West Bengal

Bankura

CC/21/2024

Manik Gorai - Complainant(s)

Versus

The Regional Manager, National Insurance Company Limited - Opp.Party(s)

Suman Patra

12 Sep 2024

ORDER

IN    THE   DISTRICT   CONSUMER   DISPUTES   REDRESSAL COMMISSION, BANKURA

  Consumer Complaint No.21/2024

         Date of Filing:  12/03/2024 

Before:                                        

1. Samiran Dutta                                     Ld. President      

2. Siddhartha Sankar Bhui                    Ld. Member

 

For the Complainant: Ld. Advocate Jayanta Kumar Mukherjee

For the O.P.1: Ld. Advocate Ardhendu Sekhar Ghosh

For the O.P.2: Ld. Advocate Ashim Kumar Mondal

 

 

Complainant:

Manik Gorai,R/O-Nutanchati,Talpukurpar,Bankura-1,P.S&Dist-Bankura,P.O-Bankura,Pin-722101,Mob-9679806615

Opposite Party:

 1.The Regional Manager,National Insurance Company Limited,Calcutta Regional Office-II,8,India Exchange Place(6^th Floor),Kolkata,Pin-700001,W.B                                                                                                                                          

2.State Bank of India, Bankura, Machantala Branch,  Dist-Bankura,W.B, Pin-722101 (Proforma Opposite Party)

 

FINAL ORDER / JUDGEMENT      

                                                                                                                                                     

Order No.09

Dated:12-09-2024

Both parties file hazira through Advocate.

The case is fixed for argument.

After hearing Argument/Written Argument from both sides the Commission proceeds to dispose of the case as hereunder: -

The Complainant’s case is that he is a small food product seller having S.B. A/c No.34460553866 with O.P. No.2/Bank with Pradhan Mantri Suraksha Bima Yojona (PMSBY) Master Policy No.240600421899999901 issued by O.P. No.1/Insurance Co. commencing since 2018 being renewed from year to year on payment of regular Annual premium and continuing till date. While the Policy was in force the Complainant met with an accident on 16/12/2018 while pulling down the shutter of his own shop whereby he sustained fatal injury on his left eye and immediately after the accident he consulted local Doctor Dr. S.N. Saraf who referred him to Dr. Anup Mondal for better treatment and management. Accordingly the Complainant was admitted to Alolika Nursing Home, Bankura and underwent operation under the care and supervision of Dr. Anup Mondal and was discharged on 27/12/2018.The Complainant lost visionary power of his left eye preventing him from performing his normal work. Thereafter on Medical Examination by the competent Medical Authority

                                                                                                                                                                                      Contd…..p/2

Page: 2

of Bankura Sammilani Medical College & Hospital (BSMCH, Bankura) Visual Disability Certificate dated: 12/03/2020 was issued in favour of the Complainant to the extent of 40% visual disability requiring further review after five years. Before filing of the instant case on 12/03/2024 the Complainant being alarmed of decreasing visionary power got further examined by said Dr. Anup Mondal who issued prescription on 04/02/2024 with the opinion “the decreased visual acuity is permanent with 100% loss of vision of left eye” without waiting for further review by the competent Medical Board. The Complainant however preferred Insurance claim before O.P. / Insurance Co. through O.P./Bank by producing 40% Visual Disability Certificate as above without any reference of existing 100% visual disability as above and as such his claim was repudiated on that ground. The Complainant has therefore approached this Commission for appropriate relief.

O.P. No.1/Insurance Co. contested the case by filing a written version contending inter alia that the Complainant is not entitled to get any Insurance claim out of his accidental injury on left eye without the production of 100% Visual Disability Certificate to be issued by the competent Authority.

O.P. No.2/Bank supported the defence of O.P. No.1/Insurance Co.

-: Decision with reasons:-

Having regard to the facts of the case, contention, submission, and documents on both sides the Commission finds that admittedly when the Insurance claim was preferred before the concerned Insurance Authority the Complainant was in possession of 40% Visual Disability Certificate issued by the competent Authority but before filing the instant case he got further examined by Dr. Anup Mondal who is a Registered Govt. Eye Surgeon who on medical examination found 100% Visual Disability on the left eye of the Complainant and issued prescription to that effect on 04/02/2024. For further confirmation with regard to the extent of Visual Disability of the Complainant the Commission by order dated: 23/08/2024 gave liberty to the Complainant to obtain 100% Visual Disability Certificate from the concerned Doctor who issued the said prescription dated: 04/02/2024 and accordingly a Visual Disability Certificate dated: 25/08/2024 is produced at the time of hearing issued by said Dr. Anup Mondal, M.S., Opthalmology, Associate Professor, Midnapore Medical College & Hospital who reaffirmed his earlier opinion to the effect that the decreased visual acuity in left eye is permanent with 100% loss of vision on left eye.

                                                                                                                                                                                      Contd…..p/3

Page: 3

Ld. Advocate for the Insurance Co. as well as the Bank has strenuously contended before the Commission that without production of 100% Visual Disability Certificate issued by the competent Authority the Complainant is not entitled to get any Insurance claim as prayed for. In this connection the Commission likes to refer to the fact that the Complainant is not in a position to obtain 100% Visual Disability Certificate from the competent Authority at this stage as it is due to be issued on 12/03/2025 on a review after five years from the date of issuance of initial Visual Disability Certificate on 12/03/2020.

Now the question is whether the Complainant in order to get the Insurance claim will wait for that period if the extent of Visual Disability has progressively increased to 100% by this time as supported by the prescription and Certificate issued by a competent Government Registered Eye Surgeon.

Considering the financial status and the surrounding facts and circumstances the Commission is inclined to rely on the current Medical Prescription and Certificate issued by Dr. Anup Mondal as referred to above to favour the Complainant with the Insurance claim of Rs.1 Lakh as provided under PMSBY Scheme in the greater interest of substantial justice.

However if any dispute or disparity arises in future with regard to the extent of Visual Disability to be issued by the competent Authority the O.P. No.1/Insurance Co. is given full right and authority to recall the disbursement of Insurance claim without any objection and plea from the side of the Complainant for which the Complainant must furnish an Indemnity Bond on Affidavit of Rs.1 Lakh before the O.P. No.1/Insurance Co.

The case succeeds accordingly.

                                                  Hence it is ordered…….

That the case be and the same is allowed on contest but without cost.

O.P.No.1/Insurance Co. is directed to pay to the Complainant Rs.1 Lakh as compensation for Insurance claim subject to furnishing Indemnity Bond on Affidavit as directed above within a month from this date in default law will take its own course.

O.P. No.2/Bank is directed to play proactive role in processing and recommending the disbursement of  the Insurance claim in favour of the Complainant.

Both parties be supplied copy of this Order free of cost.

 

    __________________                                    ________________       

 HON’BLE   PRESIDENT                           HON’BLE    MEMBER