STATE CONSUMER DISPUTES REDRESSAL COMMISSION
WEST BENGAL
11A, Mirza Ghalib Street, Kolkata - 700087 First Appeal No. A/1065/2016
( Date of Filing : 04 Nov 2016 ) (Arisen out of Order Dated 07/06/2016 in Case No. Complaint Case No. CC/71/2015 of District Howrah)
1. Swapan Kumar Banerjee - Bandopadhyay S/o Lt. Bidyut Banerjee, Vill. - Baikhali, P.O.- Dhulasimla, P.S. - Uluberia, Dist. Howrah - 711 315. ...........Appellant(s) Versus
1. The Branch Manager, National Insurance Co. Ltd. Br. office at Bazar Para, P.O.- Uluberia, Dist. Howrah - 711
316. ...........Respondent(s)
BEFORE:
HON'BLE MR. SHYAMAL KUMAR GHOSH PRESIDING MEMBER HON'BLE MR. SUBHRA SANKAR BHATTA JUDICIAL MEMBER PRESENT:Mr. Amit Pachal, Advocate for the Appellant 1 Mr. Debojit Dutta., Advocate for the Respondent 1 Dated : 20 Apr 2022
Final Order / Judgement
Shyamal Kumar Ghosh, Presiding Member
The instant appeal has been directed against the impugned order dated 07-06-2016 passed by Ld. DCDRC, Howrah in connection with the complaint case being No.71/2015 wherein the Ld. DCDRF while disposing of the said complaint case dismissed the same on contest without costs against the O.P and being aggrieved by such order, the present appeal has been preferred by the Appellant/Complainant. The brief fact of the case is that the Complainant purchased a policy being No. 153504/42/13/8100000027 from the O.P/NIC since 2005 and the said policy has been continuing till date by payment of consideration amount of Rs. 449/- as a premium to the O.P. The said policy indicates total sum assured as Rs.1 Lakh for the Complainant and 50,000/- for his son which was valid for the period from 18-06-2013 to 17-06-2014. Due to motorbike accident, the Complainant suffered from fracture of neck of femur (right) and he was compelled to admit at Sanjiban Hospital on 27-02-2014. As per advice of doctor of the said hospital the operation was done on 01-03-2014. The Complainant incurred huge expenses amounting to Rs.
1 Lakh for the purpose of major surgical operation. Thereafter, Complainant prayed for reimbursement of said amount and intimated the whole incident to the office of O.P. The necessary documents and papers were also submitted at the office of the O.P. But surprisingly, on 08-04-2014, the O.P informed the Complainant that he was not entitled to get any relief as prayed for as the aforementioned fracture did not come well within the purview of this policy. Hence, the complainant knocked at the door of the District Commission for getting relief as prayed for against O.P/ National Insurance Company.
The O.P contested this case by filing W/V stating inter alia that the instant case is not at all
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maintainable as this policy only covers the situation/fact relating to death of insured or loss of limb, eye or disablement or disability of the insured person. In the instant case the event of death of insured has not been occurred. No loss of limb or eye or disability of the insured person has not been occurred and as such the complainant was not entitled to get any sort of relief against the O.P, NIC. In such consequence O.P has prayed for rejection of the instant petition of complaint.
In course of hearing Ld. Counsel for the Appellant /Complainant submitted that Ld. DCDRC has overlooked and ignored the main contention of the petition of complaint. As such the instant appeal has been preferred by the Appellant. Ld. Counsel also submitted that on 27-02- 2014 a road accident occurred at Uluberia, Shyampur Road and to that effect the insured applicant suffered fracture injury of neck of femur (right). As per advice of the doctor the operation was done on 01-03-2014. Approx Rs. 1 Lakh has been incurred by the Complainant for the purpose of operation. Complainant prayed for Reimbursement of the aforesaid amount but the O.P/NIC rejected his claim on 08-04-2014. Though, the road accident was occurred on 27-02-2014 which was within the policy period yet the O.P/NIC had surprisingly denied to pay the aforesaid claim amount. Ld. Counsel also submitted that due to said accident the insured appellant has been permanently and orthopedically handicapped which was calculated as 50%. There is a clear gross of negligence and deficiency of service on the part of the O.P/NIC. In course of hearing Ld. Counsel appearing for the Respondent submitted that the Complainant was not entitled to get any relief as no death of insured has been occurred as well as no loss of limb, loss of eye or no disability of the insured person at the time of accident has been occurred. As such the Ld. Counsel has prayed for dismissal of the instant petition of complaint with costs.
