National Consumer Disputes Redressal
Lic Of India vs Shri Girraj Mehta on 25 May, 2010
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI Revision Petition No. 3123 of 2008 (Against the order dated 29.04.2008 in Appeal No. 406/2003 of the Rajasthan State Consumer Disputes Redressal Commission, Jaipur) 1. Life Insurance Corporation of India Branch Manager Jhalawar 2. Senior Divisional Manager Life Insurance Corporation of India Jeevan Prakash Rana De Marg Ajmer Through Assistant Secretary Northern Zonal Office Life Insurance Corporation of India Jeevan Bharti, Connaught Circus New Delhi Petitioner(s) Vs. Shri Girraj Mehta S/o Shri Hira Lal R/o Sethon Ka Charraha Jhalarapatan, District Jhalawar Rajasthan Respondent BEFORE: HON'BLE MR. JUSTICE B N P SINGH, PRESIDING MEMBER HONBLE MR S K NAIK, MEMBER For the Petitioner (s) Mr. Ashok Kashyap, Advocate For Respondent NEMO Pronounced on 25th May, 2010 ORDER
PER JUSTICE B N P SINGH, PRESIDING MEMBER Insured Shri Girraj Mehta, who secured insurance policy of value Rs.1 Lakh commencing from 28th November, 1998 along with accident and disability benefit, having met with a road accident on 11th July, 2000 got his left hand amputated. Based on the disability certificate secured by insured suggesting 75% disability, he moved petitioner-Insurance Company for payment of assured value in respect of accident and disability benefit flowing from the insurance policy. Claim was, however, repudiated by petitioner-Insurance Company holding that only in case of total and permanent disability insured was eligible for accident and disability benefit and that apart, claim was lodged with petitioner-Insurance Company not before lapse of one year and four months, which was in violation of terms of policy, which requires insured to give information of accident to insurer within 120 days of accident. Aggrieved with repudiation of claim door of consumer fora was knocked filing a complaint, which holding repudiation of claim to be valid in terms of Clause 10(b) of policy dismissed complaint. However, appeal preferred by insured bore desired result, as State Commission having reversed finding of District Forum negating claim of insured directed Insurance Company to pay to the respondent a sum of Rs.1 Lakh as claim amount under the policy along with interest @ 9% from the date of filing of complaint.
Before rival contentions raised on behalf of parties are taken notice of, reference of salient features of Clause 10(b) of terms of policy would be appropriate, which is in following terms :
The disability . must be total and permanent and such that there is neither then nor at any time thereafter any work, occupation or profession that the life assured can ever sufficiently do or follow to earn or obtain any wages, compensation or profit.
Accidental injuries which independently of all other causes and within 120 days from the happening of such accident, result in the irrecoverable loss of the entire sight of both eyes or in the amputation of both hands at or above the wrists, or in the amputation of both feet at or above ankles, or in the amputation of one hand at or above the wrist and one foot at or above the ankle, shall be deemed to constitute such disability.
Extract of Clause 10(b) of policy condition in no uncertain terms enjoins that in case of accident, there must be total and permanent disability so that insured can never sufficiently do or follow to earn or obtain any wages, compensation or profit. However, second part of the provision is quite distinct one from the first one, as if those conditions enumerated therein are satisfied, issue of insured who suffered disability to earn or obtain wages, compensation or profit was not a condition precedent. In terms of second part of the provision, in case there was loss of limbs, it would be deemed to constitute permanent disability. Admittedly, this is a deeming provision where capacity to earn and requirement of permanent disability are not dependent thereon.
Certain observations made by State Commission are, however, interesting to note.
Since in the present case one hand was completely amputed and that was due to receiving injury in an accident, the loss of limb (left hand) would by itself be deemed to be a permanent disability and therefore, if the doctor concerned had found the disability to 75%, it could not make any difference and even for the amputation of one hand the complainant appellant would be entitled to the sum insured as this disability would be treated as permanent disability.
it directly reflects to the action and power used by the injured person. If one hand is amputed whether that person can do the job in the same manner as a person having both hands works, the answer is No. Therefore, if one hand is amputed, the complainant appellant was not in a position to do job in the same manner as he was doing before amputation. Thus, there would be a reduction in his power to earn money or to do other job and for that aspect also the case of amputation of one hand should be treated as a case of permanent loss.
Least said is better to the interpretation of Clause 10(b) of policy.
Time and again Honble Courts have cautioned that the courts should give true import of terms and conditions of policy, without making any addition or even stretching those terms and conditions.
As has been noticed above, provision of Clause 10(b) of policy comprises of two distinct parts which are independent of each other; latter being only a deeming provision as even in case of loss of both hands at or above the wrists, or in the amputation of both feet at or above ankles, or in the amputation of one hand at or above the wrist and one foot at or above the ankle would constitute permanent disability.
However, permanent disability, which would render the insured not capable to constitute such disability since there was amputation of only one hand of insured, that too to the extent of 75% disability, rest part of terms of policy having been satisfied, insured would not be eligible to secure benefit of accident-cum-disability benefit policy.
State Commission while interpreting terms of policy has totally misdirected itself, stretching terms to impermissible extent, presumably on emotional perception. Finding of State Commission being not sustainable as such is set aside and revision petition is, accordingly, allowed with no order as to costs.
Sd/-
(B.N.P. SINGH, J) (PRESIDING MEMBER) Sd/-
(S.K. NAIK) MEMBER Mukesh