Complainant/petitioner obtained three insurance policies of Rs.2 lakh from the respondent insurance company with accident benefits of Rs.1 lakh.  He met with an accident on the road on 14.10.1994 and suffered grave injuries.  According to the petitioner, he was permanently disabled.  He submitted his claim for accident benefits to the insurance company, which was repudiated on the ground that the injury suffered by the petitioner was not permanent, disabling him totally rendering him unfit to take up any work/occupation/profession thereafter.  Aggrieved by the repudiation of the claim by the respondent, complainant filed a complaint before the District Forum.

          District Forum, vide its order dated 20.3.2001, allowed the complaint and directed the petitioner to pay Rs.1 lakh towards accident benefit with interest at the rate of 9% per annum.

          Aggrieved by the order passed by the District Forum, respondents filed appeal before the State Commission.  State Commission, by the impugned order, allowed the appeal, set aside the order of the District Forum and dismissed the complaint.

          Counsel for the parties have been heard.

          Clause-10 of the policy reads as under :

“Disability to the Life assured :- (i) to pay in monthly instalment spread over 10 years an additional sum equal to the sum assured under this policy.  If 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) waiving payment of future premiums.

The maximum aggregate limit of assurance under all policies on the same life to which benefits (i) and (ii) above apply shall not in any event exceed Rs.1,00,000/-.  If there be more policies than one and if the total assurance exceeds Rs.1,00,000/- the benefits shall apply to the first Rs.1,00,000/- sum assured in order of date of the policies issued.

The waiver of premiums shall extinguish all options under this policy except as to such assurance, if any, as exceeds the maximum aggregate limits of Rs.1,00,000/- and which may have been kept in force by continued payment of premiums and the benefits 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 ninety days from the happening of such accident result in the irrecoverable loss of the entire sight or 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 also be deemed to constitute such disability.”

          It is clear from reading of the relevant part of Clause-10 of the policy that to get the benefit for disability, disability has to 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. 

On 21.4.2009, the case was adjourned for today to enable the counsel for the parties to ascertain as to whether the petitioner/complainant, after accident had gone back to his work to earn his livelihood or not.  Counsel for the respondent has produced a letter from the office of Forest Officer, Rajnandgaon addressed to the LIC in which it is clearly stated that the petitioner Rajaram Mishra was on leave from 15.10.1994 to 4.10.1995.  He had also been sanctioned Rs.10,000/- as part-withdrawal from Provident Fund.  Not only that he remained in service throughout but he was promoted by order of the Government dated 8.6.2007 from the post of Deputy Ranger to the post of Ranger.  It has been further stated in the said letter that the petitioner retired from that post on 31.10.2008 with all retiral benefits.  The letter shows that the disability suffered by the petitioner was not permanent which resulted in rendering him unfit to take up a job/occupation/profession then or any time thereafter.  Petitioner, after suffering the injury, was taken back in service.  He was promoted and retired from service on 31.10.2008 with full retiral benefits.

In view of the above, we do not find any error in the order passed by the State Commission.  Dismissed.