IMPORTANT POINT
Where accident benefit under Life Insurance Policy provided to cover only permanent/total disability and insured suffered accident injury described as 81% and partial, since not to be described as permanent accident benefit was not awardable.

Dr. P.D. Shenoy, Member—This revision petition has been filed with a delay of 92 days. For the reasons submitted in para 5 of the application on behalf of the revisionist for condonation, this delay is hereby condoned.

Brief facts of the case are:

2. The revision petitioner was the complainant before the District Forum. He held three Life Insurance Policies—one for Rs. 10,000 and the other two for Rs. 25,000 each. All the three policies also covered risk of accident for which only a nominal amount of one rupee per thousand rupees sum assured per annum was charged and included in the premium instalments. The revisionist met with an accident on 22.2.1992 and produced a photocopy of the certificate showing injury suffered as well as the photocopy of the letter dated 30.10.1992 issued by NE Railway to the Director ALIMCO Kanpur for providing artificial limb to the revisionist. The certificate gives the following details:

“(R) Lower Limb below mid-thigh but above knee. The stump is more than 5½" long —60%.

Loss of use of whole of (R) Ring and little fingers —7% each —14% and terminal phalynx of (R) middle-finger and stiffness of second phalynx of the same finger —7%.

The loss of earning capacity in this case is assessed at 81 %. Partial disabled —81 %.”

3. Petitioner filed complaint before the District Forum, Gorakhpur claiming total disability and praying compensation to the tune of Rs. 99,999. The District Forum decided the complaint in favour of the petitioner vide order dated 21.9.1993 and directed the respondent -LIC to pay the amount in ten instalments under all the three policies along with interest @ 24% from the due instalments. Aggrieved by the order, the LIC filed appeal before the State Consumer Disputes Redressal Commission, Lucknow which was allowed. Hence this revision.

Findings:

4. The issue to be decided in this case is whether the double accident benefit is payable to the complainant. In this connection it would be beneficial to carefully peruse the policy conditions. Clause ten of the policy reads as follows:

“Accident Benefit: It 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 65, whichever is earlier, is involved in an accident resulting in either permanent disability as hereinafter defines or death and the same is proved to the satisfaction of the Corporation, the Corporation agrees in the case of

Disability to the Life Assured: (i) to pay in monthly instalments spread over ten 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 ten 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 if there be more policies than one and if the total assurance exceeds Rs. 5,00,000 the benefits shall apply to the first Rs. 5,00,000 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 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 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 causes and within ninety days from the happening of such a