BHARTIYA JEEWAN BIMA NIGAM vs Pratap Singh

THIS appeal is directed against the order dated 6.8.93 passed by the District Forum, Gwalior in Case No.1161/92.

THE appeal arises out of a complaint filed by the respondent. Briefly the case of the complainant was that he was working as a truck driver, that he had taken a Life Insurance Policy with accident benefit issued by the appellant and that during the period the policy was in force he met with an accident resulting in permanent disability as his right forearm was amputated and right femur was fractured and nailed. THE claim made by the complainant for disability benefit under the Accident Benefit Clause of the policy was repudiated by the appellant. Hence the complainant filed a complaint before the District Forum claiming the amount in terms of the policy of insurance. THE claim was resisted by the appellant mainly on the ground that the disability suffered by the complainant did not entitle him to claim any benefit in pursuance of the Accident Benefit Clause. THE District Forum after appreciating the material on record upheld the claim of the complainant. Aggrieved by this order, the appellant has filed this appeal. Learned Counsel for the appellant contended that the District Forum erred in holding that the disability from which the complainant suffered entitled him to the grant of disability benefit in accordance with the terms of the policy. It was also contended that as the claim of the complainant was repudiated by the appellant after application of mind, the District Forum had no jurisdiction to grant any relief to the complainant.

To appreciate the contentions advanced on behalf of the appellant, it is first necessary to ascertain facts which are not in dispute. The District Forum has found that the occupation of the respondent was that of a truck driver, that he had taken a life insurance policy with accident benefit, that during the period, the policy was in force he was involved in an accident and that as a result of that accident his right forearm was amputated, right femur was nailed and he had thus become permanently incapable of following his occupation as a truck driver. These findings were not disputed before us but it was vehemently contended that the disability from which the complainant suffered did not entitle him to claim any benefit under the Accident Benefit Clause incorporated in the policy of insurance because it was not due to injuries specified in that clause. The relevant provision of that clause is as follows: "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 ninety 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 disalility."

Our attention was invited to the latter part of the aforesaid clause and it was contended that as there was no amputation of both the hands, the disability suffered by the complainant was not covered by the Accident Benefit Clause.

THE aforesaid Accident Benefit Clause, in our opinion, cannot be construed to mean that only those accidental injuries which are specified in the latter part of the clause, can constitute disability. THE latter part of the clause is a deeming provision. It lays down that existence of the injuries specified in the latter part of the clause would by themselves, without anything more, be sufficient for holding that the resulting disability is such as would entitle the assured to the benefit of the accident clause. In cases not covered by injuries, specified in the latter part of the said clause, in order to entitle an assured to the benefit of the Accident Benefit Clause, it will have to be established that, (1) the disability which is the result of an accident is total and permanent and (2) that the disability is such that as a result of that disability the assured cannot be gainfully employed to earn his livelihood. In the instant case it has been found by the District Forum on the basis of the evidence on record that the complainant was a right hander, was educated only upto the seventh standard, that he was prior to the accident earning his livelihood by working as a truck driver, mat as a result of amputation of his right forearm he was unable to write or to work as a driver, that he was not possessed of means to start any business, that he was unable to seek any gainful employment and that as a result of the disability caused by the accident he would not be able to earn his livelihood. All these findings are based on the material on record and were not assailed before us. The only contention advanced before us was that this was not a case of amputation of both the hands or of one hand and one foot and hence was outside the purview of the Accident Benefit Clause. This contention as we have observed, fails to take into account the effect of the first part of the Accident Benefit Clause. Though the case of the complainant was covered by the earlier part of the Accident Benefit Clause, the appellant failed to apply its mind to that aspect of the matter. Under the circumstances it must be held that the repudiation by the appellant of the claim made by the complainant was wrongful and the District Forum was justified in upholding that claim. We see no cogent reason to interfere with the order passed by the District Forum.

THE appeal, therefore, fails and is accordingly dismissed. As none appeared on behalf of the respondent, parties shall bear their own costs of this appeal. Appeal dismissed without costs.