side produced 2 judgments of the tribunal, FIR, Driving License, Tax token, Registration, Insurance Certificate, Discharge summary, Referral certificate, Discharge certificate of AMRI Hospital, Boarding Pass, Air ticket, Disablement certificate, exhibited and marked as Exhibit-1 series and Exhibit–2.
Claimant petitioner also examined one witness i.e., the claimant petitioner himself. 

5.        O.P. Oriental Insurance Co. Ltd. on the other hand produced the Package Policy terms and conditions and also examined one witness.

6.        On the basis of evidence as produced by the parties we shall now determine the above points. 

FINDINGS AND DECISION AND REASONS FOR DECISION:
7.        We have gone through the certified copy of the policy certificate.  From perusal of the policy certificate it is found that policy was purchased in the year 2008. There is no denying that during the validity of the policy period i.e., from 2008 to 2009 the accident occurred. It is also admitted fact that the policy covered personal accident up to the extent of Rs.1 lakh as per policy. For that Rs.50/- as premium was paid. The petitioner in his statement on affidavit stated that the accident of his Bajaj Pulsar occurred on 12.03.09 within the policy coverage period. He was admitted in GB hospital and then admitted to AMRI Hospital, Kolkata. Treatment papers, cost of treatment not produced before us. Only the discharge summary, air tickets are produced along with disablement certificate. From the discharge summary it is found that the petitioner Kunal Debnath was admitted to AMRI Hospital and treated there by Dr. R. Roy on 07.04.09. Some medicines are prescribed. Cost of medicines not found. Another discharge certificate of the GB hospital produced. Date of admission is 12th March, 2009 date of discharge is on 13th March,2009. He was referred to SSKM Hospital and referral certificate Exhibit-5 also produced. It was considered as emergency case so immediately he was referred. Insurance company in the evidence stated that the complaint was filed on false plea. He never made any prayer for compensation. The administrative Officer, Goutam Banik in his evidence stated that the liability of company is up to Rs.1 lakh within the policy period subject to no natural death having proper  driving license at the material point of time. As per terms and conditions in case of death 100% and in case of permanent disablement he is entitled to get full benefit but in other cases he is not entitled to any benefit. On the disablement certificate it is found that he suffered 75% disablement. Admittedly the injuries sustained by the complainant does not fall within the category as prescribed in the terms and conditions of the policy as because it is partial disablement to the extent of 75%. 
8.        In this connection the judgment rendered by the Madras High Court in CMA No. 3006 of 2012 National Insurance Co. Ltd. Vrs. Krishnan required to be mentioned. In that judgment it was held that ''such narrow construction of the terms of policy proposed by the Insurance company can run to the purpose of the beneficial legislation. For the above said reasons  this court is not inclined to deny the benefits of personal accident coverage to the claimant who is the owner-cum driver involved in the accident.'' In the Rita Devi and others v. New India Assurance Co. Ltd., reported in AIR 2000 SC 1930, 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.'   Relying on this judgment we hold that the petitioner is entitled to get compensation under Personal Accident coverage policy though the injuries sustained by the petitioner does not fall within the categories mentioned in the policy of insurance. Police report, FIR  and other documents clearly prove that the accident occurred and the petitioner himself was the driver. The discharge summary report, medical report support that he sustained grievous injury, brought to the GB Hospital then he was referred to Kolkata. 

9.        It is true that liability of the Insurance company can not go beyond Rs.1 lakh as per policy certificate. It is limited within Rs.1 lakh as premium was paid accordingly. The expenses of treatment not clearly placed before us. Only some air tickets are produced to support the journey from Agartala to Kolkata. From perusal of the air ticket for the journey of the petitioner along with an escort,  the total expenditure is considered to Rs.25,000/- for to and fro journey. No papers produced to support that for the treatment at AMRI Hospital petitioner had to stay at Kolkata during treatment period from 13.03.2009 to 07.04.2009 so, expenditure will not be less than Rs.45,000/-. This expenditure petitioner is entitled to get only. But the O.P. Insurance Company did not arrange payment. Due to that petitioner suffered. The deficiency of service by the O.P. invited this sufferings, mental agony and harassment. For the mental agony and harassment petitioner is entitled to get Rs.5,000/-. Petitioner is entitled to get Rs.3,000/- for cost of litigation. It is true that there was delay in filing the case but delay was due to choosing wrong Forum. It is not intentional so, this Forum condoned the delay rightly. Both the points are decided accordingly.
        
10.        In view of our above findings over the points we hold that Oriental Insurance Company is liable to pay the amount of Rs.45,000/- + Rs.25,000/- + Rs.5,000/- + Rs.3,000/-, total Rs.78,000/-. The Policy covered Rs.1 lakh. Petitioner is entitled to get this amount of Rs.78,000/-. The O.P. Insurance Company is directed to pay the same within 2(two) months, if not paid it will carry interest @ 10% P.A. Supply copy of the judgment to the parties. 
        
                      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.