State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Prakash Chandra on 1 March, 2007
IN THE STATE COMMISSION : DELHI IN THE STATE COMMISSION : DELHI (Constituted under Section 9 clause (b)of the Consumer Protection Act, 1986 ) Date of Decision: 01-03-2007 Appeal No. FA-710/2006 (Arising from the order dated 01-06-2006 passed by District Forum (East)), Saini Enclave, Delhi in Complaint Case No.420/06) Life Insurance Corporation of India Appellant Division Office I Through Jeevan Prakash Building, Ms. Jaya Tomar, 25, K.G. Marg, Advocate. New Delhi-110001. Through Shri R.K. Srivastava, Manager (L&HPF) Versus Shri Prakash Chandra Respondent C/o Shri Sita Ram Prasad, Through 69A/1B, Street No.4 Mr. S.N. Gupta, South Ganesh Nagar, Advocate. Delhi-110092. CORAM : Justice J.D. Kapoor- President Ms. Rumnita Mittal - Member
1. Whether reporters of local newspapers be allowed to see the judgment?
2. To be referred to the Reporter or not?
JUSTICE J.D. KAPOOR, PRESIDENT (ORAL) Respondent obtained a Life Insurance Policy for Rs. 50,000/- from the appellant under Plan No. 75-205A covering accidental benefits during the subsistence of the policy.
The policy was effective from 28-12-1996. Respondent met with an accident on 28-12-1999 at about 9.30 A.M. at Seelampur as one bus hit him and he was immediately moved to GTB Hospital, Shahdara. His legs were badly injured. FIR was registered against the said driver of the bus and claim was filed for sanctioning accidental benefits under the policy with the appellant. The claim was rejected on the ground that the life assured had not suffered total and permanent disability and there was contradiction in disability of the respondent as one of the certificate shows that the disability was 40% and another shows 58%. Feeling aggrieved, the respondent filed the instant complaint before the District Forum.
2. Vide impugned order date 01-06-2006 the District Forum allowed the complaint with the direction to the appellant to pay the accidental benefits under the policy as were available to the respondent on 28-12-1999 and pay Rs. 10,000/- as compensation for mental agony and torture and Rs. 5,000/- as cost of litigation.
3. Though the impugned order has been assailed on the ground that the Counsel for the appellant was not given opportunity to argue the matter in spite of the fact that the matter was remanded to the District Forum by this Commission while allowing the appeal of the appellant but the main challenge to the impugned order is with regard to the disability of the respondent being not in terms of the condition No. 10.4 of the Policy. According to this term there has to be total and permanent disability arising out of the accident and since in this case no certificate was produced sustaining permanent disability, the respondent was not entitled for the benefit.
4. As is apparent, the main question to be decided is as to the disability suffered by the respondent as a result of accident. The factum of accident is not in dispute. The certificate (Annexure 1) shows 58% disability, which is a form filled by the life assured wherein the respondent had referred that both his legs were crushed and not working since 28-12-1999. In this form information about the accident and date was given. The name of the doctor who mainly treated him had been furnished and the disability has been referred to as 58%. However, Dr. Manoj Kumar, Professor Department of Orthopedics, GTB Hospital which is a Government Hospital after thoroughly examining the respondent found temporary disability to the extent of 40% of the joint lower limb. It is not comprehensible as to what is temporary disability and as to the percentage. If there is a disability and if it is curable it should have been cured at the time when the certificate and claim was filed. There is a specific observation in the certificate of Mr. Manoj Kumar that patient is not yet permitted to walk unaided or unsupported. As a result of his injury and subsequent delayed union and fracture site patient is not able to perform at his full capacity and also the patient may require another surgery in the form of bone grafting.
As against this the certificate issued by the Medical Board consisting five doctors showed multiple disability being 58%. This certificate shows that it is a permanent disability. In view of this certificate respondent was entitled for accidental benefits.
5. However, in the given facts and circumstances of the case, we only maintain direction No.1 that the respondent shall be entitled to all accidental benefits under the policy No. 12509898 and set aside the additional compensation of Rs. 10,000/- awarded by the District Forum but maintain cost of the proceedings.
6. Appeal is partly allowed to the aforesaid extent.
7. Payment shall be made within one month from the date of receipt of this order.
8. F.D.R./Bank Guarantee, if any, furnished by the appellant be returned forthwith after completion of due formalities.
9. A copy of this order as per the statutory requirements, be forwarded to the parties free of charge and also to the concerned District Forum and thereafter the file be consigned to Record Room.
10. Announced on the 1st March, 2007 (Justice J.D. Kapoor) President (Rumnita Mittal) Member jj