West Bengal

Paschim Midnapore

CC/120/2012

Sankar Roy - Complainant(s)

Versus

The Manager, M/S-Indusind Bank Ltd - Opp.Party(s)

19 Mar 2013

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

 

 Complaint case No.120/2012                                                         Date of disposal: 19/03/2013                               

 BEFORE : THE HON’BLE PRESIDENT :  Mr. K. S. Samajder.

                                                      MEMBER :  xxxxxxxxxxxx

                                                      MEMBER :  Mr. Kapot Chattopadhyay.

    For the Complainant/Petitioner/Plaintiff : Mr. G. P. Jana. Advocate.

    For the Defendant/O.P.S.                           : Mr. P. Sengupta.  Advocate.

          

                 Sankar Roy, S/O-late Pramatha Nath Roy of Vill-Brindabanpur P.O.-Chaklahana, P.S.-

                 Debra, Pin-721126, Dist-Paschim Medinipur ……………………………Complainant.

                                                              Vs.

1. The Manager, M/S-Indusind Bank Ltd., Kharagpur, at Inda, O.T. Road, P.O.- Inda, P.S.-Kharagpur(T), Dist-Paschim Medinipur
2. Cholamandalam MS General Insurance Co. Ltd., at Hari Nivas Towers, 1^st Floor, 163, Thambu Chetty Street, Parry’s Corner, Chennai, Pin-600001
3. Cholamandalam MS General Insurance Co. Ltd., H.O. at Dare House, 2^nd floor, 2-N.S.C. Bose Road, Chennai, Pin-600001
4. Cholamandalam MS General Insurance Co. Ltd., regional Office at Chhabildas Towers, 3^rd Floor, 6A, Middleton Street, Kolkata-700071……………………………Ops.

The case of the complainant, in short, is that he purchased an insurance policy from the Op-Insurance Company (Op. nos. 1 to 3) through the Op-Bank (Op. no.1) under “Group Personal Accident master Policy”. The validity of the policy was from 1^st March, 2011 to 29^th February, 2012.

On 23/04/2011 the complainant met with a motor vehicle accident on N.H.-6 and sustained compound facture of both legs and other injuries. He was first admitted to Midnapore Medical College and hospital and thereafter shifted to Chanayaka Hospital, Cuttack, Orissa. Where he remained under treatment as indoor patient till 12/06/2011 but he was not fully cured. The complainant further contended that he appeared before the Medical Board of Kharagpur Sub. Division Hospital and his disability were found to be 91% and the medical board issued a certificate to that effect. Over the accident a police case was also started. The complainant thereafter submitted claim before the Op. no.1 but his claim having not been entertained, he sent

Contd…………..P/2

- ( 2 ) -

Lawyer’s notice to the Op-Bank as well as the Op-Insurance Company and on 16/03/2012 the Op. no.1 and 2 sent a letter to the complainant stating the claim to be admissible claim but so far the Op-Insurance Company has not settled the claim.

Hence the complainant has prayed for the entire sum assured in the Insurance Policy alongwith interest and also litigation cost.

The Op. nos. 2 to 4 contested the case by filing a joint written objection denying the admissibility of the claim. However these Ops. did not deny that the complainant had valid insurance policy on the date of accident. The main contention of these Ops. was that, the complainant has failed to show document to the effect that he has been permanently or partially disabled and that, the claim was not made within a period of 30 days as required under the term of the policy so there Ops. prayed for dismissal of this case.

The Op. no.1 did not contest the case despite notice having been served upon him.

It is now for our consideration us to whether the complainant is entitled to get the relief as claimed and if so to what extent.

Decisions with reasons

  This is an admitted position that the complainant is a policy holder under “Group Personal Accident master Policy” under the Op. nos. 2 to 4. It also appears to be undisputed that the complainant met with an accident on 23/04/2011 when the policy was valid. The documents filed by the parties on record also support such facts.

The entitlement of the complainant in view of the policy has also not been categorically denied by the Op-Insurance Company. The objection of the Op-Insurance Company was only on two grounds.

 Firstly, the complainant has not shown cogent document to show whether there was any permanent or partial disability and secondly the claim was preferred beyond the period of 30 days from the date of accident.

As regards the alleged delay in filing the claim, we are of the view that such objection is not at all tenable because from the documents on record we find that the complainant reminded admitted in the Hospital for about one and a half month for medical treatment. Reasonably it can not been sustained that immediately after discharge from the hospital after being very seriously injured physically, the patient will be fit enough to attend his normal persuit. So the alleged delay in filing the claim is no ground for denying the claim.

Now, from the policy of insurance we find that for permanent total disability the principal sum assured was Rs.5,00,000/- (five lakhs) and for permanent partial disability the sum assured was Rs.2,50,000/- (Two lakhs fifty thousand).

The complainant contended that he has been permanently disabled due to the accident.

Contd…………..P/3

- ( 3) -

He has filed disability certificate granted by the Medical Board of Kharagpur Sub-Division Hospital where from we find that the percentage of disability of the complainant has been noted as 91% (ninety one percent). It is vital to mention that clearly it has not been mentioned as to whether the percentage of disability was permanent or partial. However it has been mentioned in the disability certificate that the changes of variation of this case requires review after ten years. It is also found from the said certificate that no prosthetic aids and appliances has been recommended for being provided to the complainant for the purpose of increasing his mobility and functional independence. Considering all these aspects and keeping in view the fact that the accident took place on 23/04/2011 and the disability certificate was issued on 10/01/2012 i.e. after about 9 (nine) months of the accident the disability can not be said to be permanent at this stage. However facts and circumstances of the case also documents on record lead us to hold that the disability can be said to be partial. More so, since the disability certificate is there, the disability must be either permanent or partial. Since the category has not been specifically mentioned in the certificate, for the reasons as stated above, we hold that in the present case the disability is partial and as such the complainant is entitled to get Rs.2,50,000/- (Two lakhs fifty thousand) which amount was assured in the policy in case of partial disability. Moreover we are of the view that the complainant is also entitled to compensation and litigation cost.

Accordingly the case should succeed in part.

                 Hence,

                             Ordered,

                                     that the case be allowed on contest against the Op. nos. 2 to 4 and exparte against the Op. no.1. The Op. nos.2 to 4 are hereby directed to pay Rs.2,50,000/- (Two lakhs fifty thousand) only  to the complainant. The Op. nos. 2 to 4 are further directed to pay Rs.10,000/- (Ten thousand) only to the complainant towards anxiety and harassment caused to the complainant. There Ops. are further directed to pay to the complainant a sum of Rs.5,000(Five thousand) towards litigation cost. All such amounts have to be paid by the Op. nos. 2 to 4 within 30 days from this date in default, the total amount shall carry interest at the rate of 9% p.a. from the date of filing of this case till recovery of the entire amount.

Contesting parties be supplied with copies of this Judgment free of cost. 

Dic. & Corrected by me

              Sd/-                                                    Sd/-                                                       Sd/-

         President                                             Member                                               President

                                                                                                                              District Forum

                                                                                                                          Paschim Medinipur.