By Sri. Chandran Alachery, Member:

The complaint is filed under section 12 of Consumer Protection Act for an order directing the Opposite parties to pay Rs.2,00,000/- as policy amount to the Complainant with 12% interest and also to pay compensation of Rs.50,000/- with 12% interest and also cost of the proceedings.

2. Complaint in brief:- On the advice of 1^st Opposite party, the Complainant joined in to an LIC policy named “New Bima Gold” on 11.06.2008 with 2^nd Opposite party. On 28.06.2010 at about 6 pm, when the Complainant was going to his house, a wild elephant attacked him and he sustained serious injuries and was referred to Medical College Hospital, Kozhikode and under gone two major surgeries. The Complainant was not able to speak and now continuing treatment at Kasthurba Medical College. The Complainant is an illiterate person and is a coolie worker. Now the Complainant cannot do any work. The Complainant spend Rs.2,00,000/- for treatment. For further treatment, the Complainant needs more than Rs.1,00,000/-. The Complainant send claim application through Opposite Parties to Divisional Office, LIC, Kozhikode. But the Opposite party did not pay the claim amount. The reason for repudiation is that the complainant did not produce permanent disability certificate. Aggrieved by this the complaint is filed.

3. On receipt of complaint, notices were issued to Opposite parties and Opposite parties appeared before the Forum and filed version. In the version of 1^st Opposite party, 1^st Opposite party contended that the Complainant is bound by the terms and conditions of policy. The petitioner had taken the policy voluntarily. The 1^st Opposite party admits the issuance of policy to Complainant with sum assured Rs.1,00,000/-. The Complainant could not produce permanent disability certificate for EPDB ie excluded permanent disability benefit. The produced treatment certificates shows that the Complainant is not able to speak and that is the only disability and there is a mention in the certificate that there is chance for recovery within 6 months and in another report there is chance for recovery within one year. The LIC policy claim is available only on death of insured or in permanent disability. But in this case, the Complainant do not have permanent disability. In the version of 2^nd Opposite party, the 2^nd Opposite Party also contended the same contention raised by the 1^st Opposite Party.

4. On perusal of complaint, version and documents, the Forum raised the following points for consideration.

1. Whether there is deficiency of service from the part of Opposite Parties?

2. Relief and cost.

5. Point No.1:- The Complainant filed proof affidavit and is examined as PW1 and documents are marked as Exts.A1 to A8. The 2^nd Opposite Party also filed proof affidavit and is examined as OPW1 and documents are marked as Exts.B1 to B3. Ext.A1 is the policy. Ext.A2 is the petition filed for getting claim before Legal Service Authority, Mananthavady. Ext.A3 is the proceedings of TLSC, Mananthavady in the above petition. Ext.A4 is the identity card issued to Complainant for disabled person. In Ext.A4 the percentage of disability is shown as 80%. The clause 11 of the policy showing accident benefit, its conditions and this portion is marked as Ext.B1. On going through Ext.B2 and B3 documents, it is seen that in Ext.B2 the disability of the Complainant will be recovered fully within one year. In Ext.B3, the recovery will be there within 6 months. In both these certificates, there is no mention regarding permanent disability sustained to the complainant. As per Ext.B1 condition it is seen that the Opposite parties are liable to pay the insurance amount only on the death of insured or on the permanent disability. In Ext.A4, the percentage of disability is shown as 80%. But there is no mention in Ext.A4 that the complainant have permanent disability. The 2^nd Opposite Party produced two rulings of Hon'ble National Consumer Disputed Redressal Commission, New Delhi. The ruling cited in 2003 II CPJ102(NC) it is stated that insurance disability benefit, the Hon'ble National Consumer Disputes Redressal Commission ruled that the disability must be total and permanent to claim disability benefit. In another ruling , the Hon'ble National Consumer Disputes Redressal Commission ruled that the policy is a contract and the conditions thereof are binding on both parties. Loss of sight of one eye suffered by life assured cannot be treated as a permanent disability within the meaning of the said clause. On perusal, the Forum found that the Complainant is not totally disabled due to the injury. The Forum analysed that the Complainant can speak but not well. It does not mean that the Complainant have total permanent disability due to injury. On analysis the entire evidence, the Forum found that the Complainant do not satisfy the terms and conditions as stated in the policy contract. Hence the repudiation of claim by the Opposite parties do not give rise to deficiency of service from the part of Opposite Parties. Point No.1 is found accordingly.

6. Point No.2:- Since point No.1 is found against the Complainant, the Complainant is not entitled to get cost and compensation.

In the result, the complaint is dismissed. No order as to costs.

Dictated to the Confidential Assistant, transcribed by him and corrected by me and Pronounced in the Open Forum on this the 21^st day of July 2015.

Date of Filing:07.05.2012.

PRESIDENT :Sd/-

MEMBER :Sd/-

MEMBER :Sd/-

/True Copy/

PRESIDENT, CDRF, WAYANAD.

APPENDIX.

Witness for the complainant:

PW1. Chinnu. T.D Complainant.

Witness for the Opposite Parties:

OPW1. Narayana Naik. Manager, LIC of India, Divisional Office,

Kozhikode.

Exhibits for the complainant:

A1. Policy Schedule.

A2. Copy of complaint. dt:05.04.2011.

A3. Proceedings of Taluk Legal Services Committee, Mananthavady. dt:14.05.2011.

A4. Identity Card for Disabled.

A5. Copy of Certificate. dt:17.11.2011.

A6. Reference Card.

A7. Reference Card.

A8 (83 in Nos) Bills.

Exhibits for the opposite Parties.

B1. 3^rd Page of Policy Schedule.

B2. Copy of Medical Report. dt:9.11.2010.

B3. Copy of Medical Report. dt:01.03.2011.