Judicial Analysis Court Copy Headnote Facts Arguments Court observation

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
A. P. Sahi, President and Bharatkumar Pandya, Member
Fulchand Chadare Since Deceased and Ors. —Petitioners
Versus
Oriental Insurance Company Limtied and Ors. —Respondents
NC/R P/465/2026 with I A No. 5184 of 2026, I A No. 5185 of 2026 and I A No. 5186 of 2026
Decided on 2.6.2026

Advocates:
Counsel for the Parties:
For the Petitioner:Mr. Rohit Rattu, Advocate

IMPORTANT POINT
Strict Interpretation of Insurance Contracts – The terms of an insurance policy, including government-backed tripartite agreements, must be interpreted strictly according to their written definitions. A consumer forum cannot dilute specific policy requirements to grant relief outside the contract’s scope.

Headnote:
The Consumer Protection Act, 2019 – Section 58(1)(b) of the CPA 2019 – Section 2(11) of the CPA 2019 – Section 2(1)(g) of the CPA 1986 – Farmers Accident Insurance Scheme – Permanent Total Disablement – Repudiation of Claim – Tripartite Insurance Agreement – Revisional Jurisdiction – A 67-year-old farmer sustained injuries to his left leg in a road accident on October 24, 2017, resulting in a medical certification of 26% permanent disability in that leg – He filed a claim of Rs. 1,00,000 under the “Gopinath Munde Farmers Accident Insurance Scheme” – Insurance Company repudiated the claim on June 2, 2019, arguing the 26% disability did not meet the scheme’s definition of “permanent total disablement” – District Commission allowed the complaint, holding that the 26% disability certificate was sufficient as the policy lacked a prescribed format for certification – State Commission reversed this decision and dismissed the complaint, ruling that the injury did not meet the specific threshold of “permanent total disablement” outlined in the scheme’s tripartite agreement – Following the original complainant’s death in 2025, his legal heirs filed a Revision Petition before the NCDRC – NCDRC dismissed the Revision Petition, upholding the State Commission’s order in favor of the Insurance Company – Commission held that the terms of the Tripartite Agreement are binding – Complainant failed to prove that the 26% disability was absolute, irrevocable, or prevented him from engaging in any gainful employment, as required by Clause 1(H) of the policy.

ORDER

This Revision Petition assails the Order of the State Commission passed in First Appeal No. 126 of 2022 decided on 30.09.2025 whereby the Petitioner’s Complaint has been dismissed and the Appeal filed by the Respondents has been allowed.

2. The brief facts giving rise to this Revision Petition are that the Complainant who was aged about 67 years, and was a farmer, received injuries in his left leg in an accident that occurred on 24.10.2017 when a Tata Sumo vehicle hit the Complainant from behind. The injuries sustained were treated in the hospital and according to the Complainant he suffered a permanent disability in his left leg. A disability certificate was issued by the Medical Authority Osmanabad, Maharashtra certifying that he had a disability to the extent of 26% in his left leg.

3. The Complainant made an insurance claim under the Gopinath Munde Farmers Accident Insurance Scheme for a sum of Rs.1,00,000/- along with interest and other ancillary benefits. The claim was declined by the Insurance Company on 02.06.2019 on the ground that the said injury did not qualify for any indemnification as it was not a permanent disability as defined under the scheme and the tripartite agreement under which the said scheme was operational.

4. Aggrieved the Complaint was filed and it was allowed on 12.10.2021 holding that since the insurance policy agreement did not specify as to what criteria or format should be used for the disability certificate therefore the defence of the Insurance Company was unacceptable inasmuch as there was no legally prescribed format for the issuance of the certificate. It was further held that a disability certificate relied on by the Complainant indicated 26% permanent disability in the left leg and consequently the same was sufficient to indemnify the claim.

5. The Insurance Company went up in Appeal against the Order of the District Consumer Disputes Redressal Commission, Osmanabad before the State Commission, Maharashtra. The Appellate Forum after having gone through the general rules, as also the tripartite agreement under which the scheme was operating, came to the conclusion that the nature of the injury and disability of the Complainant did not pass the test of clause l (H) that defined permanent total disablement. Consequently it reversed the order of the District Commission and dismissed the Complaint.

6. The Complainant has come up in this Revision Petition and the learned Counsel for the Petitioners Mr. Rohit has urged that the disability certificate clearly establishes the permanent disability that has been rightly construed by the District Commission and consequently the State Commission committed an error by misinterpreting the same on the strength of the terms of the tripartite agreement.

7. Having considered the submissions raised we do not find any sustainable ground to entertain this Revision Petition for the following reasons.

8. The disability certificate on which reliance has been placed on the Petitioner is as follows:

9. The scheme under which the claim is indemnifiable is subject matter of the Tripartite Agreement dated 02.12.2016 between the Government of Maharashtra entered on behalf of all the individual farmers who are the insured and the beneficiary through the Commissioner Agriculture, Government of Maharashtra and M/s Jaika Insurance Brokerage Private Limited and the Insurance Company, M/s Oriental Insurance Company Limited. This tripartite agreement defines the policy terms and conditions and permanent total disablement has been defined under Clause l(H) as follows:

“Permanent Total Disablement: The disablement is of permanent and Irrevocable nature and absolutely total in the sense that the insured person is prevented from engaging in gainful employment of any kind (such as paralysis). Also loss of both the eyes OR Physical separation of two entire hands or two entire feet or one eye and one limb are deemed to be permanent total disablement.”

10. There is no dispute

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