State Consumer Disputes Redressal Commission
N.I.C. Ltd.42 A.K.Road,Agartala vs Sri Bhaba Rn. Debnath on 30 April, 2012
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, STATE CONSUMER DISPUTES REDRESSAL COMMISSION, TRIPURA Appeal Case No.F.A-42/2011 N.I.C. Ltd. 42 A.K.Road, Agartala, P.S-West Agartala, Dist.-West Tripura (Represented by the Divisional Manager, NICL, Agartala,Div.) . . . . Appellant. Vs Sri Bhaba Rn. Debnath, S/O. Lt. Diwajalal Debnath Of Village South Charilam, P.S-Bishramgonj, Dist.-West Tripura. . . . . Respondent. PRESENT : HONBLE MR.JUSTICE A.B.PAL, PRESIDENT, STATE COMMISSION MR.B.K.SHARMA,IAS (Retd), MEMBER, STATE COMMISSION. For the Appellant : Mr.A.RoyBarman,Adv. Miss L.Sarkar,Adv. For the Respondent : Mr.K.K.Pal,Adv. Date of Hearing : 29-03-2012. Date of delivery of Judgment : 30-04-2012. J U D G M E N T
Mr.B.K.Sharma,IAS(retd),Member This appeal challenges the judgment and award passed by the Learned District Forum, West Tripura on 25-04-2011 in case No.C.C.29 of 2010.
2. The respondent-complainant purchased a personal accident policy No-011495349/104050806032 on 08-11-2004 covering the period from 08-11-2004 to 07-11-2014 for an assured sum of Rs.2,00,000/-.
3. On 27-12-2005 while the policy was in force, the complainant- respondent met with a road accident at Charilam, treated at G.B.Hospital for few days and then at the Peerless Hospital and B.K.Roy Research Centre at Kolkata from 31-12-2005 to 13-11-2006. During his treatment in the Peerless Hospital and B.K.Roy Research Centre the right leg of the complainant-respondent was amputated above the knee. As a result, according to certificate issued by the special medical board for physically handicapped persons, the complainant-respondent has been suffering from 80% permanent physical disability.
4. The complainant-respondent filed his claim with the appellant Insurance company on 13-01-2006 for payment of the assured sum of Rs.2,00,000/-. After a long time on 30-07-2008 the appellant- Insurance company repudiated the claim of the respondent-complainant. The respondent- complainant sent a legal notice to the insurance company on 03-10-2008 for settlement of the claim. In response the Insurance company asked for some more documents on 19-12-2008 from the complainant- respondent who complied with the same immediately but the claim remained unsettled.
5. Therefore, the complainant-respondent filed a complaint in the District Forum, West Tripura, Agartala on 19-05-2010 for settlement of his claim along with compensation and cost.
6. After hearing both the sides the Learned District Forum found the appellant-Insurance Company to be deficient in service and directed them to pay the assured sum of Rs.2,00,000/- to the complainant-respondent and interest of the 9% from 13-01-2006 along with a compensation of Rs.10,000/- and litigation cost of Rs.1500/-.
7. The insurance company being aggrieved at this judgment and award has filed this appeal in the State Commission.
8. We have gone through the records carefully and heard the learned advocates representing the appellant and the respondent.
9. In the memo of appeal the appellant-insurance company quoted clause C of the Insurance Policy according to which the amount payable is 50% of the assured sum in case of irrecoverable loss of the sight of one eye or of the actual loss by physical separation of one entire hand or one entire foot. According to the note annexed to the clause C the physical separation of a hand or foot means separation at or above wrist and/or of the foot at or above the ankle respectively.
10. According to the memo of appeal filed by the appellant-insurance company in the instant case only one foot have been amputated and hence the insured is entitled to 50% of the assured sum only and hence they prayed for reduction of the awarded amount of Rs.2,00,000/- to Rs.1,00,000/- only after quashing the direction of the Learned District Forum.
11. We have gone through the policy papers, it is seen from the policy certificate that the complainant-respondent Sri Bhaba Ranjan Debnath purchased the Group Personal Accident Policy of National Insurance Company Ltd. (Policy No-100300/42/04/8200012 for an insured sum of Rs.2,00,000/- covering the period from 08-11-2004 to 07-11-2014 ( mid night).
12. The terms, conditions, exclusion, definitions and scope of cover as printed in the back side of the certificate, the amounts payable for death or disability caused directly from accident are as follows :-
Benefits :
1.
