Judicial Analysis Court Copy Headnote Facts Arguments Court observation

2005 (1) CPR 112 (NC)
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI
M.B. Shah, President and Mrs. Rajyalakshmi Rao,, Member
Life Insurance Corporation of India and Anr.—Petitioners
versus
Pilla Appanna—Respondent
Revision Petition No. 2271 of 2003
Decided on 9-2-2005

Advocates:
Counsel for the parties:
For the Petitioner:Mr. E.S. Kumar, Advocate.
For the Respondent:Mr. V.D.N.N. Murthy, Advocate.

IMPORTANT POINT
Accident benefit under an insurance policy could not be denied to insured if he was covered by it merely because he was continued in employment on regular salary by employer.

Headnote:Consumer Protection Act, 1986 — Sections 12 and 17 — Jeevan Medical Policy for Rs. 50,000/- and Non-Medical Policy for Rs. 25,000/- taken by respondent complainant in 1994 which were to mature in 2019 — In the course of employment complainant suffered fire accident and sustained 75% burns — Claim resisted on plea that complainant failed to furnish details of disability for considering disability benefit under policy — Discharge certificate of hospital showed that complainant had suffered 75% flame burns — Disability certificate issued by Civil Surgeon of Hospital was in respect of orthopaedically handi-capped candidates having 60% disability — Distt. Forum allowed claim and
       State Commission upheld the order — Revision — Mere fact that as policy matter insured employee was continued in job and was getting regular salary, benefit of accident under policy could not be denied — Forum below had already denied double benefit -- No reason to interfere.
       Held:The learned Counsel for the LIC submitted that the Complainant is continued on the job and therefore, is not entitled to get accident benefit. It is true that the Complainant’s employer has permitted him to get the salary every month on compassionate ground as it is a Government of India Undertaking and as the Complainant suffered during his employment. That does not mean that
       he loses the benefit available under
       the contract of insurance. It is quite
       possible that a private employer or the LIC would not have continued such
       person in service. But, payment of
       wages on compassionate ground to a person who has lost capacity to work would hardly be a ground for non-payment of accident benefit to the assured.(Para 10)
       In any case, in the present case, the Consumer Forum has not granted him double benefit as contemplated. It
       has only directed the LIC to pay the
       sum assured and not the additional instalments payable for a period of ten years.(Para 11)
       Secondly, the learned Counsel rightly pointed out that the LIC has not challenged the medical certificate filed by Complainant nor cross-examined the Doctor (the Civil Surgeon). It is inter alia submitted that Corporate body like th LIC ought not to have taken advantage and delayed the payment. It was therefore. prayed that in the interest of justice Revision Petition be dismissed as the corporation can litigate for years together.(Para 12)
       Result : Revision dismissed.

ORDER

M.B. Shah, President — The insured filed C.D. No. 60 of 2001 before the District Forum, Visakhapatnam against the Life Insurance Corporation (Petitioner). It was contended that he had take out two policies: one Jeevan Medical Policy for a sum of Rs. 50,000/- and the other is Non Medical Policy for a sum of Rs. 25,000/- commencing from 28th March, 1994 under salary saving scheme and they were to mature on 28.03.2019.

2. On 15.2.2000 when the complainant was working in a ship at Hatch No. 1, he met with fire accident and sustained 75% burns while he was in employment. He was treated in Seven Hills Hospital for seven months in intensive care unit and was discharged on 1.6.2000. Thereafter he sent a letter to the Branch Manager of the L.I.C., Ship Yard Branch, with all the particulars. The Ship Yard Branch advised him by letter dated 8.11.2000 to approach Port Branch Office. As no reply was received and the claim was not settled, complaint was filed.

3. It was contended by the L.I.C. before the District Forum that the Complainant failed to furnish full details of disability and of treatment undergone for considering the disability benefit under the two policies.

4. The District Forum negatived the said contention by observing that Exhibit B-3 is a discharge slip received by the Insurance Company in which it is specifically stated that the Complainant was admitted in the hospital with 75% mixed flame burns sustained acci-dentally while working in the ship, burns have involved all areas except the

upper thighs: the patient was treated conservatively with I.V. fluids, dressing medicines, he was treated conservatively with I.V. fluids, dressing and medicines, he imporoved automatically from shock and septic wound; skin grafting was done for raw area of both the upper and lower limbs: patient developed bed sore. On

the date of discharge as on 1.6.2000 diagnosis was 75% flame burns.

5. At the time of hearing before the District Forum Complainant produced medical certificate issued by Civil Sur-geon of King George Hospital, Visakha-patnam. The certificate is in respect of orthopaedically handicapped candidates having 60% disability.

6. Thereafter, the District Forum arrived at the conclusion that failure to reply and failure to settle the claim amounts to deficiency in service on the part of the LIC and that there was negligence in asking the Complainant to produce the required information to settle the claim. Thereafter, the District Forum, by judgment and order dated

26th September, 2001, directed the LIC to pay the ‘assured sums’ of Rs.50,000/- and Rs. 25,000/- with interest at the

rate of 18% p.a. from 8.11.2000 till the date of realisation. It also awarded costs of Rs. 1,000/-.

7. The LIC preferred First Appeal No. 840 of 2001 before the State Commi-ssion. The State Commission also relied upon the certificate, Exhibit B-3 and the certificate issued by the Civil Surgeon of King George Hospital, Visakhapatnam,

in which the disability was shown

at 60%. The State Commission observed that the LIC has not produced any other evidence for negativing the claim, hence confirmed the order passed by the District Forum, but reduced the rate of interest from 18% to 9%, by its judgment and order dated 1.4.2003.

Hence, this Revision Petition by the LIC.

8. From the contentions raised by the LIC and the vigour with which the case is pursued it appears that it wants to take undue advantage of destiny saving the life of a person who sustained 75% serious burns on all parts of the body except upper thigh while in employment in the Visakahpatnam Ship Yard which is a Government of India Undertaking and was discharged from the hospital on 1.6.2000. Doctor in his certificate has stated that he improved dramatically.

9. In the written submissions filed before this Commission relevant part of Clause 10 of the terms and conditions of the policy are reproduced as under:

“10. Accident Benefit: if at any time when this policy is in force for full Sum Assured, the

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Judicial Analysis

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2005 (1) CPR 112 (NC)NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHIM.B. Shah, President and Mrs. Rajyalakshmi Rao,, MemberLife Insurance Corporation of India and Anr.—PetitionersversusPilla Appanna—RespondentRevision Petition No. 2271 of 2003Decided on 9-2-2005

IMPORTANT POINTAccident benefit under an insurance policy could not be denied to insured if he was covered by it merely because he was continued in employment on regular salary by employer.

Judicial Analysis

2005 (1) CPR 112 (NC)
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI
M.B. Shah, President and Mrs. Rajyalakshmi Rao,, Member
Life Insurance Corporation of India and Anr.—Petitioners
versus
Pilla Appanna—Respondent
Revision Petition No. 2271 of 2003
Decided on 9-2-2005

IMPORTANT POINT
Accident benefit under an insurance policy could not be denied to insured if he was covered by it merely because he was continued in employment on regular salary by employer.