Kanti Lal Rathore vs National Insurance Company Ltd.

PETITIONER was the complainant before the District Forum, where he had filed a complaint alleging deficiency in service on the part of the respondent National Insurance Company Ltd.

VERY briefly the facts of the case are that the complainant had obtained a "Janata Personal Accident Policy" from the respondent Insurance Company, for the relevant period. The complainant was assaulted by some criminal on 27.6.2000; F.I.R. was lodged and case was registered; matter was also reported to the respondent; claim was preferred taking the plea that the complainant has suffered a permanent disability in the left hand. When the claim was denied by the respondent Insurance Company, a complaint was filed before the District Forum, who after hearing the parties, directed the respondent to pay 50% of the insured amount, along with interest @ 12% and cost of Rs. 1,000. Aggrieved by this order, an appeal was filed before the State Commission, who allowed the appeal and dismissed the complaint, hence this revision petition has been filed before us. We heard the petitioner/complainant, who is, by profession, an Advocate in Mandsaur (M.P.) and also perused the material on record. There is no disputing the fact that as per the report of the District Medical Board, Mandsaur, the disability was partial, being 18% in the left upper limb and 23% in the right upper limb. The State Commission relying upon provisions of the Policy dismissed the complaint. The stated clause of the Policy reads as under: "If such injury shall within six English calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of the sight of one eye, one hand or one foot, 50% of the sum assured be granted insured person."

A simple reading of this clause will make it clear that 50% assured sum will be granted only in the case of "Total and irrecoverable loss." As per material brought on record, the loss is only to the extent of 23% and 18% which by no stretch of imagination could be said to be total loss. As rightly held by the Medical Board, it was a case of partial loss. It is in these circumstances that the State Commission has dismissed the complaint. In view of the material on record, we find that the State Commission was justified in passing this order, which it did and calls for no interference by this Commission.

REVISION Petition is without merit hence dismissed. However, petitioner shall be at liberty to file application before the Criminal Court where the proceedings in the criminal case are in progress, to make a plea for compensation resulting in above stated injuries to the complainant. REVISION Petition dismissed.