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HIMACHAL PRADESH STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, SHIMLA
Honble Mr. Justice P.N. Nag, President;
Mr. I.D. Bali & Mrs. Krishana Tandon, Members
KARAM CHAND SHARMA—Appellant
versus
BRANCH MANAGER, LIFE INSURANCE
CORPORATION OF INDIA—Respondent
Appeal No. 48 of 1996—Decided on 10.12.1996

Advocates:
Counsel for the Parties :
For the Appellant :Mr. Mahesh Chopra, Advocate.
For the Respondent:Mr. S. Dixit, Advocate.

Headnote:Consumer Protection Act, 1986 - Section 15 - Complainant insured himself with opposite party covering all risks including accidents, sustaining of disability of permanent nature etc. - Complainant seriously injured due to bursting of gas welding tank Right hand amputated - Rendered physically disabled permanently Claim repudiated by opposite party Complaint - District Forum dismissed complaint - Appeal - Opposite party averred that in order to constitute disability to enable complainant to have benefit of second part of Accident Benefit Clause not only one hand should have been amputated but also one foot at or above ankle - No doubt complainant does not come within purview of second part of Accident Benefit Clause but certainly covered under first part of the provision - Test to be applied while invoking Accident Benefit Clause should be such as a result of which assured could not be gainfully employed to earn his livelihood Complainant driver cannot adopt such profession or occupation to earn his livelihood - Entitled to benefit clause - Order of District

       Forum set aside - Opposite party directed to pay assured amount to complainant considering disability caused to complainant as total and permanent.

       Held: No doubt the case of the complainant does not come within the purview of second part of the Accident Benefit Clause but certainly his case is covered under the first part of this provision. (Para 7)

       The test which should be applied by the Courts while invoking the Accident Benefit Clause should be that disability on account of the accident should be such as a result of which the assured cannot be gainfully employed to earn his livelihood. Having applied the above yardstick, we have already held that the complainant is entitled to the benefit of the first part of the Accident Benefit Clause. (Para 10)

       We allow the appeal and set aside the order of the District Forum and direct the Life Insurance Corporation respondent to pay the assured amount to the complainant by considering the disability caused to the complainant as total and permanent in terms of the policy from the date of accident i.e. with effect from 9-9-1994. The complainant shall also be entitled to interest on the assured amount @ 18% per annum from the date of accident till actual payment. The cost of Rs. 1000/ - is also awarded.

       (Para 11)

       Result: Appeal allowed.

ORDER

Mr. Justice P.N. Nag, President—The challenge in this appeal is to the order of the learned District Forum, Mandi, dated 26.2.1996/ whereby the complaint of the complainant/ appellant (hereinafter to be referred to as the complainant) has been dismissed.

2. The relevant facts stated in the pleadings are that the complainant had insured himself with the respondent/opposite party (hereinafter to be referred to as the Life Insurance Corporation) vide Policy No. 150307483 covering all risk including accidents, sustaining of disability of permanent nature, etc. The complainant is, admittedly, a driver by profession and was driving the Truck No. HP-34-2269 and on 9.9.1994, he went with the Truck to a place called Manimajra near Chandigarh to get his truck repaired. At the workshop/shop when the truck was to be repaired, welding work was being done by one Shri Madan Lal. In the workship while the complainant was standing by the side of the truck, due to the Gas welding work being done, the Gas welding tank burst as a result of which the complainant and some other persons were seriously injured. The right hand of the complainant was seriously injured and after this incident, the complainant was taken to P.G.I. Chandigarh for treatment, where his right hand was amputated and as such the complainant has been rendered physically disabled permanently. The Life Insurance Corporation has repudiated the insurance claim on the ground that the complainant has not suffered any permanent disability. According to them, it is only one hand that has been amputated and in order to constitute total and permanent disability in terms of the insurance policy, not only one hand should have been amputated but also one foot at or above the ankle. Therefore, this case is not covered under the terms of the insurance policy.

3. We have heard the learned Counsels for the parties, Mr. Mahesh Chopra, Advocate for the appellant and Mr. S. Dixit, Advocate for the respondent-Life Insurance Corporation and also seen the record.

4. In order to appreciate the rival contentions of the parties, it is necessary to reproduce the relevant provisions in this context. Clause 10, Accident Benefit (a) Disability to the Life Assured provides that :

"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 independentlyof all other causes 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."

Under first part of the 'Accident Benefit' clause, in order to succeed and to get benefit of such clause, the Assured has to establish :

(i) the disability is as a result of accident;

(ii) the disability is total and permanent;

and

(iii) on account of such disability, the Assured cannot do any work or adopt any occupation, profession which he can sufficiently do or follow and cannot gainfully be employed to earn his livelihood.

5. Second part of the Accident Benefit Clause deals with certain disabilities resulting in 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. The injuries referred to in the second part have been constituted as disabilities under the deeming provisions. In other words, the existence of injuries specified in second part of the clause would by themselves, wi

















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