State Consumer Disputes Redressal Commission
United India Insurance Company Limited vs Shiv Kumar Sharma on 8 April, 2010
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: 08-04-2010 Case No. FA-09/65 (Arising from the order dated 05-08-2008 passed in CC No. 1278/2006 by the District Consumer Redressal Forum (New Delhi), K.G. Marg, New Delhi). UNITED INDIA INSURANCE COMPANY LIMITED - APPELLANT Divisional Office No. 8, 503-504, Kailash, 5th Floor, 26- K.G. Marg, New Delhi 1 Versus SHRI SHIV KUMAR SHARMA, - RESPONDENT S/o Late Shri Munshi Ram Sharma, R/O House No. 569, Lado Sarai, New Delhi - 30 CORAM : JUSTICE BARKAT ALI ZAIDI - President SHRI M.L. SAHNI - Member 1. Whether reporters of local newspapers be allowed to see the judgment? 2. To be referred to the Reporter or not? SHRI M.L. SAHNI, MEMBER (ORAL) ORDER
1. The OP United India Insurance Company Ltd., has filed this appeal against the order of the District Consumer Forum, K.G. Marg, New Delhi whereby they have been directed to pay Rs. Two lakhs to the complainant/respondent towards insurance claim and Rs. One lakh as compensation for mental agony and harassment with costs of Rs. 20,000/-.
2. The facts as stated by the respondent/complainant are that, he was a member of police raiding party posted as ASI in Police Station Najafgarh, when on 14-02-2005 they noticed a truck running at speed and therefore, it was signalled to stop.
Driver instead of stopping ran into the complainant/respondent whose both legs were crushed under the wheels of the truck. The injured complainant was rushed to Orthoplus Hospital and later on admitted in Inraprastha Apollo Hospital from where he was discharged on 08-12-2005 after required treatment. When examined at the All India Institute of Medical Sciences, he was declared disabled having suffered 40% disability. Certificate to this effect were issued to the injured complainant/respondent, copy of which is filed.
3. It was claimed by complainant/respondent that being member of the Delhi Police Welfare Society, he was duly insured with the appellant/OP entitled to insurance cover of Rs. Two lakhs on the basis of disability certificate issued by the AIIMS. He, therefore filed complaint before District Forum praying for directions to the OP/appellant to pay a sum of Rs. Two lakhs as compensation for the injuries he had suffered as stated in Annexure CC-2, which interalia reads:
Mr. Shiv Kumar Sharma has been under my treatment for fracture of right leg and fractures of his left foot. So far he has been totally incapacitated and has not been able to do his duty. He is totally housebound and cannot walk. We do not have any guideline to calculate the percentage of his disability.
4. The complaint was allowed by passing the impugned order by the District Consumer Forum.
5. We have heard the Ld. Counsel for the parties and have gone through material on record.
6. Perusing the impugned order, it appears on the face of it that the relief granted vide the impugned order, is more than what had been prayed by the respondent/complainant as stated above. The complainant has prayed for a sum of Rs. Two lakhs only as compensation for the injuries he has suffered and explained in para four extracted above, while the Ld. District Forum has granted Rs. One lakh with cost of Rs. 20,000/-, over and above the Insurance amount of Rs. Two lakhs. Thus the District Forum has prima facie gone over board.
7. Appellants contention is that, as per the insurance policy (annexure A-3) the complainant/respondent was entitled to sum of Rs. 80,000/- only because as per certificate, he has suffered 40% of disability which is covered under clause (e). Its sub-clause (xi) provides that in case of permanent partial disablement the percentage of the capital sum insured shall be payable as assessed by the doctor. In the present case, AIIMS has declared 40% disability of the respondent/complainant while the total sum insured was Rs. Two lakhs. Thus the plea of the appellant that, the claim of the complainant/respondent could be assessed at Rs. Eighty Thousand appears to us quite justified.
8. According to the Ld. Counsel, of the respondent/complainant, since he suffered injuries on both the legs, therefore, the claim should have been allowed @ 80% i.e. 40% for each limb (leg) of the insurance amount. This contention does not stand to reason, because of the fact that as per clause (e) cited above the injured is entitled to insurance claim as per disability assessed by the doctor. Since the Disability Certificate relied upon by the respondent/complainant himself declares 40% disablement, therefore the respondent/complainant cannot be held entitled to 80% of the insurance amount as contended now in the appeal, on behalf of respondent/complainant, and by no stretch of reasoning to full insurance amount, as awarded vide the impugned order.
9. Considering the facts as borne on record and rival contentions of both the parties, we feel satisfied that the impugned order requires modifications because the appellant is not entitled to full insurance amount on account of 40% disability declared by the doctors of AIIMS. However due to appellants failure to settle and pay the due amount to the respondent/complainant at their earliest, they cannot escape their liability for which we hold them guilty of deficiency in service.
10. Allowing the appeal partly, we therefore, modify/substitute the order of the District Forum as follows:
that the appellant/respondent shall pay to the respondent/ complainant a sum of Rs. 80,000/- (Eighty Thousand) as the insurance claim with interest @ 9% per annum with effect from the date of complaint i.e. 28-12-2006 till realization with costs of litigation of Rs. 10,000/-. No order for compensation is required to be passed in this case because the award of interest allowed on the insured amount shall amply meet in the ends of justice.
11. Bank Guarantee/FDR, if any, be returned to the appellant after completion of due formalities.
12. A copy of this order as per the statutory requirements, be forwarded to the parties free of charge and thereafter the file be consigned to Record Room.
13. Announced on 8th April 2010.
(JUSTICE BARKAT ALI ZAIDI) PRESIDENT (M.L. SAHNI) MEMBER AV