State Consumer Disputes Redressal Commission
Mahendra Singh vs Life Insurance Corporation on 11 May, 2010
APPEAL NO: 1118/2008 Mahendra Singh s/o Kalyan Singh r/o Rajat Grah Colony Bundi Tehsil & Distt. Bundi (Raj.) Complainant-appellant Vs. 1. Life Insurance Corporation of India through Manager, Bahadur Singh Circle Nainwa Road, Bundi. 2. Life Insurance Corporation of India through Sr.Mandal Manager Mandal Office, Jeevan Prakash Ranadey Marg, Polo-2, Ajmer (Raj.) Opposite parties-respondents 11.5.2010 Before: Mr.Justice Sunil Kumar Garg- President Mrs.Vimla Sethia-Member
Mr.Shashi Kumar Pareek-Member Mr.Ashok Kumar Pareek counsel for the appellant Mr.Puneet Gupta counsel for the respondents 2 BY THE STATE COMMISSION This appeal has been filed by the complainant appellant against order dated 22.5.08 passed by the District Forum,Bundi in complaint no. 260/07 by which the complaint of the complainant appellant was dismissed.
2. It arises in the following circumstances-
That the complainant appellant had filed a complaint before the District Forum, Bundi on 31.10.07 inter alia stating that the complainant had taken a LIC policy known as Asha Deep bearing policy no. 180679504 on 28.11.93 for a sum of Rs.50,000/- under salary saving scheme and the premium was being deducted from the salary of the complainant appellant and the policy was for the period of 20 years. It was further stated in the complaint that as per terms and conditions of the policy if during the continuance of the policy, the insured dies or suffers from permanent disability due to accident, in such a case respondents LIC would pay the insured amount. It was further stated in the complaint that on 21.8.06 the complainant had to face a paralytic attack of one side of the body ( Hemiplegia ) as a result of which he was got admitted in the Govt. Hospital, Kota where he had to remain for eight days and because of that attack the right portion of the body became ineffective and that is why a certificate was issued by the medical board on 29.10.07 3 in the manner that the complainant appellant had suffered the stroke of Hemiplegia on right side and because of that the disability which was assessed by the medical board was more than 40%. Thereafter claim was preferred by the complainant appellant before the office of the respondents but that claim was repudiated by the respondents through letter dated 28.9.07 on the ground that on the basis of the disability certificate in favour of the complainant appellant, the claim was not payable. It was further stated in the complaint that claim of the complainant appellant was wrongly repudiated by the respondents as since the disability was more than 40% and since right portion of the body of the complainant had became ineffective due to patalytic attack, therefore, the disability should have been treated as permanent disability and thus the present complaint was filed.
A reply was filed by the respondents before the District Forum on 27.3.08 and in the reply they have taken the same pleas which were taken by them in the repudiation letter dated 28.9.07 and apart from that it was stated that as per terms and conditions no. 11 (b) (N) of the policy the claim was not payable as the disability which was assessed by the doctors in the present case could not be said to be a permanent disability and it was prayed that claim of the complainant appellant was rightly repudiated by the 4 respondents Insurance Company and complaint be dismissed.
After hearing the parties, the District Forum,Bundi through impugned order dated 22.5.08 had dismissed the complaint of the complainant appellant inter alia holding that since the complainant appellant had resumed his duties and since the permanent disability as assessed by the medical board in the report dated 29.10.07 was 40%, therefore, disability in the present case could not be said to be a permanent disability and thus the claim was not payable.
Aggrieved from the said order dated 22.5.08 passed by the District Forum,Bundi , this appeal has been filed by the complainant appellant.
3. In this appeal the main contention of the learned counsel for the complainant appellant is that there is no dispute on the point that the doctors had assessed the disability more than 40% on the right side of the body and since that was the result of paralytic attack that had taken place on 21.8.06 and since right portion of the body had become ineffective because of that attack, therefore, that disability should have been treated as permanent disability . Hence, repudiation of the claim of the complainant appellant by the respondents was not justified and in view of this the findings of the District Forum rejecting the claim of the complainant appellant could not be sustained and liable to be quashed and set aside as they 5 suffer from basic infirmity, illegality and perversity and appeal be allowed.
4. On the other hand the learned counsel appearing for the respondents has supported the impugned order of the District Forum .
5. We have heard the learned counsel appearing for the parties and gone through the entire materials available on record.
6. There is no dispute on the point that the complainant had taken a LIC policy known as Asha Deep bearing policy no. 180679504 on 28.11.93 for a sum of Rs.50,000/- under salary saving scheme and the premium was being deducted from the salary of the complainant appellant and the policy was for 20 years.
7. There is no dispute on the point that in case of death, the LRs of the deceased or in case of permanent disability, the insured himself is entitled to the get the amount of the policy.
