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Judgment
THE Insurance Company has filed this appeal challenging the order of the Cuttack District Forum directing it to pay a sum of Rs. 45,000/ - to the respondent.
THE respondent filed complaint claiming a sum of Rs. 1,00,000/ - as compensation from the appellant. His case is that in the year 2002, he had taken the Janata Personal Accident Policy from the appellant for a period of one year (6.2.2002 to 6.2.2003). On 3.5.2002 while he was going from Pipili to Bhubaneswar by an auto -rickshaw a Maruti car dashed against the auto -rickshaw. As a result of the said accident, his right leg was fractured for which he was brought to the Capital Hospital. He was later shifted to the S.C.B. Medical College where he remained as an indoor patient from 3.5.2002 to 19.6.2002. He accordingly claimed Rs. 1,00,000/ - as compensation for the injury sustained by him.
The appellant in its written version pleaded that the insurance policy does not cover the injury sustained by the respondent. The discharge certificate indicated that he had only suffered from composite fracture on the right leg and there was no separation of limb. Since the injury does not come within the scope of the Janata Personal Accident Policy, the respondent is not entitled to any compensation.
THE District Forum held that the respondent suffered from composite fracture of right leg for which he was under treatment in the hospital for more than 45 days. The percentage of disability was 55% and accordingly the District Forum granted a sum of Rs. 45,000/ - as compensation in favour of the respondent.
COUNSEL for the appellant contended that the Janata Personal Accident Insurance Policy taken by the respondent does not cover the injury sustained by the respondent. Therefore, the District Forum erred in granting compensation relying on the aforesaid policy. It is not in dispute that a policy of insurance is purely a contract between the insurer and insured. Both parties are bound by the terms and conditions of the policy. The relevant portion of the policy states that the Insurance Company shall indemnify the insured if he sustains the following bodily injury resulting solely and directly from the accident: ''(a) If such injury shall within six calendar months of its occurrence be the sole and direct cause of the death of the insured the capital sum insured stated in the schedule hereto. The amount payable under this clause shall be paid to the nominee shows on the policy. (b) If such injury shall within six calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of sight of both eyes, or of the actual loss by physical separation of two entire hands or two entire feet, or of one entire hand and one entire foot, or of such loss of sight of one eye and such loss of one entire hand or one entire foot, the capital sum insured stated in the schedule hereto. (c) If such injury shall within six calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of sight of one eye or of the actual loss by physical separation of one entire hand or one entire foot fifty percent (50%) of the capital sum insured stated in the schedule hereto. (d) If such injury shall within six calendar months of its occurrence by the sole direct cause of permanently, totally and absolutely disabling the insured from engaging in, being occupied with or giving attention to any employment or occupation of any description whatsoever the capital sum insured stated in the schedule''
From the above, it may be seen that Clause ''a'' deals with the case of a death. Clause ''b'' deals with such injury on account of which there was loss of sight of both eyes, actual loss by physical separation of two entire hands or two entire feet etc. Clause ''d'' deals with injury of permanent disability. Clause ''c'' deals with injury on account of which there is loss of sight of one eye, or physical separation of one entire hand or one entire foot, respondent admittedly had composite fracture of his right leg and the percentage of disability was 55%. Such injury is not covered by any of the clauses of the insurance policy mentioned above. Since parties are bound by terms and conditions mentioned in the policy and the injury sustained by the respondent does not come within any of the clauses mentioned above, the District Forum clearly exceeded in its jurisdiction in granting compensation.
OUR order does not however stand on the way of the respondent from approaching any other Forum available under law to claim compensation for the injury sustained by him.
IN the result, we set aside the impugned order, dismiss the complaint and allow this appeal. No costs. Appeal allowed.