The terms and conditions of an insurance policy must be strictly interpreted, and claimants must adhere to the stipulated time period for filing a claim.

ORDER

R. Lakshminarsimha Rao, Member (Oral)- Both appeals are directed against the order of the District Forum. The opposite party No. 1 has filed appeal, F.A. No. 448 of 2012 challenging the order of the District Forum whereas the complainant has preferred appeal, F.A. No. 953 of 2012 contending that the amount awarded as compensation by the District Forum is inadequate. For the sake of convenience, the parties are referred to as they are arrayed in the complaint.

2. The complainant was under the employment of the opposite party No. 2 which is a Firm and obtained Janata Personal Accident Policy from the opposite party No. 1-Insurance Company covering risk related to accident to the employees who included the complainant. The sum assured under the insurance policy is Rs. 2,00,000 in case of death and equal amount in the event of total permanent disability sustained by the 35 employees of the opposite party No. 2. The complainant lodged claim with the opposite party No. 1 on the premise that he sustained disability to an extent of 38.75% due to electric shock and the opposite party No. 2 repudiated the claim on the ground that partial permanent disability is not covered by the scope of the JPA policy which led the complainant to approach the District Forum by filing the CC.

3. The complainant submitted that he worked as Assistant Lineman under the employment of the opposite party No. 2 and the opposite party No. 2 was carrying out electrical work relating to APCPDCL on contract basis. The complainant submitted that on 15.3.2010 he was instructed by the opposite party No. 2 to check power supply to Bio-diesel Plant and on being assured that there was no power supply, he got on the top of the electric pole and while checking the 33 KV live wire he sustained electric shock and fell down from the electric pole. The complainant submitted that he became unconscious and was shifted to NIMS, Hyderabad where he had undergone surgery for fracture of Traumatic D-12. The complainant submitted that he sustained disability to an extent of 38.75% and the opposite party No. 2 repudiated his claim on the premise that permanent partial disablement is not covered under JPA policy.

4. The opposite party No. 1 resisted the claim on the premise that the complainant suffered disability to an extent of 38.75% only and that as per Clause C "if such injury shall within one year of its occurrence be the sole and direct cause of the total irrecoverable loss of sight of one eye or total irrecoverable loss of USE of a hand or foot, 50 percent of the capital sum insured state in the schedule hereto" and as per the Clause D if such injury shall within one year of its occurrence be the sole and direct cause of permanently totally and absolutely disable the insured from engaging in being occupies with or giving attention to any employment or occupation of and description whatsoever, the capital sum insured stated in the schedule. As per the conditions of the policy the complainant is not entitled to any compensation. As per the terms and conditions of the policy, the complainant also did not intimate about the incident to the Insurance Company within the stipulated time of one month.

5. The complainant filed his affidavit and the documents, Exs. A1 to A5. On behalf of the opposite parties, the Divisional Manager of the opposite party No. 1 and the proprietor of the opposite party filed their respective affidavits and Ex. B1, the policy schedule.

6. The District Forum allowed the complaint directing the opposite party No. 1 to pay Rs. 77,500 towards the amount covered under Ex. B1 together with Rs. 5,000 towards compensation and costs of Rs. 2,000.

7. Feeling aggrieved by the order of the District Forum, the opposite party No. 1 preferred appeal contending that as per Clauses C and D the complainant is not entitled to claim amount and that as per Ex.A3, the medical certificate issued by NIMS there is no disability was mentioned and also there is no signature and seal