Death 100% of sum insured 1.1. Permanent total disablement 100% of sum insured
2. Total and irrecoverable of.
2.1. sight of both eyes 100% of sum insured 2.2. Actual loss by physical separation of two entire hands 100% of sum insured 2.3. Actual loss by physical separation of two entire feet 100% of sum insured 2.4. Actual loss by physical separation of one entire hand and one entire foot. 100% of sum insured 2.5 Actual loss of sight of one eye and actual loss by physical separation of one entire hand 100% of sum insured 2.6. Actual loss of sight of one eye and actual loss by physical separation of one entire foot 100% of sum insured 2.7. Loss of sight of one eye 50% of sum insured 2.8. Actual loss by physical separation of one entire hand 50% of sum insured 2.9. Actual loss by physical separation of one entire foot. 50% of sum insured
13. The appellant-Insurance company is trying to take shelter under sub clause 2.9 above claiming that the complainant-respondent have lost one foot only and hence he is entitled to 50% of the insured sum.
14. To strengthen their plea the appellant-insurance company has submitted the details of the Personal Accident Insurance Policy with shows under clause C - I that in case of irrecoverable loss of sight of one eye or of the actual loss by physical separation of one entire hand or one entire foot, 50% of the capital sum insured is payable.
15. Under the note below clause C it is provided that for the purpose of clause B and clause C physical separation of a hand or a foot means separation at or above wrist and / or of the foot at or above the ankle respectively.
16. Below clause E different percentages of capital sum insured have been shown as payable. Under this, loss of different limbs or parts thereof have been shown with corresponding amounts payable. Under items XII of the same. It has been printed as follows :
(XII). any other permanent partial disablement percentage as assessed by Doctor.
17. Under a caption cumulative bonus it is printed as follows :-Cumulative bonus :- compensation payable under clause A,B,C and D of the policy viz death, loss of limbs(s) or sight and permanent total disablement arising out of accidental injuries shall be increased by 5% thereof in respect of each completed year during which the policy shall have been in force prior to the occurrence of an accident for which the capital sum becomes payable but amount of such increase shall not exceed 50% of the capital sum insured.
18. From the certificate issued by the Peerless Hospital and Dr.B.K.Roy Research Centre it is seen that Guillotine amputation above the knee of the right leg of the complainant-respondent was done on 31-12-2005. The Special Medical Board for Physically Handicapped Persons (Tripura State) G.B.P. Hospital Agartala issued a certificate infavour of the complainant-respondent Sri Bhaba Ranjan Debnath certifying that he has suffered from 80% permanent physical disability.
19. Thus, this is not a case of loss of one entire foot only as in such cases amputation is done at or above the ankle. Here amputation was done above the knee. Therefore, the plea of the National Insurance Company that the complainant-respondent is entitled to 50% of the insured sum is not acceptable. The complainant-respondent Sri Bhaba Ranjan Debnath, a young man of 26 years of age has lost his right leg and has suffered from 80% permanent physical disability because of this accident. Therefore, according to the policy guide lines the complainant- respondent is entitled to at least 80% of this sum insured if not 100% along with accumulated bonus and other benefits.
20. Therefore, we find no reason to disagree with the judgment of the Learned District Forum, West Tripura, Agartala passed in case No.C.C-29 of 2010 on 25-04-2011. However, we are of a firm opinion of modifying the award granted by the Learned District Forum.
21. In view of the foregoing discussions the National Insurance Company, the appellant is directed to pay to the respondent-Sri Bhaba Ranjan Debnath 80% of the insured sum and 5% of the same as accumulated bonus for one completed year during which the policy was in force prior to the accident along with interest of 9% p.a. from 31-01-2006, the date on which the respondent filed his claim to the appellant-Insurance Company till the date of actual payment. The appellant-Insurance Company shall also pay a compensation of Rs.1,00,000/- to the respondent-claimant, a disabled Youngman, for the harassment and mental agony inflicted upon him by the Insurance Company, though their deficiency in service over the last 6(six) years. The appellant-insurer shall also pay Rs.25,000/- as cost to be deposited into the Legal Aid Account maintained by this Commission.
22. In brief, the appellant-Insurance Company is directed to pay an amount of Rs.1,70,000/- (Rupees one lakh seventy thousand) (85% of the insured sum of Rs.2,00,000/-) and a compensation of Rs,1,00,000/-(Rupees one lakh only) along with interest @ 9% p.a. w.e.f. 13-01-2006 till the date of actual payment to the respondent-claimant. The appellant-Insurance Company shall also deposit Rs.25,000/- as cost into the Legal Aid Account of this Commission. All the aforesaid amounts shall be paid by the appellant-Insurance Company within a period of 45 days from today, failing which all the amounts shall carry interest @ 12% p.a. from the 46th day from today, in addition to the other consequences of disobedience of this Commissions order as prescribed in the Consumer Protection Act 1986.
23. The appeal is, thus, disposed of with cost.
MEMBER PRESIDENT State Commission State Commission Tripura Tripura.