Sonu Rathee vs LIFE INSURANCE CORPORATION OF INDIA

THIS revision petition is directed against the order of the Haryana State Consumer Disputes Redressal Commission, Panchkula (in short, "the State Commission") dated 14.9.2012 in first appeal No.601/2011.

THE facts are not in dispute. The respondent/complainant had taken a life insurance policy which also extended accident disability benefit. Unfortunately on 27.2.2009 the complainant met with an accident resulting in loss of both his legs besides other multiple injuries. Disability certificate confirming 100% disability was issued by CMO, Sonepat. Complainant submitted the insurance claim for disability benefit. It was, however, repudiated. This has led to filing of the consumer complaint.

THE opposite party resisted the complaint and took the plea that the injuries suffered by the petitioner do not amount to total/permanent disability and as such the insurance claim was rightly repudiated as per clause 10 (a) of the terms and conditions of the insurance policy. The District Forum on appraisal of pleadings and the evidence allowed the complaint and directed as under: "After going through the entire relevant records, we have observed that there is deficiency in service on the part of the respondent since the respondent only to harass unnecessary harassment and mental agony to the complainant with -held his legal and genuine claim and rather they received the regular premium even after 27.02.2009, the date of accident. The complainant to prove that the respondent has also received the premium of Rs.1533/ - per month even after 27.2.2009 has placed on record the detail of monthly LIC policy premium deducted from the salary of Sonu Rathee (complainant) against policy No.171974259 w.e.f. 2/2009 to 2/2011 i.e. for 25 months at the rate of Rs.1533/ - total amounting to Rs.38,325/ -. Accordingly, we have observed that the complainant is not legally liable to pay the premium of Rs.1533/ - to the respondent after the date of accident i.e. 27.02.2009 and thus, we direct the respondent to refund the amount of premium w.e.f. 2/2009 to 2/2011 total Rs.38,325/ - which the respondent has received from the complainant after the date of accident i.e. 27.02.2009 and not to charge any further premium from the complainant and the amount of Rs.38,325/ - is directed to be paid to the complainant alongwith interest at the rate of 09% per annum from the date of receipt till 2/2011. Further the respondent is directed to make the payment of Rs.4166/ - per month w.e.f. 2/2009 to 2/2011 i.e. Rs.104150/ -. The respondent is also directed to pay Rs.4166/ - per month for the remaining approximately eight years after 2/2011. The respondent is also directed to compensate the complainant to the tune of Rs.2000/ - (Rs.two thousands only) for rendering deficient services, unnecessary harassment to the complainant who is totally disabled person and has lost his both legs in the ill -fated accident. The respondent is further directed to pay a sum of Rs.1000/ - (Rs.one thousand) under the head of litigation expenses."

BEING aggrieved of the order of the District Forum the respondent/opposite party approached the State Commission in appeal and the State Commission vide impugned order taking note of clause 11 (a) of the Insurance Contract allowed the appeal, set aside the order of the District Forum and dismissed the complaint. Thus, the revision petition.

LEARNED Shri J.S. Malik, Advocate for the petitioner has contended that the impugned order is not sustainable because it is in contravention of the judgment of the National Commission in the matter of LIC of India vs. Ram Singh Tanwar,2007 1 CLT 500.

LEARNED Shri Mohinder Singh, Advocate for the respondent/opposite party on the contrary has argued in support of the impugned order. He has contended that the judgment in the matter of LIC of India vs. Ram Singh Tanwar is not applicable to the facts of this case. In the aforesaid case claimant was a driver who lost one of his legs in the accident, which obviously rendered him incapable of earning his livelihood as a driver. Learned counsel has contended that in the instant case undisputedly the petitioner who was LDC in UHBVNL despite of having suffered disability continued in service to earn salary. Therefore, in view of the judgment five Members Bench of this Commission in the matter of LIC of India vs. Ramesh Chandra II,1997 CPJ 45 (NC), his insurance claim was rightly repudiated in view of clause 11 of the terms and conditions of the insurance policy.

I have considered the rival contentions. Perusal of the impugned judgment would reveal that the State Commission was persuaded to allow the appeal of the opposite party and dismiss the complaint in view of clause 11 of the terms and conditions of the insurance contract which reads as under: - 11. Accident Benefit: If the Accident Benefit is opted for at any time when this Policy is in force for the full Sum Assured if the Life Assured before the date of expiry of policy term or before the policy anniversary on which the age nearer birthday of the Life Assured is 70 exceed Rs.50 Lakhs. If there be more policies then one and if the total Accident Benefit exceeds Rs.50 Lakhs, the benefits shall apply to the first 50 Lakhs assured in the order of date of policies issued. The waiver of premium shall, extinguish all options under this policy and the benefits covered by (b) of this clause except as to such assurances, if any, as exceeds the maximum limit of Rs.50 Lakhs and which may have been kept in force by continued payment of premiums. "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 within 180 days from the happening of such accident, result in the irrecoverable loss of 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.

Immediately after the happening of the disability, full particulars thereof must be given in writing to the office of the Corporation where this Policy is serviced together with the then address and whereabouts of the Life Assured within 180 days after the happening of the disability there must be given to the serving Office of the Corporation in the manner required by it proof of disability satisfactory to the Corporation and without any expense to the Corporation and thereafter similar proof must be given as and when required by the Corporation of the continuous of such disability, Any Medical Examiner nominated by the Corporation shall be allowed to examine the Life Assured in respect of any disability claimed, in such manner and at such times before and/or after the disability is accepted by the Corporation as the Corporation may require.

In the event of it being discovered at any time that a claim under the clause has been wrongly admitted, all premiums falling after due after the date Corporation''s intimation to that effect shall be paid and no further installment of additional sum assured shall be paid as if no disability had occurred."

ON reading of the latter part of the above term of the insurance contract it is clear that the insurance benefit in case of 100% permanent disability on account of accident would be available to the insured only if the disability is of such a nature that it has rendered the insured unable to follow his work, occupation or profession to earn or obtain any wages, compensation or profit. Undisputedly, in the instant case after having suffered the permanent disability the petitioner continued to work as LDC in UHBVNL and was paid salary which he was getting prior to the accident. Thus, the impugned order of the State Commission allowing the appeal dismissing the consumer complaint in view of above condition of insurance contract cannot be faulted. So far as the judgment of the Co -ordinate Bench of this Commission in the matter of LIC of India vs. Ramesh Chandra is concerned that judgment is of no avail to the petitioner because in that case the claimant was a driver and who lost his right leg which rendered him incapable of earning wages/livelihood by driving a vehicle. 9. In view of the discussion above, I do not find any material irregularity or jurisdictional error in the impugned order which may call for interference in exercise of revisional jurisdiction. Revision petition is, therefore, dismissed.