Judicial Analysis Court Copy Headnote Facts Arguments Court observation

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
AVM J. Rajendra, AVSM VSM (Retd.),
Presiding Member
Rajwinder Singh – Petitioner
versus
Tata AIG General Insurance
Company Limited and Ors. – Respondents
Revision Petition No.295 of 2016
(Against the Order dated 08/10/2015 in Appeal No. 450/2014 of the State Commission Punjab)
Decided on 20.5.2024

Advocates:
Counsel for the Parties:
For the Petitioner:Mr. Karan Dewan, Advocate Through VC
For the Respondent Nos.1 and 2:Ms. Anjalli Bansall, Advocate
For the Respondent No.3: Ex-Parte Vide Order Dated 01.03.2017

IMPORTANT POINT
Accidental Guard Policy – Loss of index finger & ring finger does not fall under the coverage provided by “Accidental Dismemberment” Section of policy.

Headnote:
Insurance Policy – Accidental Guard Policy – Determination of compensation – Amputation – Loss of ring and index fingers – OPs-1 and 2 allowed claim of Rs. 30,000/- under “Weekly Indemnity” component, which was in accordance with terms and conditions of policy – Insurance policy covered specific aspects such as ‘Accidental Death’, ‘Accidental Dismemberment’ & Weekly Indemnity – However, loss of ring finger and index finger does not fall under the coverage provided by the “Accidental Dismemberment” section of policy – Complainant did not pay any premium for coverage related to “Permanent Total Loss of Use”, which is not covered under insurance policy in question – Impugned order of State Commission does not suffer from any illegality or impropriety & upheld.(Paras 10 and 11)
Result: Revision petition dismissed.

ORDER

This Revision Petition No. 295 of 2016 challenges the impugned order of Punjab State Consumer Disputes Redressal Commission, Chandigarh (‘the State Commission’) dated 08.10.2015 vide which, the State Commission allowed the First Appeal No.450 of 2014 and set aside the order of the District Consumer Disputes Redressal Forum, Bathinda (‘the District Forum’) dated 12.02.2014.

2. Brief facts of the case, as per the Complainant, are that he purchased an Accident Guard Policy from OP-1&2 for a sum assured of Rs.25,00,000/- for the period from 28.12.2012 to 27.12.2013. The Complainant suffered an accident on 06.03.2013, resulting in injuries to his middle and ring fingers that required amputation. This disability was certified by a medical professional, indicating an 8% disability. The Complainant contended that he is entitled to compensation under the policy terms for this disability, amounting to 10% of the sum assured, which is Rs. 2,50,000/-. However, the Opposite Parties (the OP-insurer) have disbursed only Rs. 30,000/-, which the Complainant claims is insufficient and not aligned with the terms of the policy. Being aggrieved, he filed a Consumer Complaint before the learned District Forum seeking balance compensation of Rs. 2,20,000/- as part of his claim, along with additional Rs.50,000/- as compensation for hardship endured due to accident, and Rs. 5,500/- towards costs.

3. In Reply, the Opposite Party (OP) No. 1 & 2 acknowledged that the Complainant obtained the policy through OP-3 and suffered injuries resulting in the dismemberment of his middle and ring fingers. The Complainant had opted for specific type policy coverage such as “Accidental Death & Dismemberment” and “Weekly Indemnity Up to 52 Weeks” by paying the corresponding premium. The “Accidental Dismemberment” coverage under the policy only applies to the loss of thumb and index finger, not the middle finger and ring finger that he lost. Therefore, he is not entitled for compensation under the policy for loss of his middle and ring fingers. OP-1&2 stated that he has already been compensated for the “Weekly Indemnity” as per the policy terms and is not eligible for any further amount beyond what has been paid. They alleged that the Complainant is attempting to benefit from a section of the policy (“Permanent Total Loss of Use”) that he did not opt for and did not pay premiums towards. The Complainant misrepresented the facts before the District Forum. OP-1 & 2 requested the dismissal of the complaint under Section 26 of the Act, citing that the complaint is false, frivolous, and based on concealed material facts.

4. The learned District Forum, vide order dated 12.02.2014, allowed the complaint and directed the OP-1 and 2 as under:

“6. The undisputed facts of the parties are that the complainant has purchased one accident guard policy bearing No.0200114697 00 of the opposite party Nos.1 and 2 with client ID No.6554431, w.e.f 28.12.2012 to 27.12.2013 against the principal sum assured of Rs.25 lacs, in his name, from the opposite party No.3 and deposited the premium of Rs.3170/-. As per the terms and conditions of the abovesaid policy, the complainant is entitled to the compensation in case of any accident. The complainant met with an accident while cutting the fodder for the cattle, due to this his right hand came in the fodder cutting machine, resulting in crushing of his middle and ring finger of the right hand on dated 6.3.2013. The complainant lodged the claim with the opposite parties No.1 and 2 through the opposite party No.3, they have paid him the claim amount of Rs.30,000/- only.

7. The disputed facts of the parties are that as per the disability certificate issued by Dr.Dhiraj Goyal, MBBS, MS (Ortho), Civil Hospital, Bathinda, the complainant has become a disabled person upto the extent of 8%. The complainant is entitled for the compensation from the opposite party Nos.1 and 2 atleast 10% of the principle sum assured of Rs.25 lacs i.e. 5% for one joint e