NATIONAL INSURANCE COMPANY LIMITED Vs. SUBRATA BARAN SEN

JUDGEMENT

(1.) THIS appeal has arisen against the judgment passed by the learned District Forum, Kolkata, Unit -II, on 21.1.2008 in its case No. 305/2006, wherein the learned Forum below has allowed the complaint on contest but without any cost and directed the OP -NIC to the tune of Rs. 4,00,000 towards policy money together with compensation of Rs. 5000 towards deficiency in service, harassment and mental agony to the Complainant within a period of one month from the date of the judgment, failing which the Complainant would be at liberty to put the decree into execution through the District Forum.

(2.) THE brief facts of the case of the Complainant before the Forum below were that being a holder of Group Janata Personal Accident Insurance Policy for the period from 1.6.2002 to 31.5.2017 for a sum of Rs. 10,00,000. On 1.11.2005 the Complainant met with an accident on the Barrackpore -Kalyani Expressway near Kampamore under the police station Bijpur and due to the said injury he sustained injuries on his right knee. He had fallen on the road all of a sudden as the road became slippery due to lubricated oil and parts. He lodged a general diary with the said police station on the same day. The Complainant had attended Balaram Government Hospital at Khardah on 2.11.2005 as an outdoor patient. He was treated by the doctor and was advised for X -Ray. He had suffered from pain due to the injury sustained by him. In the X -Ray report it was detected that he had sustained fracture on his right Patella. He got admitted in the Cantonment General Hospital on 6.11.2005 and discharged from there on the next day. Consultation was made with Dr. C.Chattopadhyay for his medical treatment for the period from 14.11.2005 to 28.4.2006. Further consultation was made with the Dr. B.D.Chatterjee of Apollo Gleneagles Hospital and the said doctor for total replacement of his knee advised the Complainant. Thereafter he appeared before a Medical Board for assessment of gravity of the injury and the Medical Board has opined that he had suffered 70% permanent disablement due to RTA. Due to disablement he cannot walk without the help of an escort. Subsequently several doctors treated him also. He lodged his claim to the office of the Insurance Company on 5.1.1006 through the OP -2 but the OPs did not allow his claim till the date of filing the complaint before the Forum below. Thereafter, finding no other alternative the complainant filed the complaint before the Forum below praying for direction upon the OP -Insurance Company to pay him the policy money as well as cost and compensation due to harassment and mental agony.

(3.) BEING dissatisfied with the above -mentioned judgment passed by the learned Forum the OP -1 Appellant has preferred the present appeal before this Commission contending that the Forum below has failed to understand that as per policy contract certificate of a doctor regarding any percentage of disability cannot be the main criteria of any compensation, when in the policy condition it is clearly stated that in case of permanent disablement the insured is entitled to get 100% money as per policy coverage. It has been argued by the Appellant that the insured suppressed that he was suffering from pre -existing disease at the time of taking the policy. For such suppression the Complainant is not entitled to get any amount towards his claim. According to the Appellant the judgment passed by the District Forum is erroneous, illegal and liable to be set aside. The Appellant has prayed for allowing the present appeal.