Life Insurance Corporation of India vs PILLA APPANNA

THE insured filed C.D. No. 60 of 2001 before the District Forum, Visakhapatnam against the Life Insurance Corporation (petitioner). It was contended that he had taken out two policies; one Jeevan Medical Policy for a sum of Rs. 50,000/- and the other is Non-medical Policy for a sum of Rs. 25,000/- commencing from 28th March, 1994 under ''salary saving scheme'' and they were to mature on 28.3.2019.

ON 15.2.2000 when the complainant was working in a ship at Hatch No. 1, he met with fire accident and sustained 75% burns while he was in employment. He was treated in Seven Hills Hospital for seven months in intensive care unit and was discharged on 1.6.2000. Thereafter he sent a letter to the Branch Manger of the LIC Ship Yard Branch, with all the particulars. The Ship Yard Branch advised him by letter dated 8.11.2000 to approach Port Branch Office. As no reply was received and the claim was not settled, complaint was filed. It was contended by the L.I.C. before the District Forum that the complainant failed to furinsh full details of disability and of treatment undergone for considering the disability benefit under the two policies.

The District Forum negatived the said contention by observing that Exhibit B-3 is a discharge slip received by the Insurance Company in which it is specifically stated that the complainant was admitted in the hospital with 75% mixed flame burns sustained accidentally while working in the ship, burns have involved all areas except the upper thighs; the patient was treated conservatively with I.V. fluids, dressing medicines; he was treated conservatively with I.V. fluids dressing and medicines, he improved dramatically from shock and septic wound; skin grafting was done for raw area of both the upper and lower limbs; patient developed bed sore. On the date of discharge as on 1.6.2000 diagnosis was 75% flame burns.

AT the time of hearing before the District Forum complainant produced medical certificate issued by Civil Surgeon of King George Hospital, Visakhapatnam. The certificate is in respect of orthopaedically handicapped candidates having 60% disability. Thereafter, the District Forum arrived at the conclusion that failure to reply and failure to settle the claim amounts to deficiency in service on the part of the LIC and that there was negligence in asking the complainant to produce the required information to settle the claim. Thereafter, the District Forum, by judgment and order dated 26th September, 2001, directed the LIC to pay the ''assured sums'' of Rs. 50,000/- and Rs. 25,000/- with interest at the rate of 18% p.a. from 8.11.2000 till the date of realisation. It also awarded costs of Rs. 1,000/-.

THE LIC preferred First Appeal No. 840 of 2001 before the State Commission. THE State Commission also relied upon the certificate, Exhibit B-3 and the certificate issued by the Civil Surgeon of King George Hospital, Visakhapatnam, in which the disability was shown at 60%. THE State Commission observed that the LIC has not produced any other evidence for negativing the claim, hence confirmed the order passed by the District Forum, but reduced the rate of interest from 18% to 9%, by its judgment and order dated 1.4.2003. Hence, this Revision Petition by the LIC. From the contentions raised by the LIC and the vigour with which the case is pursued it appears that it wants to take undue advantage of destiny saving the life of a person who sustained 75% serious burns on all parts of the body except upper thigh while in employment in the Visakhapatnam Ship Yard which is a Government of India Undertaking and was discharged from the hospital on 1.6.2000. Doctor in his certificate has stated that he improved dramatically.

IN the written submissions filed before this Commission relevant part of Clause 10 of the terms and conditions of the policy are reproduced as under: "10. Accident Benefit-If at any time when this policy is in force for full sum assured, the life assured before the expiry of the period for which the premium is payable or before the policy anniversary on which the age nearer birthday of the life assured is 70, whichever is earlier, 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 sum assured 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 except as to such assurance, if any as exceeds the maximum aggregate limit of Rs. 5,00,000/- and which may have been kept in force by continued payment of premiums, and the benefit covered by (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 one-twenty 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 deemed to constitute such disability."

THE learned Counsel for the LIC submitted that the complainant is continued on the job and, therefore, is not entitled to get accident benefit. It is true that the complainant''s employer has permitted him to get the salary every month on compassionate ground as it is Government of India Undertaking and as the complainant suffered during his employment. That does not mean that he loses the benefit available under the contract of insurance. It is quite possible that a private employer or the LIC would not have continued such person in service. But, payment of wages on compassionate ground to a person who has lost capacity to work would hardly be a ground for non-payment of accident benefit to the assured. In any case, in the present case, the Consumer Forum has not granted him double benefit as contemplated. It has only directed the LIC to pay the sum assured and not the additional instalments payable for a period of ten years.

Secondly, the learned Counsel rightly pointed out that the LIC has not challenged the medical certificate filed by the complainant nor cross-examined the Doctor (the Civil Surgeon). It is, inter alia, submitted that Corporate body like the LIC ought not to have taken advantage and delayed the payment. It was, therefore, prayed that in the interest of justice Revision Petition be dismissed as the Corporation can litigate for years together.

TAKING overall view of the matter, in the interest of justice this revision petition is dismissed. There shall be no order as to costs. Revision dismissed.