State Consumer Disputes Redressal Commission
Amarjit Singh vs 1. National Insurance Company Ltd on 31 August, 2009
2nd Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB,
SCO NOS.3009-12, SECTOR 22-D, CHANDIGARH.
First Appeal No. 937 of 2003
Date of institution : 22.7.2003
Date of Decision : 31.8.2009
Amarjit Singh s/o Hardial Singh, resident of Bhucho Kilan, District Bathinda.
....Appellant.
Versus
1. National Insurance Company Ltd., The Mall, Bathinda through its
Divisional Manager.
2. Bathinda Central Cooperative Bank, Bhucho Mandi, through its
Manager.
...Respondents.
First Appeal against the order dated 24.6.2003 of
the District Consumer Disputes Redressal Forum,
Bathinda.
Before:-
Mrs.Jasbir Kapoor, Presiding Member.
Shri Piare Lal Garg, Member.
Present:-
For the appellant : Sh. Ashok Jindal, Advocate For respondent No.1: Sh. Vinod Mahendru, Advocate For respondent No.2: None.
MRS. JASBIR KAPOOR, PRESIDING MEMBER:
This is an appeal filed by Amarjit Singh(in short 'the appellant') against the order dated 24.6.2003 of the District Consumer Disputes Redressal Forum, Bathinda(in short the 'District Forum') by which the complaint of the appellant was dismissed by the District Forum.
2. Brief facts of the case are that the appellant was having saving account No. 2539 with respondent No. 2. Respondent No. 2 bank had purchased Group Personal Accident Policy for its accounts holder for a sum of Rs. 1 lac each. This policy was again renewed for the year 2002- 2003. The appellant's hand had damaged on 7.8.2002 when he was working on fooder cutter machine and in this accident his right hand's four fingers were fully cut and half of his thumb was also cut. Appellant was First Appeal No. 937 of 2003 2 insured with respondent No. 1 during this period. He gave intimation regarding injury to respondent No. 2 alongwith bills, who sent this information to respondent No. 1 insurance company. Respondent No. 1 deputed its investigator Mr. R.K. Sharma, who after investigation assured him that he would be paid compensation earlier. On inquiry from respondent No. 2 about his claim he was informed that respondent No. 1 repudiate his claim. It was prayed that respondent No. 1 be directed to pay the due insurance amount alongwith interest @ 18% P.A. and also demanded Rs. 10,000/- as compensation.
3. Respondent No. 1 replied and pleaded that total right hand of the appellant has not become incapable and only four fingers and ½ thumb had been cut as such his claim was not covered under the terms and conditions of the policy and after application of mind his claim was rightly repudiated. Respondent No. 2 replied he was made a party in the complaint only a proforma respondent and there was no dispute between the appellant and respondent No. 2.
4. Learned District Forum after hearing the counsel for the parties, perusing the pleadings of the parties and going through the record, dismissed the complaint of the appellant after observing that claim of the appellant does not cover with Clause 'C'(ii) of the policy in dispute.
5. Hence, the appeal by the appellant/complainant.
6. We have perused the grounds of appeal, order, judgments cited as well as record of the District Forum and heard the submissions of the learned counsel for the parties; following are our findings:-
(a) It is an admitted fact between both the parties that on
07.08.2002 four fingers of the right hand and ½ of the thumb of the appellant had cut when he was working on fodder cutter machine. It is also no dispute between the parties that First Appeal No. 937 of 2003 3 the appellant was insured with respondent No.1 on the date of the accident.
(b) The main point of contention between both the parties is with regards to the claim. Does the injury which has unfortunately happened to the appellant make him eligible to claim the insurance amount or not?
(c) To answer this we have thoroughly gone through the Group Accident Policy (Ex R-2); which was placed on pages 41 to 43 of the District Forum file. It would be imperative to re-produce and discuss the clause (C) of the Group Accident Insurance Policy so as to answer the question mentioned above. The following is Clause (C) of the Group Accident Policy:
"(c) If such injury shall within twelve (12) calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of:
(i ) the sight of one eye or the actual loss by physical separation of entire hand of one entire foot of the Insured Person (50%) of the Capital sum Insured stated in the Schedule hereto applicable to such Insured Person.
(ii) Use of a hand or a foot of the Insured Person without physical separation, fifty percent (50%) of the Capital Sum Insured stated in the Schedule hereto applicable to such Insured Person. "
(d) The Clause C (ii) mentioned above clearly states that in case of total and irrecoverable loss of use of a hand or a foot of the First Appeal No. 937 of 2003 4 Insured Person without physical separation, then in such case the insured person shall be eligible for 50% of the Capital Sum Insured applicable to such insured person. Accordingly, in the instant case the insured person met with an accident whereby he lost his four fingers and ½ of his thumb and the fact of the disability of his hand is also corroborated by the disability certificate issued by CMO, which has resultantly made total and irrecoverable loss of use of a hand without physical separation; thereby he is very well covered under the Clause C (ii) as described above and shall be eligible to get 50% of the Capital Sum Insured.
7. In the view of the above, the appellant is eligible for 50% of the total Capital Sum Insured applicable to him with any applicable bonus that might have accrued on the sum insured plus an interest @7.5% p.a from 7.10.2002 i.e. after two months of the accident till its payment to the appellant.
8. The arguments in this appeal were heard on 26.8.2009 and the orders were reserved. Now the order be communicated to the parties.
9. The appeal could not be decided within the statutory period due to heavy pendency of Court cases.
(Mrs. Jasbir Kapoor)
Presiding Member
August 31, 2009. (Piare Lal Garg)
as Member
First Appeal No. 937 of 2003 5