The main legal point established in the judgment is that the claim must be covered by the expressed terms and conditions of the Insurance Policy, and the applicability of the Indian Tariff Act, specifically Section III, is crucial in determining the coverage of the claim.

1. In this petition the petitioner has called in question order dated 28.01.2015 passed by the Jammu & Kashmir State Consumer Disputes Redressal Commission (hereinafter referred to as the State Consumer Commission, for short), whereby appeal preferred by the respondent-Company against the award of District Forum, Jammu dated 27.09.2012 passed in complaint titled Ghulam Mohd. Khandey v. Oriental Insurance Co. has been allowed and order of the District Forum constituted under the Consumer Protection Act, set aside.

2. Facts of the case, as narrated by the petitioner in this petition, are that the petitioner was owner of a Maruti Car bearing registration No.JK02P-3894. He had obtained an insurance policy in respect of the aforesaid vehicle i.e. Policy No.546/2005, which was valid for a period of one year w.e.f. 18.05.2005 to 17.05.2005. The petitioner claims that at the time of issuance of insurance policy, respondent-Insurance Company had charged an additional premium of Rs.100/- from the petitioner for extending personal accident cover to the petitioner. It is submitted that on 04.06.2004 when the petitioner was coming from Kishtwar to Jammu in his Maruti Car along with his PSO, which was being driven by Gh. Mohidin, the driver of the petitioner, it met with an accident near Karni Nallah By Pass resulting in damage to the vehicle as well as serious injuries to the petitioner. The petitioner was immediately shifted to Govt. Medical College, Jammu for treatment where he remained admitted till 17.06.2004. The petitioner claims that he was operated twice and remained as indoor patient for more than six months. It is further submitted that the intimation of the accident was given to the Police Station, Nagrota as well as to the respondent-Company. It is also alleged by the petitioner that on account of grievous injuries sustained by him he incurred an amount of Rs.2.50 lakh on medical and other ancillary expenses, therefore, grievance of the petitioner is that despite intimation to the respondent-Company with regard to the occurrence and the grievous injuries sustained by the petitioner, the latter did not reimburse the loss sustained by the petitioner.

Feeling aggrieved of the failure of the respondent-Company to provide service and indemnify the petitioner for the loss suffered by him, a complaint was filed before the District Forum, Jammu. The District Forum, Jammu put the respondent-Company on notice and after considering the claim and counter claim of the parties to the complaint, passed its award dated 27.09.2012 whereby respondent-Company was directed to pay a sum of Rs.2,50 lakh along with interest @ 9% for the medical expenditures and Rs.10,000/- for forced litigation. The respondent-Company feeling aggrieved of the award passed by the District Forum filed an appeal before the State Consumer Commission, which was allowed by the Commission vide its order dated 28.01.2015.

3. As is apparent from the perusal of the order impugned, the appeal was accepted and the award made by the District Forum dated 27.09.2012 was set aside on the ground that the policy of Insurance only covered personal injury of owner-driver, which according to the policy specifications would mean that person injured must be the registered owner of the vehicle possessing effective driving license and that the petitioner was though registered owner travelling in the Car was not possessed of driving license and therefore, incompetent to drive. Claim of the petitioner was also rejected yet on another ground that even in case of injuries covered under the insurance policy, the insurer’s liability only extends to death or an injury causing death or loss of limb, eyes and permanent disablement within six months of the accident only, which, as found by the learned State Consumer Commission was not the case with the petitioner, who had suffered some in