LIFE INSURANCE CORPORATION OF INDIA vs Jaipal Singh Kaler

IN this revision petition there is challenge to order dated 3.10.2008, passed by State Consumer Disputes Redressal Commission, Rajasthan (for short, ''State Commission''). Brief facts are that respondent/complainant took an insurance policy for a sum of Rupees one lakh with accident benefit on 15.4.1997 from petitioner No. 1/opposite party No. 1. On 2.8.2001, respondent while riding on a scooter he met with an accident. Due to the accident, respondent sustained serious injuries and was admitted in the hospital and had to undergo prolonged treatment as lower part of the waist has become absolutely paralyzed due to the bone injury resulting in 100% permanent disability and now he is able to move only on wheel chair. It is further stated that as per in terms of the policy conditions, respondent furnished Permanent Disability Certificate for his claim to petitioner No. 1. However, claim of respondent was disallowed on the ground that he is in Government Service and therefore is not entitled to receive the accident benefit. Alleging deficiency on the part of the petitioners, respondent filed a complaint before the District Consumer Disputes Redressal Forum, Jhunjhunu (for short, ''District Forum'') claiming Rs. one lakh towards accident benefit, a sum of Rs. 50,000 as compensation on account of disability and also claimed Rs. 5,000.

PETITIONER S in their reply did not dispute the issuance of accident benefit policy. However, it is stated that claim of respondent was denied rightly as he is working as a teacher in the service of State and is regularly receiving the salary. Therefore, under the terms and conditions of the policy, he is not entitled to the said benefit. District Forum vide order dated 27.7.2005, allowed the complaint with directions to the petitioners to make the payment of insurance claim of Rupees one lakh within a period of one month. Failure to make payment of this amount within a period of one month, would attract simple interest @ 9% p.a. for the period commencing after lapse of one month till the date of realization. The respondent was also entitled to receive exemption from premium while continuing the said policy. In addition, petitioners had to pay a sum of Rupees one thousand to the respondent towards cost of complaint.

PETITIONER S being aggrieved by the order of the District Forum, filed an appeal before the State Commission which dismissed the same, vide its impugned order.

HENCE , this revision petition. We have heard the learned Counsel for the petitioners as well as respondent who has argued his case on its own.

IT has been contended by learned Counsel for the petitioners that as per terms of the policy, disability benefit can be granted where injury is permanent. It has been further contended that as per terms of the policy, since the life assured is working at the post of Teacher in the Govt. Service of the State and he is regularly receiving the salary, therefore, under the terms and conditions specified in the insurance policy, he is not entitled to accidental benefit. Moreover, it is settled law that terms and conditions of the insurance policy has to be construed strictly. In support learned Counsel has relied upon following judgments; (i) Oriental Insurance Company Ltd. v. Samayanallur Primary Agricultural Cooperative Bank, : IX (1999) SLT 250 : AIR (2000) SC 10;

(ii) Oriental Insurance Company Ltd. v. Sony Cheriyan, : II (1999) CPJ 13 (SC) : VI (1999) SLT 565 : II (1999) ACC 196 (SC) : AIR 1999 SC 3252; and

(iii) United India Insurance Company v. Harchand Rai Chandan Lal, : IV (2004) CPJ 15 (SC) : V (2004) SLT 876.

ON the other hand, it has been stated by the respondent that he has suffered 100% permanent disability and as such he is entitled to the accidental benefit. Further, both the Fora below have rejected the above plea taken by the petitioners. The State Commission while dismissing the appeal of the petitioners in its impugned order observed as under: "10 Thus, in the facts and circumstances just narrated above, the question for consideration is whether the repudiation of claim of the complainant/respondent by the appellants was justified or not or whether the findings recorded by the District Forum could be sustained or not.

Before proceeding further for convenience Clause 10.4 of the policy is re -produced here -

"The disability above referred to must be disability, which is the result of an accident and must be total and permanent and such that there is neither then nor at any time thereafter any work, occupation or profession that the Life Assured can ever sufficiently do or follow to earn or obtain any wages, compensation or profit. Accidental injuries which independently of all other causes and without one hundred and twenty days from the happening of such accident, result in the irrecoverable loss of the entire sight of both eyes or in the amputation of both hands at or above the wrists or in the amputation of both feet at or above ankles or in the amputation of one hand at or above the wrist and one foot at or above the ankle shall also be deemed to constitute such disability."

