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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
V.K. Jain, Presiding Member
M/s. HDFC Egro Gen. Ins. Co. Ltd. —Petitioner
versus
Surinder Handa —Respondent
Revision Petition Nos.414 and 415 of 2011
Decided on 24.6.2020
Counsel for the Parties:
For the Petitioner:Mr. Amit, Advocate
For the Respondent:Mr. S. Sirish Kumar, Advocate
IMPORTANT POINT
Compensation for 50% permanent total disablement upheld.
Headnote:
Consumer Protection Act, 1986 2(1)(c) and 21 : [Consumer Protection Act , 2019 – Section 2(6) and 58] – Insurance – Personal injury – Disability – Policy claim – Scope – Complainant slipped in the bathroom of her house and sustained injuries – Underwent knee replacement – District Forum directed the insurer to assess the claim of the complainant – State Com-mission directed the petitioner to pay a sum of Rs. 10,98,000/- to the complainant along with interest @ 9 % p.a. – Challenge against – Complainant had suffered an accident which had resulted in 50% permanent disability even if it is assured that she already an underlying problem at that time – As per medical certificate, the complainant suffered this disability on account of accidental fall she had at her home – State Commission has awarded 50% of compen-sation payable to the insured since he suffered permanent total disablement – Interference with declined. [Paras 7 to 13]
Result: Petition Dismissed.
ORDER (ORAL)
V.K. Jain, Presiding Member—The complainant Smt. Surinder Handa had obtained an insurance policy from the petitioner co. which interalia covered the injuries and disability specified in the said policy, meaning thereby if the complainant was to suffer any of the injuries or disabilities specified in the policy, she was entitled to compensation in terms of the said policy. The complainant slipped in the bathroom of her house and was taken firstly to a doctor who advised shifting her to the hospital. She was taken to the PGI Chandigarh on 4.4.2005 and was hospitalized there for the period from 25.4.2005 to 27.5.2005. She incurred an expenditure of Rs.172376/- on her treatment. She also had to undergo knee replacement in PGI Chandigarh. The insurer paid only a sum of Rs.27,000/- to the complainant in terms of Section 15 of the policy, which she accepted under protest. Thereafter, she approached the concerned District Forum by way of a consumer complaint seeking compensation to the extent of Rs.11,25,000/-.
2. The complaint was resisted by the insurer which claimed that the complainant had been paid in terms of the insurance policy and that he had not suffered a permanent disability for a consecutive period of 12 months.
3. The District Forum vide its order dated 10.7.2019, directed the insurer to assess the claim of the complainant as per the rules and pay the same within 45 days.
4. Being aggrieved from the order passed by the District Forum, both the parties i.e. the complainant as well as the petitioner company approached the concerned State Commission by way of separate appeals. Vide impugned order dated 28.09.2010, the State Commission directed the petitioner to pay a sum of Rs.10,98,000/- to the complainant alongwith interest @ 9% p.a. from the date of the complaint and Rs.10.000/- as the cost of litigation. The said amount was arrived at after deducting Rs.27,000/- which the insurer had already paid to the complainant. Being aggrieved from the order passed by the State Commission, the petitioner company is before this Commission by way these revision petitions.
5. Section 7 of the insurance policy which deals with permanent disability to the extent it is relevant, reads as under:-
“Permanent Disablement
If during the period of insurance an insured person sustains bodily injury which directly and independently of all other causes results in disablement within twelve (12) months of the date of loss, then the company agrees to pay to the insured person the compensation stated in the specific Table of Benefits below which is shown as the Table of Benefits in the Schedule. The deductible or Franchise, if applicable shall be deducted from the compensation payable.”
‘Table of Benefits
| 1. | Permanent Total Disablement | 100% |
| 2. | Permanent and incurable insanity | 100% |
| 3 | Permanent total loss of two limbs | 100% |
| 4. | Permanent total loss of sight in both eyes | 100% |
| 5 | Permanent total loss of one sight and on limb | 100% |
| 6 | Permanent total loss of speech | 100% |
| 7 | Complete removal of the lower jaw | 100% |
| 8 | Permanent total loss of Mastication | 100% |
| 9 | Permanent total loss of the central nervous system or the thorax and all abdominal organs resulting in the complete inability to engage in any job and the inability to carry out Daily Activities essential to life without full time assistance | 100% |
| 10 | Permanent total loss of hearing in both ears | 70% |
| 11 | Permanent total loss of limb | 50% |
| 12 | Permanent total loss of sight of one eye | 50%” |
6. Section 15 of the insurance policy which deals with a case of broken bones which to the extent it is relevant, reads as under:-
“Broken Bones
If during the period of insurance an insured person sustains bodily injury which directly and independently of all other causes results in a bro
