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2008 Supreme(UK) 538
2009 (2) UAD 107
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, UTTARAKHAND, DEHRADUN
Hon’ble Mr. Justice Irshad Hussain and Mr. C.C.Pant, Member
First Appeal No. 72/2004
BRANCH MANAGER, LIFE INSURANCE
CORPORATION OF INDIA – Appellant/Opposite Party
Versus
RAMESHWAR SINGH NEGI – Respondent/Complainant
Decided on : 02.12.2008
For the Appellant : Mr. Deepak Ahluwalia, learned counsel
For the Respondent: Mr. M.K. Kohli, learned counsel
Headnote:Consumer Protection Act, 1986, Sec. 2(g), (O) — Deficiency in service — Claim for double accident benefit arising out of life insjurance policy — Repudiation of by L.I.C. of India — Justification for — Complainant insured for double accident benefit sustaining fracture of backbone resulting from accidental slip on hill track while on official duty as Forest Animals Guard — Complainant getting disabled to the extent of 75% in the result of such fracture — Repudiation of complainants claim for double accident benefit by L.I.C. on ground that under terms of contract of insurance for claiming such benefit, disability must be total (100%) and permanent — Proper and justified and no deficiency in service held to have been made by L.I.C. thereby — Order of District Forum directing L.I.C. to pay to complainant Rs. 70,000/- by way of double accident benefit of his insurance policy for a sum of Rs. 35,000/- — Set aside. (Paras 5, 6, 7)
miHkksDrk laj{k.k vf/kfu;e] 1986] /kkjk&2(g),(O) & lsok esa deh & thou chek ikWfylh ds vUrxZr Mcy ,DlhMsUV ykHk gsrq nkos dks thou chek fuxe }kjk udkjus dk vkSfpR; & Mcy ,DlhMsUV ykHk ds fy;s chfer O;fDr dks nq?kZVuko'k igkM+h jkLrs esa fQly tkus ds dkj.k mldh jh<+ dh gM~Mh esa ÝSDpj vk tkus ls og 75% dh lhek rd fu;ksZX; gks x;k & Hkkjrh; thou chek fuxe }kjk ifjoknh ds izfrdj ds nkos dks bl vk/kkj ij udkjuk fd chek dh lafonk ds vuqlkj iz'uxr ykHk dsoy 100% ,oa LFkk;h fu;ksZX;rk dh n'kk esa gh fey ldrk gS & mfpr ik;k x;k rFkk lsok esa deh ugha ik;h x;hA ¼izLrj 5] 6] 7½
(Per : Justice Irshad Hussain, President) :
By order dated 04.05.1998 passed by the District Forum, Pauri Garhwal in consumer complaint No. 278 of 1995, appellant – Life Insurance Corporation of India, was directed to pay sum of Rs. 70,000/- to the complainant by way of double accident benefit of his insurance policy for sum of Rs. 35,000/- commencing from 27.09.1990 together with interest @ 18% p.a.; Rs. 500/- as litigation expenses and Rs. 2,000/- as damages, by observing that the complainant became disabled due to fracture of backbone, resulting from accidental slip on hill track, while the complainant was on his official duty as Forest Animals Guard on 27.04.1993. The District Forum has rejected the defence plea that the claim had been validly repudiated on account of the fact that the disability of the complainant was reported to be only 75%, whereas under the terms of the contract of insurance, the disability for getting double accident benefit, must be total and permanent and other pleas that the insurance policy was lying lapsed since 27.09.1993 and further that the information about the accident and alleged disability, was given as late as on 26.11.1993, despite the accident having taken place on 27.04.1993. The complainant still continues to be in the service of the Forest Department and is getting his salary/wages as usual. Regarding this, the District Forum observed that in case, the employer is not so heartless, as to deprive payment of salary/wages even on compassionate ground, the same would not be taken to suggest that despite the disability, the complainant has been able to earn his salary/wages and on that account, was not entitled to double accident benefit under the terms of the contract of insurance. Aggrieved by the order, appellant filed this appeal.
2. We have heard the learned counsel for the parties and have considered their submissions in the light of the facts, circumstances and legal aspects of the case. The main plea raised by the learned counsel for the appellant is that the accident benefit is available to the insured only if he is involved in an accident, resulting in total and permanent disability, as defined in Clause 10 of the policy. In this case, insured had suffered 75% disability and, as such, accident benefit was not available to the insured and the claim has been rightly repudiated. According to the learned counsel, the District Forum fell in error in holding otherwise by making the aforesaid observations, which run counter to the terms and conditions of the policy of insurance. On the other hand, learned counsel for the complainant supported the order of the District Forum and urged that though the percentage of disability has been assessed to be 75% only per certificate of the doctor of the PGI, Chandigarh, the complainant became disabled totally and permanently on account of breaking of backbone in the accident and on account of paralytic condition, forcing him to take assistance of a helper in his day-to-day ordinary and usual way of life.
3. Having considered the respective submissions, we may state at the outset that the submissions of the learned counsel for the appellant have force and the appeal is fit to be allowed and the order of the District Forum is liable to be set aside, so as to dismiss the consumer complaint filed by the complainant.
4. Clause 10 of the policy of insurance in question read as under:
“10. Accident Benefit : If at any time when this Policy is in force for the full Sum Assured, the Life Assured, before the expiry of the period for which the premium is payable or before the Policy anniversary on which the age nearer birthday of the Life Assured is 70 whichever is earlier, is involved in an accident resulting in either permanent disability as hereinafter defined or death and the same is proved to the satisfaction of the Corporation, the Corporation agrees in the case of :
(a) Disability to the Life Assured : (i) to pay in monthly instalments spread o
