Punjab

Rupnagar

CC/16/12

Paramjit Singh - Complainant(s)

Versus

Life Insurance Corporation of India - Opp.Party(s)

Sh. Hemant Burmi, Adv.

15 Jul 2016

ORDER

BEFORE THE DISTT. CONSUMER DISPUTES REDRESSAL FORUM, ROPAR

 

                               Consumer Complaint No. : 12 of 01.03.2016

                               Date of decision                 : 15.07.2016

 

Paramjit Singh, son of Late Bhajan Singh, resident of Village Banmajra, P.O. Kurali, Tehsil Chamkaur Sahib, District Rupnagar.

 

                                                       ......Complainant

                                             Versus

Life Insurance Corporation of India, Jeevan Jyoti Building, Plot N o.191-192, Giani Zailk Singh Nagar, Rupnagar, through its Branch Manager. 

 

 

                                                                                   ....Opposite Party

 

                                       Complaint under Section 12 of the                                                           Consumer Protection Act, 1986

 

QUORUM

                             MRS. NEENA SANDHU, PRESIDENT

                             MRS. SHAVINDER KAUR, MEMBER

 

ARGUED BY

Sh. Hemant Burmi Advocate, counsel for the complainant  

 Sh. H.C. Verma Advocate, counsel for the Opposite Party   

 

 

ORDER

                                      MRS. NEENA SANDHU, PRESIDENT

                   Sh. Paramjit Singh has filed this complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’) against the Opposite Party (hereinafter referred to as ‘the O.P.’)  praying for issuance of the following directions to it:-

i)       To release the amount of the claim of the policies in question to him along with interest @ 18% per annum from the date of accident till realization.

 

ii)      To pay Rs.50,000/- on account of mental agony, physical harassment and financial loss,

 

iii)     To pay Rs.50,000/- as cost of present proceedings.

 

iv)     To award any other relief, which this Forum may deem fit.

 

2.                In brief, the case of the complainant is that that he had taken money back policy with profits plus accident benefits vide policy No. 161538660 on 21.09.2007 from OP, which was to mature on 08.10.2017. He had also taken another policy Jeevan Saral vide policy No. 165447379 on 27.05.2013, which was to mature on 27.05.2028.  He is driver by profession and is having wife and three children to look after he has no other means to earn his livelihood except the profession of driver. Unfortunately, he met with an accident on 27.03.2014 and a DDR No. 20 dated 28.03.2014 was logged at police station Morinda. After the accident he was taken to P.G.I , where his right leg was  amputated and he became disabled to the extent of 74% , as per disability certificate issued by P.G.I. Since, he was working as driver and due to amputation and disability of 74%, he cannot drive any vehicle , so his disability is to counted as 100% as per settled law. He lodged the claim with the O.P. and requested for release of the claim amount against the insurance policies. However, the O.P. vide letter dated 15.1.2016 repudiated his claim on the ground that contingency is not covered as per terms and conditions of the policy. Hence, this complaint.

3.       On being put to the notice, the O.P. has filed written version in the shape of affidavit of Smt. Hem Lata, Manager (Legal) LIC of India Divisional Office taking preliminary objections that; that the complainant has no locus standi to file the complaint; that this Forum has no jurisdiction to entertain and try the complaint; that the complainant has no cause of action against the answering O.P, thus, complaint is not maintainable; that there is no deficiency in service on the part of the O.P. On merits, it is stated that it is correct that certificate of disability is of 74% and the Board shall reassess the disability after two years. As per policy conditions disability must be total and permanent and must be within 180 days from the date of accident, which is 27.3.2014 and hence, the complainant is not entitled to get any amount as per terms and cnditions of the policy. Since as per certificate the disability is of 74% which cannot be counted or treated as 100%. It is admitted that the claim has been filed to get the disability benefits. The claim cannot be paid to the complainant as per the norms as well as policy conditions of the O.P.  Rest of the allegations made in the complaint have also been denied and a prayer has been made for dismissal thereof, with costs, the same being without any merit.

 

4.                On being called upon to do so, the learned counsel for the complainant tendered his affidavit, Ex. C1, along with photocopies of documents, Ex.C2 to Ex.C6 and his counsel closed the evidence. On the other hand, the learned counsel for the O.P.  tendered affidavit of Smt. Hem Lata, Manager Ex.OP1 along with photocopies of documents Ex.OP-2 to Ex.OP-11 and closed the evidence. 