In our considered opinion, looking to the facts that the complainant -respondent was having 100% disability and further his lower part beneath the waist was totally damaged and if he was being given some job on compensate grounds for that claim should have not been repudiated by the appellants, especially when the complainant -respondent had to engage a person for carrying the wheel chair for coming to the place where he was working. In such a case if benefit of Clause 10.4 is not given to the appellants by the District Forum, the District Forum had not committed any mistake and the appellants were not justified in repudiating the claim of the complainant -respondent and the District Forum was right in decreeing the claim of the complainant -respondent.

For the reasons stated above, no illegality or irregularity has been committed by the District Forum in decreeing the claim of * the complainant -respondent. The findings of the District Forum decreeing the claim are based on correct appreciation of entire materials available on record and they do not suffer from any basic infirmity, illegality and perversity and hence, no interference is called for with the same and this appeal deserves to be dismissed."

AS per Permanent Disability Certificate issued by the Medical Board of the Government of Rajasthan, there is "Approx 100% permanent disability of the lower limbs." Admittedly, this permanent disability has occurred due to accident. The petitioners have not placed on record the accidental benefit policy in question. Be that as it may, relevant clause of the policy, that is, Clause 10.4 as quoted by the State Commission in its order has been reproduced herein above. Thus, according to Clause 10.4 of the policy, the only interpretation of the policy can be that, the life assured due to the accident and thereafter, not able to do any work, occupation or profession to earn or obtain any wages compensation or profit. But in the present case, the life assured was already gainfully employed as a school teacher before he occurrence of the accident. Therefore, the above noted Clause 10.4 of the insurance policy, is not applicable in the case of the respondent. Accordingly, none of the judgments cited above, are applicable to the facts of the present case.

IT is well settled that under Section 21(b) of the Act, this Commission can interfere with the order of the State Commission where such State Commission has exercised jurisdiction not vested in it by law, or has failed to exercise jurisdiction so vested, or has acted in the exercise of its jurisdiction illegally or with material irregularity. Hon''ble Supreme Court in Mrs. Rubi (Chandra) Dutta v. United India Insurance Co., : (2011) CPJ 19 (SC) : (2011) SLT 303 : 2011 (3) Scale 654, has observed: "Also, it is to be noted that the revisional powers of the National Commission are derived from Section 21(b) of the Act, under which the said power can be exercised only if there is some prima facie jurisdictional error appearing in the impugned order, and only then, may the same be set aside. In our considered opinion there was no jurisdictional error or miscarriage of justice, which could have warranted the National Commission to have taken a different view that what was taken by the two Forums. The decision of the National Commission rests not on the basis of some legal principle that was ignored by the Courts below, but on a different (and in our opinion, an erroneous) interpretation of the same set of facts. This is not the manner in which revisional powers should be invoked. In this view of the matter, we are of the considered opinion that that the jurisdiction conferred on the National Commission under Section 21(b) of the Act has been transgressed. It was not a case where such a view could have been taken, by setting aside the concurrent finding of two Fora."

IN view of the concurrent findings of facts given by Fora below, no jurisdiction or legal error has been shown to call for interference in the exercise of power under Section 21(b) of the Act.

BEFORE parting with, we must express our deep anguish that petitioner, being a Government Corporation has formulated Clause 10.4 of the accident benefit policy in such a manner that, no life assured can understand the real intention behind this clause, that is, to make this policy ineffective for all intent and purposes. No life assured who is gainfully employed at the time of taking such policy, would get any benefit even if he becomes hundred percent Permanent Disabled. Respondent herein who is 100% disabled, has personally appeared before us in the wheel chair. Furthermore, he has been made to run from pillar to post for the last 12 years. We hope that Petitioner -Corporation, in future would deal with such type of cases in a more human and sympathetic manner and will not give any cause for such type of disabled person to fight endless litigation and deprive them from the fruits of the award passed more than 12 years ago. We hope that henceforth, Petitioner -Corporation would incorporate the policy conditions in a simple, clear and unambiguous terms. Hence, the present revision petition Stands dismissed with cost of Rs. 10,000 (Rupees ten thousand only). Cost be paid by the petitioners directly to the respondent by way of demand draft, within six weeks from today.

IN case petitioners fail to pay the aforesaid cost to the respondent within the prescribed period, then they shall also be liable to pay interest @ 9% per annum, till realization. List for compliance on 25.10.2013.