State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India. vs Sh. Rajinder Kumar. on 3 January, 2023
H. P. STATE CONSUMER DISPUTES REDRESSAL
COMMISSION SHIMLA.
First Appeal No.: 89/2021
Date of Presentation: 16.12.2021
Order Reserved on : 14.12.2022
Date of Order : 03.01.2023
___
Life Insurance Corporation of India, Office at 96/24-25, Raura
Sector, Bilaspur, H.P. through its Branch Manager.
...... Appellant/Opposite party.
Versus
Rajinder Kumar S/o Sh. Bishan Dutt, Resident of Village and
Post Office Kothi, Tehsil Ghumarwin, District Bilaspur, H.P.
.......Respondent/Complainant.
Coram
Hon'ble Justice Inder Singh Mehta, President
Hon'ble Ms.Sunita Sharma, Member
Hon'ble Mr.R.K. Verma, Member
Whether approved for reporting?1 Yes
For the Appellant: Mr.Navlesh Verma, Advocate.
For Respondent: Mr.Mehar Chand, Advocate vice
Mr.Subhash Sharma, Advocate.
Justice Inder Singh Mehta, President
ORDER
Instant appeal is arising out of the order dated 28.07.2021 passed by Learned District Consumer Forum, Una camp at Ghumarwin, in Consumer Complaint No.20/2017 titled Rajinder Kumar Versus Life Insurance Corporation of India. 1 Whether reporters of the local papers may be allowed to see the order?
Life Insurance Corporation of India Vs. Rajinder Kumar (F.A. No.89/2021) Brief facts of the Case:
2. Briefly, the case of the complainant is that complainant had purchased LIC policy No.151226587 on 28.12.2002 and the quarterly installment was Rs.1681/- and date of maturity of policy was 28.12.2022. On 21.04.2016, the right arm of complainant suddenly dragged into the machine and later on 2/3 portion of arm was removed by the doctor of PGI, Chandigarh and zonal hospital issued permanent disability certificate to the extent of 80%. The complainant after suffering permanent disability submitted his claim with opposite party/Life Insurance Corporation, but opposite party repudiated the claim vide letter dated 22.11.2016.
3. The opposite party/ Life Insurance Corporation resisted and contested the complaint by filing reply. It is submitted that as per condition No.10.4 of the policy, disability of complainant does not fall under this category and as per the disability certificate of complainant, disability of the complainant was 80%, therefore, claim was rightly repudiated and there is no deficiency in service on behalf of opposite party.
4. In rejoinder, the complainant has reiterated the contents of complaint and refuted the objections put forth by the opposite party.
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Life Insurance Corporation of India Vs. Rajinder Kumar (F.A. No.89/2021)
5. Thereafter, the parties led evidence in support of their respective pleadings.
6. After hearing the parties, learned District Commission partly allowed the complaint of the complainant.
7. Feeling aggrieved by the order of learned District Commission, the appellant/opposite party has preferred the instant appeal before this Commission.
8. We have heard learned counsel appearing on behalf of the parties and have also gone through the record carefully.
9. Learned counsel of the appellant/Life Insurance Corporation has submitted that the respondent/complainant Rajinder Kumar had purchased a policy from the appellant/LIC on 28.12.2002. The policy sum assured was Rs.1,00,000/- lacs and premium was Rs.1681/- quarterly. The premium was paid regularly till 2017. The complainant Rajinder Kumar was driver in HRTC. On 21.04.2016, right arm of complainant was dragged in wheat threshing machine while he was doing the work of wheat threshing. The Medical Board of Zonal Hospital has issued a disability certificate to the extent of 80%. The claim submitted by the complainant Rajinder Kumar was repudiated in view of clause No.10.4 of the policy, which provides that disability benefit under the policy is admissible, if there is permanent and 100% disability.
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Life Insurance Corporation of India Vs. Rajinder Kumar (F.A. No.89/2021)
10. On the other hand, Mr. Bishan Dutt Sharma, father of the respondent/complainant present along with counsel, has submitted that complainant at the time accident was driver and his hand was amputated and he cannot work as a driver. He further submitted that there is no complaint on the part of appellant that insurance premium has not been paid. FINDING
11. The fact emerging on record indicates that the complainant Rajinder Kumar had purchased Life Insurance Policy from the appellant/LIC on 28.12.2002. The policy sum assured was Rs.1,00,000/- lacs. The quarterly premium amount of Rs.1681/- was paid regularly till 2017.
12. On 21.04.2016, right arm of complainant was dragged in wheat threshing machine while he was doing the work of wheat threshing, which later resulted into amputation of right arm permanently.
13. The claim submitted by the complainant Rajinder Kumar was repudiated by the Life Insurance Corporation of India on the ground that disability benefit under the policy is admissible if there is permanent and 100% disability and since the Medical Board of Zonal Hospital had issued a disability certificate to the extent of 80%, the complainant is not entitled to the sum assured under the policy.
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Life Insurance Corporation of India Vs. Rajinder Kumar (F.A. No.89/2021)
14. The disability certificate Annexure C-5 is proved on record, which indicates that nature of injury is permanent. Since the nature of injury is permanent, the same in itself tantamounts to 100% disability in terms of clause 10.4 of the policy. Relevant portion of clause 10.4 of the policy is reproduced as under:-
"10.4......Accidental injuries which independently of all other causes and within 180 days from 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 wrist or in the amputation of both feet or above ankles or in the amputation of one hand at or above the wrist and one foot at or above the ankle shall also be deemed to constitute such disability."
15. In view of above discussion, we do not find any substance to interfere with the impugned order. Consequently, appeal of the appellant/Life Insurance Corporation of India is dismissed and impugned order dated 28.07.2021 passed by learned District Forum, Una camp at Ghumarwin, remains upheld.
16. No order as to costs.
17. Certified copy of order be sent to the parties and their counsel(s) strictly as per rules. File of District Commission alongwith certified copy of order be sent back and file of State 5 Life Insurance Corporation of India Vs. Rajinder Kumar (F.A. No.89/2021) Commission be consigned to record room after due completion. Appeal is disposed of. Pending applications, if any, also disposed of.
Justice Inder Singh Mehta President Sunita Sharma Member R.K. Verma Member 03.01.2023 Manoj 6