8. There is no dispute on the point that on 21.8.06 the complainant had to face a paralytic attack of one side of the body ( Hemiplegia ) and as per opinion of the medical board dated 29.10.07 the complainant appellant had suffered the stroke of Hemiplegia on right side and because of that the disability which was assessed by the medical board was more than 40%.
69. There is also no dispute on the point that the claim of the complainant appellant was repudiated by the respondents through letter dated 28.9.07 on the grounds mentioned therein as stated above.
10. On file there is a report dated 14.11.06 given by the doctor of the respondents LIC showing that there was paralytic attack on right hand and leg of the body of the complainant appellant.
11. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the findings recorded by the District Forum by which complaint of the complainant appellant was dismissed could be sustained or not and whether the repudiation of the claim of the complainant appellant by the respondents was justified or not.
12. The Hon'ble National Commission in the case of LIC of India Vs. Ram Singh Tanwar reported in I (2007) CPJ 48 (NC) has held that loss of limb is deemed to constitute permanent disability and in that case loss of one leg was treated as permanent disability and claim was decreed and it was further observed that if there was ambiguity in terms of the policy, that should be interpreted in favour of the insured.
13. Even the Hon'ble State Commission of Himachal Pradesh in case of Karam Chand Sharma Vs. Br.Manager LIC of India reported in I (1998 ) CPJ 498 has observed that repudition of the claim on ground that only one hand was 7 amputed was wrong one and even the amputation of one hand was found a total and permanent disability.
14. Taking into consideration the law laid down by the Hon'ble National Commission in the case of LIC of India Vs. Ram Singh Tanwar ( supra ) as well as by the Hon'ble State Commission of Himachal Pradesh in case of Karam Chand Sharma Vs. Br.Manager LIC of India (supra ), this Commission is of the view that if there was a paralytic attack on the right side of the body as a result of which it had effected the normal working of the right leg as well as right hand, therefore, the loss for right side of the body which includes right leg and hand should be treated as permanent disability and not only this the team of doctors had also found the case of Hemiplegia more than 40% and thus from that point of view also the disability in the present case should be treated as permanent disability.
15. No doubt in the present case the complainant appellant might have resumed his duties but a person whose right hand and leg were not working because of paralytic attack, therefore, even then the loss of the limb of right hand and leg due to paralytic attack would be deemed to be a permanent disability and if the doctor had found the disability of more than 40%, that would not make any difference .
16. Apart from that the law laid down by the Hon'ble National Commission as well as by the Himachal Pradesh State Commission as stated above, the Madhya Pradesh State 8 Commission also in a case of Bhartiya Jeewan Bima Nigam Vs. Pratap Singh reported in III (1995) CPJ 10, has held that if in the accident one hand was amputed, that would amount to total disability and the complainant would be entitled to full amount insured under the accidental benefit clause.
17. The word ' permanent disability' has been defined in Advanced Law Lexicon at page 3541 in the following manner-
" The permanent disability for which recovery may be had in an action for personal injuries, is the permanent reduction of the injured person's power to earn money, resulting from the injury, caused by the negligent act of the other party."
18. From the above definition it appears that it directly reflects to the action and power used by the injured person. If half portion of the body is effected due to paralytic attack, whether that person can do the job in the same manner as a person having both hands works, the answer is ' No'. Therefore, if half portion of the body is effected due to paralytic attack, the complainant appellant is not in a position to do job in the same manner as he was doing before that attack. 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 non-functioning of right portion of the body should be treated as a case of permanent loss.
919. Since in this case half portion of the body is effected due to paralytic attack, therefore, why it should not be treated as permanent loss and thus the repudiation of claim of the complainant appellant by the respondents could not be justified and similarly dismissal of the complaint of the complainant by the District Forum could not be justified.
20. For the reasons stated above, the respondents were not justified in repudiating the claim of the complainant appellant and the respondents have repudiated the claim of the complainant appellant without any basis and on wrong assumption and in an arbitrary manner and in view of this the findings of the District Forum rejecting the claim of the complainant appellant could not be sustained as they suffer from any basic infirmity, illegality or perversity . Hence, the impugned order is liable to be quashed and set aside and this appeal deserves to be allowed and the appellant complainant is entitled to get claim amount of Rs.50,000/- under the policy in question alongwith interest @ 9% p.a. from the date of filing of the complaint till the payment is made and the complainant appellant is further entitled to get a sum of Rs. 3000/- as cost of litigation from the respondents.
Accordingly, this appeal filed by the appellant complainant is allowed and the impugned order dated 22.5.08 passed by the District Forum,Bundi is quashed and set aside and the complaint of the complainant appellant stands allowed in the manner that the respondents are directed to pay to the complainant 10 appellant a sum of Rs. 50,000/-
as claim amount under the policy in question alongwith interest @ 9% p.a. from the date of filing of the complaint till the payment is made and further a sum of Rs. 3000/- as cost of litigation.
Member Member President