Orissa

Cuttak

CC/71/2021

Sankarsan Sahoo - Complainant(s)

Versus

United India Insurance Co Ltd - Opp.Party(s)

self

15 Sep 2022

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL COMMISSION,CUTTACK.

                                                                C.C.No.71/2021

Sankarsan Sahoo,

S/O:Sadhucharan Sahoo,

At:Dhanamandal,P.O:Malapatna,

P.S:Aul,Dist:Kendrapara,

At present C/o:Anadi Nayak,

At:Bidanasi,Near Back side of Municipality Medical,

P.O/P.S:Bidanasi,Dist:Cuttack.                                                   ... Complainant.

 

                                                Vrs.

Manager,(Legal),United India Insurance Co. Ltd.,

Block-2,Bikash Sadan, College Square,

Cuttack-12.                                                                       ... Opp. Party.

 

 

Present:               Sri Debasish Nayak,President.

                                Sri Sibananda Mohanty,Member.

 

Date of filing:    07.04.2021

Date of Order:   15.09.2022

 

For the complainant:            Self.

For the O.Ps               :           Mr. M.K.Dash,Adv. & Associates.

 

Sri Debasish Nayak,President.                                               

            Case of the complainant as made out from the complaint petition in short is that he met with an accident on 15.4.19 at about 11.10 A.M while he was proceeding by driving his bike bearing Regd. No.OD-05-N-1393  on  the road near Board of Revenue office.  The cause of accident was due to dash with a stranger who approached with high speed in another bike.  The complainant had fallen down at the spot from his bike as a result of which he had sustained grievous injuries on his right leg and was admitted to Orthopaedic ward in bed no.64 of S.C.B.Medical College & Hospital at Cuttack.  His right leg was operated on 25.4.19 and he was discharged from the said hospital on 30.4.19.  When he was able to walk slowly he proceeded to lodge F.I.R at Lalbag Police Station,Cuttack on 11.9.19 vide Lalbag P.S.Case no.193.  His injury report was issued in his favour on 21.11.19.  The complainant had a valid insurance policy for his Honda CBZ motorcycle bearing Regd. No.OD-05-N-1393.  The said insurance was covering personal accident for owner/driver to the tune of Rs.1,00,000/-.  He had also a valid driving license.  He had made claim for his insurance on 15.10.19 through registered post as because he spent approximately a sum of Rs.1,00,000/- towards the treatment of his grievous fracture as sustained on his right leg.  When his claim was not settled he had to file this case before this Commission seeking compensation to the tune of Rs.1,00,000/- alongwith interest thereon @ 18% per annum together with a sum of Rs.20,000/- towards his litigation expenses from the O.P. who is the insurer of his policy.

            The complainant has filed copies of several documents in order to prove his case including the FIR as lodged at the Lalbag P.S and as regards to his treatment in his right leg.

2.         The O.P has contested this case and has filed his written version.  As per the written version of O.P this case is not maintainable which is liable to be dismissed since because the complainant has no cause of action.  As it appears from the written version of the O.P, he disbelieves the accident as alleged by the complainant and about the injuries as alleged to have been sustained by the complainant at his right leg and also about the treatment undergone by him at the S.C.B.Medical College & Hospital at Cuttack.  Ofcourse, the O.P admits about the insurance policy undertaken by the complainant but according to him, as per the policy undertaken by the complainant, the terms and conditions of such insurance policy as envisages is towards the coverage of owner/driver only on death and permanent disabilities.  Hence, the insurance policy of the complainant as per the terms and conditions does not cover the injuries and for the medical treatment as alleged to have been sustained by the complainant.  Thus, according to the O.P, the complaint petition is liable to be dismissed.

3.         Keeping in mind the averments as made in the complaint petition and the contents of the written version, this Commission thinks it proper to settle the following issues in order to arrive at a definite conclusion here in this case.

i.          Whether the case of the complainant is maintainable?

            ii.         Whether there was any deficiency in service on the part of O.Ps?

            iii.        Whether the complainant is entitled to the reliefs as claimed by him?

Issue no.i.

            On perusal of the averments as made in the complaint petition together with the copies of supportive documents as filed, it is noticed that infact the complainant after sustaining fracture at his right tibia plateu was admitted to the S.C.B Medical College and Hospital as an indoor patient and was discharged on 30.4.19 after being treated there.  The copy of the FIR as filed by the complainant goes to show that the incident was reported at Lalbag P.S by the complainant.  On perusal of all the copies of documents as available in the case record, this Commission comes to a conclusion that infact the complainant had met with an accident thereby sustaining fracture at his right leg for which he was treated at the S.C.B Medical College and Hospital as an indoor patient and as the plea taken by the O.P on contrary is set aside being only a bald statement lacking supportive documents.  The complainant has mentioned in his complaint petition that after being discharged when he was able to walk slowly, he had lodged FIR at the Lalbag P.S and had made his insurance claim thereafter.  He had received his injury report from the S.C.B Medical College and Hospital on 21.11.19.  Thus, when his claim being made and was turned down by the O.P, the complainant had filed this case before this Commission which is undoubtedly maintainable.  Accordingly, this issue is answered.

Issue no.ii.

            Admittedly, the complainant had an insurance coverage which was valid on the date of the incident.  He had made his claim before the competent authority/the O.P after recovering from his injuries but the same was turned down by the O.P with the plea that the insurance policy as obtained by the complainant do not provide coverage to the injuries and for medical treatment but only covers the personal death and permanent disablement of the driver/owner.  The complainant on the other hand has urged that he is entitled to the coverage of insurance policy to the tune of Rs.1,00,000/- which he had already spent towards  his own treatment and the same should have been given to him by the O.P when he made his claim.  The O.P had not filed any scrap of paper in order to prove that infact  the policy as undertaken by the complainant do not cover the injuries and the treatment thereof as administered to the complainant after the accident.  On the other hand, from the copies of the insurance policy documents as filed by the complainant when perused minutely, nowhere it was noticed that the injuries and the fracture as sustained by the complainant could not be covered under the policy as undertaken by the complainant.

 Thus, when the claim was made by the complainant after being cured from the injuries regarding the claim amount of Rs.1,00,000/- from the insurance policy as undertaken by him which was also very much valid; when turned down by the O.P ofcourse warrants deficiency in service by the O.P here in this case.  Accordingly this issue is answered in favour of the complainant.

Issue no.iii.

            From the discussions as made above, it is noticed that infact the complainant is entitled to the reliefs as claimed by him here in this case.  Hence it is so ordered;

                                                            ORDER

            The case is decreed on contest against the O.P.  The O.P is directed to pay the complainant the assured sum of his policy to the tune of Rs.1,00,000/- alongwith interest thereon @ 18% per annum with effect from 15.10.19 till the total amount is quantified.  The O.P is further directed to pay compensation to the tune of Rs.50,000/- to the complainant towards his mental agony and harassment as caused to him and also to bear his litigation expenses to the tune of Rs.20,000/-.  This order is to be carried out within a period of 30 days from the date of receipt of this order.

Order pronounced in the open court on the 15^th day of September,2022 under the seal and signature of this Commission.

                                                                                                                                                                                                     

                                                                                                                                Sri Debasish Nayak

                                                                                                                                            President

                                                                                                                                                               Sri Sibananda Mohanty

                                                                                                                                               Member.