State Consumer Disputes Redressal Commission
Surinder Singh S/O Hari Ram vs The New India Assurance Company on 5 February, 2013
PUNJAB STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
DAKSHIN MARG, SECTOR 37-A, CHANDIGARH
First Appeal No. 286 of 2008
Date of institution: 02.04.2008
Date of decision : 05.02.2013
Surinder Singh S/o Hari Ram (wrongly written as Hari Singh in original
complaint, being typographical error) R/o H.No. 3533/13, Aadarsh Nagar,
Near Nirmal Kutia, Ropar, Tehsil and District Ropar.
..........Complainant/Appellant
Versus
The New India Assurance Company, through its regional manager, SCO
104-106, Sector 34-A, Chandigarh.
...........OP/Respondent
First Appeal against the order dated
20.02.2008 passed by the District Consumer
Disputes Redressal Forum, Ropar
Before:-
Sardar Jagroop Singh Mahal,
Presiding Judicial Member
Mr. Piare Lal Garg, Member Shri Vinod Kumar Gupta, Member Argued by:-
For the appellant : Sh. Munish Goel, Advocate For the respondent : Sh. Vinod Mahindru, Advocate JAGROOP SINGH MAHAL, PRESIDING JUDICIAL MEMBER This is complainant's appeal under Section 15 of the Consumer Protection Act, 1986 against the order dated 20.02.2008 passed by the learned District Consumer Disputes Redressal Forum, Ropar (in short the District Forum) vide which the complaint was dismissed.
2. The case of the complainant is that he was employed in Swaraj Mazda factory as operator and was drawing a salary of Rs. 20,000/- per month, that the Swaraj Mazda had obtained a group insurance personal accident policy from the OP/respondent, that in an accident the complainant/appellant suffered injuries due to which he First Appeal No.286 of 2008 2 became permanent disabled. Due to the accident, the complainant was unable to perform heavy duty, he was therefore, given a light work and his salary was decreased by Rs. 2000/- per month. The left shoulder of the complainant was fractured regarding which he remained an outdoor patient in the Civil Hospital, Ropar and his disability was assessed at 25%. The OP/respondent however obtained a report from their own doctors under which his disability was alleged to be of temporary nature and the compensation was denied to him. The complainant/appellant filed the present complaint for direction to the OP/respondent to pay Rs. 2 lacs as insurance amount, Rs. 20,000/- as damages alongwith interest @ 18% per annum.
3. The complaint was opposed by the OP/respondent alleging that the same is false, frivolous and fictitious, that the complaint is barred by time and the same is bad for non-joinder of necessary parties. It was admitted that the Swaraj Mazda has obtained a group insurance personal accident policy and an intimation was received from the complainant upon which he was asked to appear before the penal of doctors who reported that the disability was of temporary nature and the complainant was therefore, no entitled to any compensation. It was denied if he was suffering from the permanent disability to the extent of 25% or if he is entitled to the compensation and damages.
4. Both the parties were given opportunity to adduce evidence in support of their contentions.
5. After hearing arguments of the learned counsel for the parties and perusing the record, the learned District Forum vide impugned order dated 20.02.2008 dismissed the complaint. The complainant has challenged the same through the present appeal.
6. We have heard arguments of the learned counsel for the parties and have perused the record.
First Appeal No.286 of 2008 3
7. The learned counsel for the appellant/complainant has referred to Ex. P-11 which is a Disability Certificate issued by Civil Surgeon, Civil Hospital Ropar showing that the complainant was suffering from permanent disability of left shoulder to the extent of 25%. It is on the basis of this certificate that the complainant wants the compensation of Rs. 2 lacs. According to the learned counsel his entitlement is under Para- 1,clause-e, sub-clause (xii) of the insurance policy. Ex. R-1, relevant portion of which is to the following effect :
1. Sustain any bodily injury resulting solely directly from accident caused by external, violent and visible means, the sum hereinafter set forth in respect of any of the Insured persons specified in the Schedule.
(a) xxxxxxxxx
(b) xxxxxxxxx
(c) xxxxxxxxx
(d) xxxxxxxxx
(e) If such injury shall within twelve calendar months of its
occurrence be the sole and direct cause of the total and/or partial irrecoverable loss of use or of the actual loss by physical separation of the following, then the percentage of the Capital Sum Insured applicable to such insured person in the manner indicated below :
(i) to (xi) xxxxxxx
(xii) Any other permanent partial disablement (Percentage as assessed by the Company's Panel Doctor)
8. A perusal of the entry therefore shows that the compensation would be determined from the percentage of permanent partial disability as assessed by the Company's Panel Doctor. There is no dispute about it that the complainant was directed to appear before the panel doctor who First Appeal No.286 of 2008 4 gave his report Ex. R-5. In view of this report, the disability was only of temporary nature due to muscular wasting and permanent disability can only be assessed once the muscle strength was regained after a dedicated properly supervised rehabilitation treatment. Neither the complainant claims to have undergone the said treatment nor he again appeared before the panel doctor nor the disability has been reported to be permanent. In view of the provision in the policy that the compensation would be assessed only from the report of the panel doctor, the report Ex. P-11 obtained from the Civil Hospital cannot be accepted.
9. In view of the above discussion, we are of the opinion that the complainant has failed to prove if he is suffering from a permanent disability and therefore, he is not entitled to any compensation. The learned District Forum rightly dismissed the complaint. There is no merit in this appeal and the same is, accordingly, dismissed. Parties are left to bear their own costs.
Copies of the orders be supplied to the parties free of costs.
(JAGROOP SINGH MAHAL) PRESIDING JUDICIAL MEMBER (PIARE LAL GARG) MEMBER ((VINOD KUMAR GUPTA) MEMBER February 05 , 2013 Kalyan First Appeal No.286 of 2008 5