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KERLA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, THIRUVANANTHAPURAM
Hon’ble Mr. Justice P.K. Shamsuddin, President &
Mr. K. Balakrishnan, Member
DIVISIONAL MANAGER, NEW INDIA
ASSURANCE CO. ALWAYE—Appellant
versus
JOB MATHEW—Respondent
Appeal No. 210 of 1994 — Decided on 23.7.1996
Counsel for the Parties:
For the Appellant :Mr. George Mathew, Advocate.
For the Respondent: None
In case of ambiguity in an insurance policy, the interpretation which is favorable to the insured has to be adopted.
Headnote:
INSURANCE - PERSONAL ACCIDENT INSURANCE - CLAIM FOR COMPENSATION - INTERPRETATION OF POLICY - AMBIGUITY - BENEFIT OF DOUBT TO INSURED - DOUBLE PAYMENT - TEMPORARY TOTAL DISABLEMENT - PERMANENT DISABILITY - SAME PERIOD OF DISABLEMENT - INSURANCE ACT, 1938 - SECTION 45.
Fact of the Case:
The complainant had taken a Personal Accident Insurance policy for a sum of Rs. 50,000/- from 19.9.90 to 18.9.91. He met with an accident on 22.8.91 and sustained fracture of the clavicle bone and deafness of the right ear as a permanent disability. He claimed Rs. 17,500/- for the temporary disability and permanent disability.
Finding of the Court:
The District Forum held that the complainant was entitled to compensation for both temporary total disablement and permanent disability as they were not for the same period of disablement. The court interpreted the policy in favor of the insured and found that the insurer was not liable to pay compensation under more than one of the foregoing sub-clauses in respect of the same period of disablement.
Issues: Whether the complainant was entitled to compensation for both temporary total disablement and permanent disability under the personal accident insurance policy.
Ratio Decidendi: The court held that the complainant was entitled to compensation for both temporary total disablement and permanent disability as they were not for the same period of disablement. The court interpreted the policy in favor of the insured and found that the insurer was not liable to pay compensation under more than one of the foregoing sub-clauses in respect of the same period of disablement.
Final Decision: The appeal was dismissed and the order of the District Forum was upheld.
Mr. Justice P.K. Shamsuddin, President — This appeal is directed against the order passed by the District Forum, Ernakulam, in Opp. Party No. 750/92. The opposite party is the appellant
2. The allegations in the complaint are as follows:
The complainant had taken a Personal Accident Insurance policy for a sum of Rs. 50,00/- from 19.9.90 to 18.9.91. He met with an accident on 22.8.91 and was admitted to the Malankara Orthodox Syrian Church Medical Mission Hospital, Kolenchery, since he sustained fracture of the clavicle bone and as a consequence of the accident he also developed deafness of the right ear as a permanent disability. The complainant made claim for Rs. 17,500/-. The opposite party did not pay the amount and hence the complainant filed the complaint for seeking a direction to the opposite party to pay the said amount together with interest at the rate of 15% and also Rs. 2000/- as compensation and a sum of Rs. 500/- as cost.
3. The opposite party contended that they partly allowed the claim and offered Rs. 8,351/- but the complainant had not accepted the amount. The complainant has claimed more then one benefit in respect of the same period of disablement which is not allowable under the policy and therefore the amount sanctioned is perfectly valid and proper and the complainant is not entitled to get more amount.
4. The District Forum found that the complainant suffered permanent disability of the loss of hearing on the right side and Ext. A2 is the certificate regarding the same. In Ext. A3 claim form, it is certified by the Medical Officer concerned that he was under temporary disability for three months due to the fracture of the right clavicle and it is the compensation for this temporary disability the complaint was filed. As per Ext. Al Policy conditions 15 per cent of the capital sum insured is payable for loss of hearing of one ear and that has been completely allowed, namely Rs. 7,500/-. Under clause (f) "if such injury shall be the sole and direct cause of temporary total disablement, hen so long as the insured shall be totally disabled from engaging in any employment or occupation of any description whatsoever, a sum at the rate of one per cent of the capital sum insured in schedule hereto per week but in any case not exceeding Rs. 1,500/- per week in all, under all policies shall be payable. Under Clause (1) of the exceptions, compensation under more than one of the earlier Subclause shall not be liable to be paid for the same period of disablement and on the basis of this clause the opposite party refused to pay the claim for the period of temporary disability.
5. The District Forum took the view that the stand taken by the opposite party is not justified in terms of the condition in the policy. What the opposite party is not liable to pay is compensation under more than one of the foregoing sub- clauses in respect of the same period of disablement. The claim for temporary total disablement is on account of the fracture of right clavicle whereas compensation for permanent disability is for loss of hearing of the right ear. It found the object of the Clause (1) under the exception is to avoid double payment and earlier in the very same clause, clause 'f had been excluded. It also held that the payment for the same period of disablement due to the loss of hearing is a subsequent development or in other words it was not immediately known and the temporary disability was only due to the fracture of clavicle. It also held that the loss of hearing power did not disable him from engaging in his employment or occupation and temporary disability was only due to the fracture of clavicle and, therefore, he does not think that the interpretation given by the opposite party is correct and the complainant cannot be denied the compensation for temporary disablement, In that view, the District Forum passed an order directing the opposite party to pay Rs. 14,851/- less the amount if any received by the complainant toge
