New India Assurance Co. Ltd. vs MUTHAIYAN

THE 1st opposite party in O.P. No. 59/2002 on the file of the District Consumer Disputes Redressal Forum, Nagercoil, is the appellant herein. THE case of the complainant was as follows: (a) THE complainant a member of Poothurai Fishermen Co-operative Society, in Kanyakumari District took a group personal Accident Insurance Policy From opposite party No. 1 along with other fishermen registered with various co-operative societies and as per the records available at the office of the Assistant Registrar of the Fisheries at various places. THE policy for the period from 25.3.2000 to 24.3.2001 covering all the members as per the records of the Fisheries Department came to be issued. THE sum insured under the policy in respect of each member was Rs. 15,000. On 15.6.2000 at 6 a.m., when he had gone to the sea in catamaran for fishing, a tidal wave of the sea dashed against him and his catamaran resulting in grievous injury over his right upper limb. He was brought to the sea shore and he was taken to hospital for treatment. He got permanent disability and the percentage was 70%. Investigations by the police also confirmed causation of the injury sustained by him. A claim was made to the 1st opposite party. THE 1st opposite party took the stand that as per the doctor''s certificate, the complainant had sustained dislocation of right upper arm and he was given treatment by open reduction with place and screws and the doctor had opined that the injury was a grievous one. THE injury had caused only a partial loss. THE 1st deposit party had issued a policy for Rs. 15,000 to the complainant. After the occurrence, the complainant had forwarded the claim papers through the 2nd opposite party. THE policy covered only permanent total disability and the complainant having suffered only partial disability nothing was payable. In any event, if the complainant was aggrieved, he could approach the Civil Court for appropriate remedies.

THE 2nd opposite party took a stand that the complainant had not paid any amount for insurance policy through their society and the complaint was liable to be dismissed. The District Forum found that the 1st opposite party was liable that there was total permanent disability of right upper limb i.e., 70% as a result of catamaran injury. The doctor had issued a certificate stating that the complainant could not swim using his right arm and, therefore, he would not be able to perform his fishing job for his livelihood. The District Forum by order dated 30.1.2003 directed the opposite party to pay Rs. 1,82,500 together with sum of Rs. 5,000 as compensation. It is as against that the present appeal has been filed.

The learned Counsel for the appellant/1st opposite party submitted that this was not a case of total permanent disability and only when there was total permanent disability there could be a claim made and the person compensated. Even otherwise, according to learned Counsel the District Forum was in error in awarding such a large sum of Rs. 1,82,500 for an alleged partial disability at 50% as certified by the doctor and if at all the complainants would be entitled to only half of Rs. 15,000 i.e., Rs. 7,500 for 50% disability. The individual share of every policy holder being only Rs. 15,000.

WE have gone through the materials on record. WE are satisfied that the District Forum was in error in directing the 1st opposite party to pay Rs. 1,82,500 together with compensation of Rs. 5,000 and also cost. WE are at a loss to find as to how the District Forum had arrived at such a large sum. If at all the complainant would be entitled to a maximum of Rs. 15,000. It was a group insurance and the total payable in respect of the members of the group was Rs. 3,75,000. Apparently, the District Forum had made a mistake that the total amount could be claimed in respect of a single individual for disability in any accident. The District Forum ought not to have awarded such a large sum as compensation. It is seen from the records that the complainant had suffered 50% partial permanent disability. It is also seen he will not be in a position to swim in water and consequently he would not be in a position to fish. In these circumstances, we deem it proper to direct the 1st opposite party to pay a sum of Rs. 7,500 with interest @ 12% p..a from the date of accident namely 15.6.2000 till date of payment. Consequently, the appeal shall stand allowed in part and instead of Rs. 1,82,500 directed by the District Forum, the complainant would be entitled to Rs. 7,500 with interest @ 12% p.a. from the date of complaint till payment. The order of the District Forum directing payment of compensation will stand set aside. The order as to payment of cost will stand. The appeal is disposed of accordingly. No cost. Appeal partly allowed.