We have heard the Ld. Counsel for the Appellant as well as Respondent and have also carefully gone through the materials on record.
After rejection of the prayer of the Complainant by Ld. DCDRC, the instant Appeal has been preferred and as such we try to study carefully the main features of the Personal Accident Insurance Policy. As per Personal Accident Insurance Policy this insurance provides and covers a benefit to the insured person by way of indemnification in the event of insured person sustaining bodily injuries resulting solely and directly from an accident caused by external, violent, visible means causing in death or disablement within 12 months of its occurrence. The Personal Accident Insurance covers the following benefits.
Accidental death:-It provides for the payment of compensation on the insured person's death caused by bodily injury arising out of accidental, violent, external and visible means and resulting in death within 12 calendar months of occurrence of the accidental injury. i.
Permanent total disablement: - It provides for payment of compensation for bodily injury caused by accidental violent, external and visible means resulting in permanent total disablement within 12 calendar months of the occurrence of disablement. ii.
Permanent partial disablement: - It provides for payment of compensation for bodily injury caused by accidental, violent, external and visible means resulting in permanent partial disablement within 12 calendar month of occurrence of the aforesaid disablement. iii.
Temporary total disablement: - It provides for payment of compensation for bodily injury caused by accidental, violent, external and disable means resulting in temporary total iv.
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disablement. The compensation shall be payable for the temporary period for which the insured person suffers from temporary total disablement due to accidental bodily injury. So, as per analytical discussion in respect of aforementioned policy, it is clear to us that the insured is entitled to get benefit upon fulfilling the following conditions:-
Death of insured ora.
Disablement of insuredb.
It appears from the record that the Complaint Case being No. HDF 71/2015 was filed in DCDRC, Howrah on 18.02.2015. The final order was passed on 07.06.2016. It is admitted that no death of insured has been occurred in the instant consumer case. But one document regarding disability certificate issued by Uluberia Sub-Division Hospital, Uluberia, Howrah, has been filed by the Appellant/Complainant in the instant Appeal for consideration. After meticulous inspection of record, it is found that the aforementioned document has been procured by the Complainant on 13.07.2016 i.e. after passing of the final order. So, it is clear to us that without considering of the said document, the final order dated 07.06.2016 was passed by DCDRC, Howrah. Though, there is no such fault or error on the part of DCDRC, Howrah in passing of the final order dated 07.06.2016. Rather, there is an apparent fault on the part of the Complainant as this pertinent and important document was not filed by the Complainant in CC case for consideration by the Ld. DCDRC, Howrah. On the said ground, we have an ample opportunity to reject the instant Appeal but for principles of natural justice, we do not take any harsh decision against the Complainant. At this juncture, we think that this document is very vital one and should be taken into consideration for disposal of the matter. This opportunity should be given to the Complainant since the Consumer Protection Act, being a benevolent social legislation, has been enacted exclusively for providing better protection to the interest of the consumers/Complainants.
Keeping in view of the above observation and also for finality of litigation, the matter is remanded back to the Ld. DCDRC, Howrah for disposal of the case only taking into consideration of the aforementioned disability certificate.
Both parties are directed to appear before the Ld. DCDRC on 10.05.2022. Accordingly, the instant Appeal stands disposed of on contest as per above observations.
[HON'BLE MR. SHYAMAL KUMAR GHOSH]
PRESIDING MEMBER
[HON'BLE MR. SUBHRA SANKAR BHATTA]
JUDICIAL MEMBER
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