High Court Of Calcutta
INDIRA BANERJEE
PRABIR KUMAR NATH - Appellant
Versus
LIFE INSURANCE CORPORATION OF INDIA - Respondent
W. P. 14347 Of 2000
Decided On : 02/17/2003
INSURANCE - DISABILITY BENEFIT - INTERPRETATION OF POLICY - 'TOTAL DISABILITY' - AMPUTATION OF ONE LEG - WHETHER CONSTITUTES TOTAL DISABILITY - LIBERAL INTERPRETATION IN FAVOUR OF INSURED - PAYMENT OF DISABILITY BENEFIT DIRECTED.
Fact of the Case:
Petitioner, a bus driver, lost his job after his leg was amputated above the knee in an accident. He claimed disability benefits under an accident benefit clause in an insurance policy issued by LIC, but LIC denied the claim on the ground that the disability was only 60% and not 100%.
Finding of the Court:
The court held that the policy did not require 100% disability for claiming the accident benefit and that the word 'total' in the policy should be given a liberal interpretation in favour of the insured. The court found that amputation of one leg from above the knee constituted total disability and that the petitioner was entitled to the disability benefit.
Issues: 1. Whether 100% disability is a condition precedent for claiming disability benefit under the policy. 2. Whether amputation of one leg from above the knee constitutes total disability.
Ratio Decidendi: 1. The policy does not require 100% disability for claiming the accident benefit. 2. The word 'total' in the policy should be given a liberal interpretation in favour of the insured. 3. Amputation of one leg from above the knee constitutes total disability.
Final Decision: The court allowed the petition and directed LIC to disburse the disability compensation to the petitioner within eight weeks.
( 1 ) THIS writ petition, is directed against the action of the Respondent No. 1, which is hereinafter REFERRED TO as Respondent LIC in disowning its liability to the petitioner on account of disability benefit under Policy No. 420717908, taken out by the petitioner, which is hereinafter REFERRED TO as the "said policy". The decision of Respondent LIC was communicated to the petitioner by a letter dated 20/08/1997 which is under challenge in this writ petition.
( 2 ) THIS is a most unfortunate case where the petitioner who had been a bus driver became permanently disabled by reason of amputation of one of his legs, consequent to an accident.
( 3 ) THE petitioner claims to have lost his job on account of the amputation of his leg as aforesaid.
( 4 ) THE petitioner was/is the holder of the said Policy No. 420717908 issued by respondent LIC which provides for an accident benefit.
( 5 ) THE relevant clause is set out hereinbelow for convenience :-"10. Accident Benefit : If at any time when this policy is in force for the full sum assured, the Life Assured, before the expiry of the period for which the premium is payable or before the policy anniversary on which the age nearer birthday of the Life Assured is 70 whichever is earlier, is involved in an accident resulting in either permanent disability as hereinafter defined or death and the same is proved to the satisfaction of the Corporation, the Corporation agrees in the case of : (a) Disability to the Life Assured : (i) to pay in monthly instalments spread over 10 years an additional sum equal to the Sum Assured under this Policy. If the policy becomes a claim before the expiry of the said period of 10 years, the disability benefit instalments which have not fallen due will be paid along with the claim, (ii) to waive the payment of future premiums. The maximum aggregate limit of assurance under all policies on the same life to which benefits (i) and (ii) above apply shall not in any event exceed Rs. 5,00,000. 00. If there be more policies than one and if the total assurance exceeds Rs. 5,00,000. 00 assured in order of date of the policies issued. The waiver of premiums shall extinguish all options under this policy except as to such assurance, if any, as exceeds the maximum aggregate limit of Rs. 5,00,000. 00 and which may have been kept in force by continued payment of premiums and the benefits covered by (b) of this clause. 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. Accidental injuries which independently of all other clauses and within ninety 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 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, shall also be deemed to constitute such disability. Immediately after the happening of the disability, full particulars thereof must be given in writing to the office of the Corporation where this policy is serviced together with the then address and whereabouts of the Life Assured and within ninety days after the happening of the disability there must be given to the Branch Office of the Corporation where the Policy is serviced, in the manner required by it, proof of disability satisfactory to the Corporation and without any expense the Corporation, and thereafter similar proof must be given, as and when required by the Corporation, of the continuance of such disability. Any Medical Examiner nominated by the Corporation shall be allowed to examine the person of the Life Assured in respect of any disability claimed, in such manner
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