AI Structured Summary
Not yet generated for this judgment
Judgment
IN this case, despite issue notice on 22.8.2005, the respondent did not appear for hearing on 5th April, 2006. The Law Officer of LIC, who was present, agreed to send a demand draft for Rs. 5,000 to the respondent to enable him to appear in this case and accordingly a fresh notice was issued to the respondent on 25.4.2006 to appear on 10th October, 2006. Since 30 days'' time had already been elapsed, it was presumed that notice was served on the respondent.
ON 9.9.2007, the respondent wrote a letter to the Assistant Registrar of this Commission stating that Insurance Company has filed revision petition intentionally to delay the matter. He requested the Commission to direct the opposite party to pay atleast half of the amount for his livelihood. This means that he is aware of the proceedings before this Commission. Finally notice was issued on 19.1.2009 to both the parties for appearance on 19th February, 2009. None appeared for the respondent. Mr. Mohinder Singh appeared for the petitioner. We heard him in detail.
THE facts of the case in brief are that the complainant has taken Bima Kiran Policy on 23.2.1997 and paid first yearly instalment premium of Rs. 615 through the agent. The said policy commenced from 1.1.1997 and the maturity period is 1.1.2022 with the face value of Rs. 40,000 and the maturity value of Rs. 80,000. The complainant has been paying the premium amount without any default. On 26.11.2001, the complainant was involved in a motor accident and he was treated at Seven Hills Hospital,Visakhapatnam as an in patient and the doctor operated on both legs and inserted steel rods for which he was under treatment for six months. Accordingly, he claimed maturity value from the Life Insurance Corporation. On 22.9.2002, LIC repudiated the claim. The complainant filed a complaint before the District Forum, with doctor''s certificate, who assessed the disability at 50%. LIC contended that there should be permanent disability to claim the benefits under the policy and the policy holder has suffered 50% disability and is able to walk, therefore, he is not entitled to any claim. The District Forum, after hearing the parties, directed the LIC to pay a sum of Rs. 80,000 to the complainant along with interest at 12% p.a. from 26.11.2001 till the date of realization together with costs of Rs. 1,000.
DISSATISFI ED by the order of the District Forum, LIC filed appeal before the State Commission. The learned Counsel for the LIC submitted that under Clause 8(a) of the terms and conditions of the policy; the disability should be a total and permanent disability whereas in this case the disability is only 50%. The State Commission observed that though the percentage of disability is 50%, with reference to attending to work or occupation it can be inferred that the disability suffered by the complainant is permanent and he cannot adopt to any work, therefore, the appeal was dismissed.
AGGRIEVED by the order of the State Commission, LIC has filed this revision petition before us. The learned Counsel for the LIC submitted that the complainant is able to walk and earn his livelihood and he is employed. Further they brought to our notice the relevant clause of the insurance policy. The following clause of the insurance policy, which is relevant is reproduced as under: "8. Accident Benefit -If at any time when this Policy is in full force, the life assured, before the expiry of the period for which the premium is payable is involved in an accident resulting in either permanent disability as hereinafter defined or death and the same is proved to the satisfaction of the Corporation, the Corporation agrees in the case of: (a) Disability to the life assured: (i) to pay in monthly instalments spread over 10 years an additional sum equal to the death benefit under this Policy. If the policy becomes a claim before the expiry of the said period of 10 years, the disability benefit instalments which have not fallen due will be paid along with the claim, (ii) to waive the payment of future premiums.
The waiver of premium shall extinguish all options under this Policy and also the benefit covered by para (b) of this clause. 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 120 days from the happening of such accident, result in the irrecoverable loss of the entire sight of both eyes or in amputation of the 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 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 where -abouts of the Life Assured and within 120 days after the happening of the disability there must be given to the servicing 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 continuance of such disability. Any Medical Examiner nominated by the Corporation shall be allowed to examine the person of 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 this case there is no medical certificate to show that the complainant has suffered total and permanent disability. The case is covered by the judgment of this Commission in Ajay Kumar v. Life Insurance Corporation of India and Anr., I (2007) CPJ 230 (NC), Revision Petition No. 1511 of 2005, decided on 8th January, 2007, wherein it was held that it is very clear from the certificate given by the Railway Authorities that disability is to the extent of 81% and it is partial. Further, in this connection this judgment also refers to the decision of this Commission in LIC of India v. Ramesh Chandra, II (1997) CPJ 45 (NC)=1997 (2) CPR 8 (NC), wherein it is stated that disability to get insurance benefits under this clause, the disability must be total and permanent. Similar view was held in Shri Ajay Kumar v. LIC and Anr. (supra).
AS the ratio of the above judgments are squarely applicable to the case on hand, this Revision Petition is allowed. The orders of the fora below are set aside. There shall be no order as to cost. R.P. allowed.