No. 9/11.08.2011.

HON’BLE JUSTICE SRI PRABIR KUMAR SAMANTA, PRESIDENT.

Both sides are present through their Ld. Advocates.  Respondent No. 2 files BNA.

The Complainant is the beneficiary of the insurance cover that was taken by the O.P. No. 1 namely Golden Trust Financial Services from the Appellant – Insurer covering the risk of accidental death/loss of limbs/permanent total disablement of the Complainant beneficiary for an overall capital sum insured for Rs.1,00,000/-.

In the complaint case it has been alleged by the Complainant that he met with an accident on 19.07.2003 sustaining injury in his left knee.  The said accident occurred at the factory premises where the Complainant was employed.  After the accident he was admitted to ESI Hospital at Budge Budge wherefrom he was referred to ESI Hospita, Maniktala for better treatment.  He was further referred to S.S.K.M. Hospital for further treatment.  It has been alleged by the Complainant that because of such injury he has become permanently disabled and as such he is entitled to the permanent disablement benefit to the extent of the sum insured as above.

Interestingly the claim as submitted by the aforesaid Golden Trust Financial Services who took the insurance cover from the Insurer with the Complainant as the beneficiary of the said insurance did not contain any medical certificate and/or doctor’s certificate showing permanent disability of the Complainant due to such accident.  The claim form as submitted by the Complainant with the Insurer – Appellant on the other hand recorded the version of the authorities of ESI Hospital at Maniktala that the Complainant did not loss any limb or eyes or suffer any permanent disability of any other type which may prevent the insured from engaging or being occupied with or giving attention to any permanent occupation due to the accidental injury suffered by him. 

At the hearing of the complaint case the Complainant has also not produced any material document whatsoever to establish that he had suffered a permanent disablement or any other disablement that has been covered under the aforesaid insurance policy.  In the absence of such material evidence the permanent disability or any other type of disability making the Complainant unable to lead a normal life cannot be presumed only on the basis of the allegation made in his complaint. 

We are, therefore, of the view that the findings as made by the Forum below holding the Complainant as permanently disabled is absolutely perverse.  The same, therefore, cannot be sustained.  We, therefore, set aside the impugned judgement and order allowing the claim case  as filed by the Complainant.  The appeal is thus allowed.

However, it is made clear that the Complainant would be entitled to make a fresh claim if he is still entitled to do so on the basis of any document and/or medical certificate showing that he has suffered a permanent disability in such accidental injury.