State Consumer Disputes Redressal Commission
Lic vs Chandrabhan on 2 July, 2021
M.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION
PLOT NO. 76, ARERA HILLS, BHOPAL (M.P.)
APPEAL NO. 1331/2013
Manager,
Life Insurance Corporation of India,
Branch No.2, Branch Civil Line,
Opposite Residence of Chancellor,
Sagar (M.P.).
... Appellant
Vs.
Chandrabhan Rajak
S/o Kaluram Rajak,
Age 24 years,
Village Simnapur, Post Kesli,
Tahasil Devri,
District Sagar ... Respondent
BEFORE;
HON'BLE SHRI JUSTICE SHANTANU KEMKAR, PRESIDENT
HON'BLE DR. MONIKA MALIK, MEMBER.
HON'BLE SHRI S.S. BANSAL, MEMBER.
COUNSEL FOR THE PARTIES:
MS. CHITRA SHARMA, LEARNED COUNSEL FOR APPELLANT.
NONE FOR RESPONDENT.
ORDER
( 02.07.2021 ) The following order of the Bench was delivered by Dr. Monika Malik, Member.
: 2 :This appeal is directed against the order dated 24.4.2013, passed by the District Consumer Disputes Redressal Commission, Sagar (for short 'the District Commission'), in complaint case No.37/12, whereby the complaint filed by the complainant has been allowed and the opposite party has been directed to give sum assured of Rs.1 lac to the complainant with interest @ 7% per annum from the date of filing of complaint till its realization. In addition Rs.3,240/- (instalment deposited after accident) with interest @ 7% per annum has also been awarded. Rs.50/- as postal stamp charges, Rs.2000/- on account of deficiency in service on part of the opposite party, with sum of Rs.1,000/-, as cost has also been awarded to the complainant.
2. Briefly put, the facts of the case, as narrated by the complainant are that the complainant, who is a farmer, had taken an insurance policy for accidental benefits from the opposite party on 28.9.2009. The sum assured was Rs.1 lac under the aforesaid policy and he was regularly paying the premium amount. The complainant met with an accident on 1.12.2010, while working with a thresher and received grievous injuries. His right hand, above elbow was amputated. The complainant filed a claim with the opposite party, seeking sum assured under the aforesaid accident cover policy but the same was denied. Alleging deficiency on the part of the opposite party, the complainant filed the complaint as aforesaid, before the District Commission seeking relief.
3. Opposite party/Insurance Co. resisted the complaint stating that the complainant did not receive permanent : 3 : disability, as a result of the accident. His disability certificate mentions disability percentage up to 75% only. Therefore, his claim is not payable.
4. Heard. Perused the record.
5. Learned counsel for the opposite party/appellant argued that the District Commission had no jurisdiction to go beyond the terms and conditions of the policy bond and could only order payment of the disability benefit if it was specific event covered under clause 10 of the policy condition. The amputation of only one had does not fall within the definition constituting disability in terms of clause 10.
6. Referring to the clause No. 10 (4) of the terms and conditions of the policy, learned counsel for the opposite party/appellant made a submission that the complainant is not entitled for the sum assured. In support of her contention, learned counsel for appellant has referred order dated 12th July,2011 passed by the National Commission in Bal Krishna Mishra vs. Life Insurance Corporation of India and others in Revision Petition No. 813/2007, order dated 11th April 1997, in the case of L.I.C. of India vs. Ramesh Chandra, Order dated 30th August, 2013 passed by the National Commission in Life Insurance Corporation of India vs. Banwaril Lal Yadav, in Revision Petition No.4575/2008. Order of the National Commission in Bajaj Allianz General Insurance Co. Ltd. vs. Sh. Ashish Saxena 2015 NCJ 533 (NC), Order of the National Commission in Kamlesh Gupta vs. ICICI Lombard General Insurance Co. Ltd. and Ors. 2017 NCJ 252 (NC), Order dated 29th September, 2008 passed by the State Consumer Disputes : 4 : Redressal Commission, Circuit Bench Rajasthan, Jaipur in the case of LIC of India vs. Shri Sripat Mali, in Appeal No. 1146/2007 and judgment of the Supreme Court in the case of Suraj Mal Ram Niwas Oil Mills (P) Ltd. vs. United India Insurance Co. Ltd. and another 2011 CTJ 11 (Supreme Court)(CP).
7. As we carefully go through the terms and conditions of the policy placed on record of the District Commission, clause 10 (4) of the terms and conditions of the policy reads as under:-
"The disability above referred to must be disability which is the result of an accident and must be total and permanent and such that there is neither then nor at any time thereafter any work, occupation or profession that the life assured can ever sufficiently do or follow to earn or obtain any wages, compensation or profit. Accident injuries which independently of all other causes and within 180 days from the happening of such accident, result in the irrecoverable loss of the entire sight of both eyes or in the amputation of both hand at or above the wrist, or in the amputation of both feet at 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."
8. Bare perusal of the aforesaid clause, leads us to infer that it has two parts. The first part of the clause refers to disability, which is the result of accident and must be total and : 5 : permanent and such that there is neither then nor at any time thereafter any work, occupation or profession that the life assured can ever sufficiently do or follow to earn or obtain any wages, compensation or profit.
9. The other part, however, deals with the injuries which independently of all other causes and within 180 days from the happening of the accident result in the irrecoverable loss of the entire sight of both eyes or in the amputation of both hand at or above the wrist, or in the amputation of both feet at or above ankles, or in the amputation of one hand at or above the wrist and one foot at or above the ankle. We have also gone through the disability certificate issued by the Medical Board, Sagar
10. In view of the above, we are of the considered opinion that the District Commission has rightly inferred that the complainant had suffered a permanent disability owing to amputation of one hand above his elbow and such that the complainant, who is a farmer, can never sufficiently carry out his profession, to earn or obtain any wages, compensation or profit. Though the disability percentage is 75% in complainant's case, but uncontestably, it is permanent in nature. The District Commission has rightly passed a well reasoned order, relying on various judgments including the one, passed by the Hon'ble National Commission in the case of LIC of India vs. Ram Singh Tanwar Vol. I (2007) CPJ 48 (NC).
11. In the instant matter, the complainant's case falls in the first part of the clause 10(4) of the terms and conditions of the policy and therefore, the argument by the Insurance Co. is uncorroborated regarding the other part of the aforesaid clause, : 6 : which is not relevant in the complainant's case. The facts of the cases referred to by the counsel for appellant are different from the case in hand. Therefore, the appellant is not benefitted by the judgments cited by her.
12. In view of the foregoing discussion, we are of the considered opinion that this appeal by the Life Insurance Corporation/appellant deserves to be and is hereby dismissed. The impugned order, which does not suffer from any illegality or infirmity, is, therefore affirmed. No order as to costs of this appeal.
(JUSTICE SHANTANU KEMKAR) (DR. MONIKA MALIK) (S.S. BANSAL)
PRESIDENT MEMBER MEMBER
Mercy