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Judgment
THIS appeal is directed against the order passed by the District Forum, Ernakulam, in Opp. Party No. 750/92. The opposite party is the appellant
THE allegations in the complaint are as follows: THE complainant had taken a Personal Accident Insurance policy for a sum of Rs. 50,00/- from 19.9.90 to 18.9.91. He met with an accident on 22.8.91 and was admitted to the Malankara Orthodox Syrian Church Medical Mission Hospital, Kolenchery, since he sustained fracture of the clavicle bone and as a consequence of the accident he also developed deafness of the right ear as a permanent disability. THE complainant made claim for Rs. 17,500/-. THE opposite party did not pay the amount and hence the complainant filed the complaint for seeking a direction to the opposite party to pay the said amount together with interest at the rate of 15% and also Rs. 2000/- as compensation and a sum of Rs. 500/- as cost. The opposite party contended that they partly allowed the claim and offered Rs. 8,351/- but the complainant had not accepted the amount. The complainant has claimed more then one benefit in respect of the same period of disablement which is not allowable under the policy and therefore the amount sanctioned is perfectly valid and proper and the complainant is not entitled to get more amount.
The District Forum found that the complainant suffered permanent disability of the loss of hearing on the right side and Ext. A2 is the certificate regarding the same. In Ext. A3 claim form, it is certified by the Medical Officer concerned that he was under temporary disability for three months due to the fracture of the right clavicle and it is the compensation for this temporary disability the complaint was filed. As per Ext. Al Policy conditions 15 per cent of the capital sum insured is payable for loss of hearing of one ear and that has been completely allowed, namely Rs. 7,500/-. Under clause (f) "if such injury shall be the sole and direct cause of temporary total disablement, hen so long as the insured shall be totally disabled from engaging in any employment or occupation of any description whatsoever, a sum at the rate of one per cent of the capital sum insured in schedule hereto per week but in any case not exceeding Rs. 1,500/- per week in all, under all policies shall be payable. Under Clause (1) of the exceptions, compensation under more than one of the earlier Subclause shall not be liable to be paid for the same period of disablement and on the basis of this clause the opposite party refused to pay the claim for the period of temporary disability.
THE District Forum took the view that the stand taken by the opposite party is not justified in terms of the condition in the policy. What the opposite party is not liable to pay is compensation under more than one of the foregoing sub- clauses in respect of the same period of disablement. THE claim for temporary total disablement is on account of the fracture of right clavicle whereas compensation for permanent disability is for loss of hearing of the right ear. It found the object of the Clause (1) under the exception is to avoid double payment and earlier in the very same clause, clause ''f had been excluded. It also held that the payment for the same period of disablement due to the loss of hearing is a subsequent development or in other words it was not immediately known and the temporary disability was only due to the fracture of clavicle. It also held that the loss of hearing power did not disable him from engaging in his employment or occupation and temporary disability was only due to the fracture of clavicle and, therefore, he does not think that the interpretation given by the opposite party is correct and the complainant cannot be denied the compensation for temporary disablement, In that view, the District Forum passed an order directing the opposite party to pay Rs. 14,851/- less the amount if any received by the complainant together with interest @ 12% per annum from the date of filing the complaint and also Rs. 250/- as cost. Feeling aggrieved by the said order this appeal has been preferred.
IN this appeal, it is contended by learned Counsel for appellant that the interpretation put forward by the District Forum to exceptions in Clause (1) was not consistent with the object of the policy. He also contended that in view of the accident the opposite party shall not be liable to pay compensation under more than one of the foregoing sub-clauses in respect of the same period of disablement. IN other words, he submitted that the complainant will not be entitled to get compensation for permanent and temporary total disablement simultaneously and, therefore, the complainant is not entitled to get the double benefit. It is the cardinal principle of interpretation, if there is ambiguity in a policy, an interpretation which is favourable to the insured has to be adopted. This is what is stated in Ext. A 1, page number 48 of principles of General INsurance published by INsurance INstitute of INdia, which reads as follows:- "54. Another feature of an INsurance contract is that it is drafted by one party only viz. the insurer in the form of standard policies and endorsements. The insured usually has to say in the matter. Therefore, whenever there is an ambiguity in the wording of policy, the Courts have given the benefit of doubt to the insured that is to say, the policy is interpreted by the Courts in favour of the insured and against the insurers, because the policy was drafted by the insurers."
The other important rules are as follows: (i) Printed and typed portions are to be construed together as far as possible, but if there is contradiction between the two portions the typed portion over-rides the printed portion. The hand-written portion over-ride the typed portions. (ii) The clauses in the margin over-ride the clauses in the main body of the policy. (iii) The policy is to be interpreted as a whole, i.e., if possible, effect must be given to every party of the policy. (iv) The words in the policy are to be given their plain, ordinary, and popular meaning. However, technical terms are to be given their strict technical meaning. (v) The ordinary rules of grammar shall apply.
Learned Counsel appearing for the appellant was not able to convince us about the correctness of interpretation adopted by opposite party. The District Forum held under the Clause (1) of the exceptions the opposite party was not liable to pay compensation more than one of the foregoing sub-clauses in respect of the same period of disablement and the claim for temporary total is on account of the fracture of right clavicle whereas compensation for permanent disability is for loss of hearing of the right ear and what is intended by the clause is to avoid double payment. It also cannot be said that the payment is for the same period because permanent disablement is a subsequent development. IN other words it was only due to a fracture of the clavicle that temporary disability occurred which is not a disability of permanent nature. It appears to us the interpretation put the District Forum is reasonable especially having regard to the principle of interpretation to be adopted in the matter of ambiguity in the policy. IN the circumstances we do not find any ground to interfere with the order passed by the District Forum. We accordingly dismiss the appeal and direct the parties to bear their respective costs. Appeal dismissed.