Life Insurance Corporation of India vs Khazan Singh

MR. Justice Ashok Bhan, President-Life Insurance Corporation of India and another petitioners herein, which were the opposite parties before the District Consumer Disputes Redressed Forum, Bundi (hereinafter referred to as ''the District Forum'' for short), have filed the present Revision Petition against the Order dated 17.4.2006 passed by the Rajasthan State Consumer Disputes Redressal Commission, Jaipur (hereinafter referred to as ''the State Commission'' for short) and the Order dated 18.5.2004 passed by the District Forum. By the impugned Order, the District Forum had directed the petitioners to pay a sum of Rs. 1,00,000 by way of compensation and Rs. 500 for mental harassment and Rs. 500 towards costs to the complainant/ respondent

SHORTLY stated, the facts leading to the filing of the case are:

THAT respondent had taken an Endowment Policy bearing Policy No. 193247043 for a sum of Rs. 1,00,000 on 21.2.2001. The Policy commenced w.e.f. 28.1.2001 and the date of maturity was 28.1.2011. The premium was to be paid yearly. Respondent deposited the first instalment of Rs. 11,283 towards premium on 21.2.2001. It was alleged in the complaint that on the evening of 1.11.2001, respondent had a fight with one Girdhari and some other unknown persons, who, without any reason, made an attempt to kill the respondent due to which the respondent got several injuries on his body and lost one of his ears and became deaf. It was also alleged that the respondent''s one hand and one leg were broken and he had also suffered head injuries due to which he became permanently handicapped. Respondent lodged a claim with the petitioner-Insurance Company along with permanent disability certificate issued by the Doctor. The Insurance Company repudiated the claim, aggrieved against which, the respondent filed the complaint before the District Forum.

PETITIONERS, on being served, filed their Written Statement and it was stated that the respondent had failed to produce a permanent disability certificate from the Medical Board in spite of repeated requests made by the petitioner-Corporation. It was further submitted that the respondent was still undergoing treatment and all the injuries of the respondent were curable and, as per Clause 10.4 of the Policy, the injuries suffered by the respondent were not covered under the Permanent Disability Clause. Clause 10.4 of Policy reads as under: "The disability above referred to must be disability which is a result of an accident and must be total and permanent and such that there is neither then or at any time thereafter any work, occupation or profession that the life assured can ever sufficiently do or follow to earn or obtain wages, compensation or profit. Accidental injuries which independently of all other causes and within 120 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 be also deemed to constitute such disability."

RELYING upon this, Counsel appearing for the petitioners contends that the permanent disability has been defined in the above clause and the respondent could be paid only in terms of the clause. That the injuries suffered by the respondent did not fall within the meaning of Clause 10.4 of the Policy. That the parties are governed by the terms of the Policy. He has also relied upon two judgments of this Commission in LIC of India v. Ramesh Chandra, reported in II (1997) CPJ 45 (NC), and LIC of India v. Sh. Satpal Kashyap, in Revision Petition No. 3122 of 2003 (dated 15.5.2008).

A perusal of Clause 10.4 would show that the life assured can be paid the amount only if the disability suffered by him is total and permanent and is a result of an accident which renders him unfit thereafter to work, occupy or do any profession to earn his livelihood. The disability has to be as a result of the accident and must be total and permanent. The injuries suffered independently of other causes must result in irrecoverable loss of the entire sight of both eyes or in the amputation of both hands at or above wrists or in the amputation of feet at or above ankles, or in the amputation of one hand at or above the wrist and one foot at or above the wrist within 120 days of the happening of the accident. Only such injuries are deemed to constitute permanent disability under Clause 10.4. Admittedly, the petitioner did not suffer any such permanent disability in the present case.

IN Ramesh Chandra''s case (supra), a 4-Member Bench of this Commission, after taking into consideration a similar clause, held as under: "5. The question is whether the amputation of right hand suffered by the complainant is a specified event and constitute disability entitled to an accident, benefit under Clause 10(a) of the policy bond. The accident benefit is available to the assured only if he is involved in an accident resulting in total and permanent disability as defined in Clause 10. The disability referred in the said clause must be disability which is the result of accident and must be total and permanent. The accidental injuries which independently of all other causes and within 120 days from 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 wrists or in the amputation of feet at or above ankles, or in the amputation of one hand at or above the wrist and one foot at or above the wrist only constitute such disability. The case of the complainant is not of the amputation of both the hands at or above the wrist or in the amputation of feet at or above ankles. The case of the complainant is the amputation of one hand at or above the wrist but that is not independently deemed to be a disability as is covered since the coverage in the clause is only in cases of amputation of one hand at or above the wrist and one foot at or above ankle. It bears repetition that the deeming clause constituting the disability will get attracted only if there was the amputation of one hand at or above the wrist and one foot at or above the ankle. If it is the amputation of one hand at or above wrist or the amputation of one foot at or above the ankle, then it does not by the fiction of the Clause 10(a) constitute disability. The constitution of the policy bond which is the basis of the contract of insurance, is a question of law and its true and correct interpretation would give justification to the Fora to pronounce upon the deficiency in service, if any. The District Forum as well as the State Commission had no jurisdiction to go beyond the terms and conditions of the policy bond and could only order the payment of the disability benefit if it was specified event covered under Clause 10 of the conditions of policy. The amputation of only one hand does not fall within the deeming definition constituting disability in terms of Clause 10(a) of the policy bond and thus the impugned orders suffer from serious illegalities."

[Emphasis supplied]

TO the similar effect is the judgment of this Commission in S.K. Mittal''s case (supra), wherein after taking into consideration the same clause as in the present case, it was held as under: "Bare reading of the above clause would show that on the life assured''s suffering from permanent disability as a result of an accident, the Insurance Company subject to a ceiling of Rs. 1,00,000 will pay additional sum equal to the sum assured under a policy in monthly instalments spread over 10 years and if the policy becomes a claim before the expiry of this period the benefit instalments which have not fallen due will be paid along with the claim and future payment of premiums will be waived. Permanent disability consists of loss of entire sight of both the eyes or amputation of both the hands at or above the wrists or amputation of both feet at or above the ankles, or amputation of one hand at or above the wrist and one foot at or above the ankle. Policy is a contract and the conditions thereof are binding on both the parties. Obviously, loss of sight of one eye suffered by Sat Pal Kashyap-life assured cannot be treated as a permanent disability within the meaning of the said clause. Assuming that it is a permanent disability Shri Kashyap was entitled to the additional amount of disability benefit of Rs. 1,00,000 and not Rs. 1,25,000. Decision in Ramesh Chandra''s case (supra), which was rendered with reference to similar Clause 10(a) of the policy applied on all fours to this case. Order of District Forum as affirmed by the State Commission, thus, deserve to be set aside being legally erroneous."

[Emphasis supplied]

WE agree with the view taken in the aforesaid two judgments of this Commission and, respectfully following the same, hold that the respondent had not suffered permanent disability entitling him to claim the amount under the Policy. The Fora below have erred in taking a view contrary to the decision of this Commission. Accordingly, the Revision Petition is accepted. Orders passed by the Fora below are set aside and the complaint is ordered to be dismissed with no orders as to costs. R.P. allowed.