5.                We have heard the learned counsel for the parties and gone through the record of the file, carefully.

8.                At the outset, the learned counsel for the O.P. argued that as per disability certificate, the disability of the complainant is 74% and same cannot be treated as 100% as alleged by the complainant. As per policies condition, the disability referred above 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 180 days from the happening of such accident, result in the irrecoverable loss of the entire sight of both eyes, or in amputation of both hands at or above the wrists or in the amputation of both feet at or above the ankles, or in the amputation of one hand at or above the wrist and one foot at or above the ankles, shall also be deemed to constitute such disability. Therefore, as per terms and conditions, complainant is not entitled to get any accident benefit and the O.P. has rightly repudiated the claim vide letter dated 15.01.2016 and the complaint is liable to be dismissed with cost.  

To this effect, the learned counsel for the complainant contended that although as per disability certificate, his disability is 74% but as he was driver by profession and now after the amputation of his right leg, he cannot carry on the profession of driving, therefore, his disability has to be counted as 100%. He relied upon the judgment of the Hon’ble Apex Court, in the case of K. Janardhan Vs United India Insurance Company Ltd (2008-3) PLR 757 to contend that the the disability of the driver was adjudged as 100 per cent, who suffered 60% disability as his earning capacity was affected due to the injuries suffered by him. He was not able to drive the vehicle. Therefore, in this case also, the disability of the complainant has to be assessed 100%. He further contended that the Hon’ble Apex Court by relying on the judgment in the case of Partap Narain Singh Deo Vs Shrinivas Sabata, 1976 A.C.J. 141 (SC), has held that “driver suffered amputation of right leg upto knee joint. High Court found that as per schedule I it amounted 60% of the earning capacity. Held had suffered a 100% disability.

Applying the ratio of the cited judgments to the facts of the present case, we are of the opinion that complainant herein has also suffered 100% disability and incapacity in earning as a driver as his right leg had been amputated from below knee. Additionally, a perusal of Sections 8 and 9 of the Motors Vehicles Act, 1988, would show that the complainant would now be disqualified from even getting a driving licence.

 From the copy of Insurance Policy, Ex.C2/OP-2, it is evident that complainant had purchased policy bearing No.165447379 on 27.5.2013 for sum assured of Rs.81,005/-, death benefit sum assured for Rs.1,25,000/- and accident benefit sum assured for Rs.1,25,000/- having maturity date 27.05.2028. From the copy of the insurance policy, Ex.C3/OP-3, it is evident that complainant had also purchased another policy bearing No.161538660 on 08.10.1997 for sum assured of Rs.30,000/- having maturity date 08.10.2017. In this policy, it is mentioned that it is a money back policy with profits + accidental benefits. Thus, it is evident that complainant is entitled to get accident benefit in both the policies. For the policy bearing No.165447379, complainant is entitled to get accident benefit sum assured of Rs.1,25,000/- as mentioned on the policy document. In policy bearing No.161536660 no specific amount has been mentioned for the accidental benefits. However, in term No.10 (a), of insurance policy, Ex.OP-4, disability to the life assured: it is mentioned that “The maximum aggregate limit of assurance under all the policies on the same life to which benefits (i)  and (ii) above apply shall not in any event accede Rs.5,000,00/- if there be more policies, then one and if the total assurance accede Rs.5,000,00/- the benefit shall apply to the first Rs.5000,00/- sum assured in order of the date of the policies issued”.

          Taking these facts and circumstances into consideration, we are of the opinion that complainant is entitled to get the accidental benefits in both the insurance policies purchased by him. He is also entitled to get compensation on account of mental agony and physical harassment suffered by him along with litigation expenses.

          In view of the aforesaid discussion, we allow the complaint against the O.P. and direct the O.P. in the following manner:-

i)       To release the amount of claim in both the policies.  

          ii)      To pay Rs.10,000/- as compensation.

          iii)     To pay Rs.5000/- as litigation expenses.   

The O.P is further directed to comply with the above said directions within 30 days from the date of receipt of certified copy of this order, failing which the O.P. shall pay interest @ 9% per annum on the due amount from the filing of the complaint till its realization.

 10.             The certified copies of this order be supplied to the parties    forthwith, free of costs, as permissible under the rules and the file be indexed & consigned to the Record Room.

 

ANNOUNCED                                                                      (NEENA SANDHU)

Dated          15.07.2016                                                PRESIDENT

 

 

                                                (SHAVINDER KAUR)

                                                                     MEMBER.