State Consumer Disputes Redressal Commission
National Insurance Co.Ltd & Ors vs Ashok Kumar on 4 May, 2011
BEFORE
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CIRCUIT BENCH (COURT
No. 2), RAJASTHAN, JAIPUR
Appeal No. 106/2008
National
Insurance Co. Ltd. & Ors vs Ashok Kumar
04.05.2011
Before:
Mr.
G.S. Hora, Presiding Member
Mr. Vinay Kumar Chawla, Member Present:
Mr. Ram Kalyan Sharma, counsel for the Appellants None appeared for the Respondent This appeal arises out of order dated 3.10.2007 passed by the District Consumer Forum (DCF), Bundi whereby the Appellant Insurance Co. has been directed to pay to the Complainant within a period of one month a sum of Rs. 50,000/- +Rs. 2,000/-towards mental agony and Rs. 1,000/- as litigation expenses.
The Complainant Shri Ashok Kumar had taken a 'Personal Accident Policy' from the Appellant Insurance Co. He sustained injury in left eye in a car accident and therefore he claimed Rs. 50,000/- on the ground of total and permanent loss of vision in his left eye. As per the certificate of Dr. Naveen Vijay and the report of the Medical Board of Government Hospital, Bundi, the loss to his left eye vision was 6/24. The Appellant Insurance Co. sought an opinion from Dr. J.S. Saroya, an eye specialist of Kota who gave his opinion Annexure-C which has been placed on record along with Memo of Appeal. As per Dr. Saroya, the patient had suffered perforating injury in the left eye which resulted in Corneal Scarring and induced astigmatism due to which the vision in the affected eye is 6/24. Thus the visual loss in the affected eye reported is 40% only.
The learned counsel for the Appellant Insurance Co. has submitted that the learned DCF has erred in holding that loss of his left eye vision was permanent and hence the accident benefit of Rs. 50,000/- for loss of one eye sight is payable. As per the learned counsel, the learned DCF failed to notice that the permanent loss of vision should be total i.e. 100% which is not the case with the Complainant who has loss of vision only upto 40% and as such as per the policy condition, nothing is payable.2
In United India Insurance Co. Ltd vs Harchand Rai & Anr (2004) IV CPJ 15 (SC), Hon'ble the Supreme Court has held that the policy is a contract between the parties and both parties are bound by the terms of the contract. It was further held that terms of the contract has to be strictly read and natural meaning be given to it. No outside aid should be sought unless the meaning is ambiguous. In Revision Petition No. 3123 of 2008 LIC of India vs Girraj Mehta, Hon'ble the National Commission observed as under:
"Least said is better to the interpretation of Clause 10(b) of policy. Time and again Hon'ble Courts have cautioned that the courts should give true import of terms and conditions of policy, without making any addition or even stretching those terms and conditions. As has been noticed above, provision of Clause 10(b) of policy comprises of two distinct parts which are independent of each other; latter being only a deeming provision as even in case of loss of both hands at or above the wrists, 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 would constitute permanent disability. However, permanent disability, which would render the insured not capable to constitute such disability since there was amputation of only one hand of insured, that too to the extent of 75% disability, rest part of terms of policy having been satisfied insured would not be eligible to secure benefit of accident-cum-disability benefit policy. State Commission while interpreting terms of policy has totally misdirected itself, stretching terms to impermissible extent, presumably on emotional perception."
In LIC of India vs Prakash Chandra (2008)III CPJ 208 (NC), Hon'ble the National Commission held that where the disability suffered by the Complainant is not 100%, he is not entitled to accidental benefit. In that case,. The Complainant had suffered disability to the extent of 58% only.
In the light of the above observations, we have to see the terms & conditions of the policy which reads as under:
"(b) If such injury shall within twelve(12) calendar months of its occurrence be the sole and/or direct cause of the total and irrecoverable loss of sight of both eyes or of the actual loss by physical separation of the two entire hands or two entire feet or one entire hand 3 and one entire foot or of such loss of sight of one eye and such loss of one entire hand or one entire foot, the capital sum insured stated in the Schedule hereto.
Use of two hands or two feet or of one hand and one foot or of such loss of sight of one eye and such loss of use of one hand or one foot, the capital sum insured instated in the Schedule hereto.
© If such injury shall within twleve (12) calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of the sight of one eye or of the actual loss by physical separation of one entire hand or one entire foot fifty percent (50%) of the capital sum insured stated in the Schedule hereto.
Total and irrecoverable loss of use of one hand or a foot without physical separation, fifty percent (50%) of the capital sum insured stated in the Schedule hereto."
From the above terms & conditions, it is clear that the Complainant is entitled to get compensation only when there is total and permanent loss of vision. Total loss means 100% loss. Here in this case, the loss of vision is only 40% and therefore as per terms & conditions of the policy, the amount was not payable.
For the foregoing reasons, we set aside the impugned order and dismiss the complaint leaving the parties to bear their own costs.
Member Presiding Member Hira Lal