West Bengal

Bankura

CC/165/2014

Sri Nanigopal Ghosh - Complainant(s)

Versus

1. The Divisional Manager, National Insurance Co. Ltd. and others - Opp.Party(s)

Tapan Dey

07 Feb 2023

ORDER

IN    THE   DISTRICT   CONSUMER   DISPUTES   REDRESSAL COMMISSION BANKURA

Consumer  Complaint  No. 165/2014

Date of Filing : 16-12-2014

Before:

1. Samiran Dutta                              Ld. President.      

2. Rina Mukherjee                          Ld. Member. 

3. Siddhartha Sankar Bhui            Ld. Member.

For the Complainant: Ld Advocate Sib Sankar Mukhopadhyay

For the O.P. Ld Advocate Asim Patra 

Complainant   

Nanigopal Ghosh, Kanchanpur, Bankura

Opposite Party  

The Divisional Manager, National Insurance Co. Ltd., 8 No. India Exchange Place, Ruby House, Kol-1

FINAL ORDER / JUDGEMENT 

Order No.46

Dated:07-02-2023

Both parties file hazira through Advocate.

The case is fixed for argument.

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

The father of the complainant Tirthapada Ghosh had an Insurance policy (Group Janata Personal Accident Insurance) from O.P. No.1 & 2 through O.P. No.3 No. being 100300/47/01/9600022/2/96/30442, dated: 31-03-2003 valid from 31-03-2003 to 30-03-2018. Said Tirtha Pada Ghosh met with an accident on 05-09-2010 at Bankura-Jhargram main road near Amritpal and Jandanga under Raipur P.S., District-Bankura with one Bolero Car whereby he received serious injuries and after prolong treatment he has been permanently disabled declared by the Handicapped Board of Bankura Sammilani Medical College & Hospital (BSMCH), Bankura by issuing Disability Certificate dated: 26-04-2012. The complainant has applied for getting Accidental benefits as per the aforesaid policy from O.P. No.1 & 2 by supplying all the requisite documents and information but the same was refused by the O.P.s for the reason best known to them. Hence this case for Accidental benefits of Rs.5 Lakh with Compensation and Litigation cost.

                                                                                                                                                                                        Contd…..p/2

Page: 2

The O.P. No.1 & 2 / National Insurance Co. contested the case by filing a written version contending inter alia that the complainant is not entitled to get any Accidental benefits as the nature of accidental injury suffered by the Insured is not covered under the aforesaid Policy.

Written version is filed on behalf of the O.P. No.3 supporting the complainant case.

In support of the complaint case Disability Certificate dated: 26-04-2012 has been produced along with Policy documents.

Ld. Advocate appearing for the Insurance Co. has argued at the outset that the Insured is the father of the complainant who has not come forward to file the instant complaint but the complainant being his son and Nominee without any authority from the Insured has filed the instant case and thus the case is not maintainable under the Consumer Protection Act. His contention is that under the aforesaid Policy of the Insured scope of cover is inter alia Permanent Total Disablement, loss of limbs and loss of eyes and accidental benefits in such cases is 100% of Sum Assured but in this case the Disability Certificate as produced by the complainant shows that it is a Partial Disability to the extent of 90%.  The Insured has not suffered any loss of limbs and loss of eyes resulting in permanent disablement and as such the Policy of the Insured does not cover such injuries and partial disability so as to get any accidental claim benefit therefrom.

Having regard to the facts of the case and the documents on record it is crystal clear that the nature of injuries suffered by the Insured does not come within the purview of the coverage of the Policy. The Disability Certificate showing partial disability even to the extent of 90% is of no help to the victim to get the Accidental benefits as prayed for.

This apart no FIR / Police Report has been produced by the complainant to prove the factum of accident and claim application before the concerned Insurance authority is also wanting in this case.

Hence it is ordered……..

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

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

____________________                   _________________            _________________

HON’BLE   PRESIDENT              HON’BLE MEMBER        HON’BLE MEMBER