1. This Revision Petition No. 295 of 2016 challenges the impugned order of Punjab State Consumer Disputes Redressal Commission, Chandigarh (‘the State Commission’) dated 08.10.2015 vide which, the State Commission allowed the First Appeal No.450 of 2014 and set aside the order of the District Consumer Disputes Redressal Forum, Bathinda (‘the District Forum’) dated 12.02.2014. 2. Brief facts of the case, as per the Complainant, are that he purchased an Accident Guard Policy from OP-1&2 for a sum assured of Rs.25,00,000/- for the period from 28.12.2012 to 27.12.2013. The Complainant suffered an accident on 06.03.2013, resulting in injuries to his middle and ring fingers that required amputation. This disability was certified by a medical professional, indicating an 8% disability. The Complainant contended that he is entitled to compensation under the policy terms for this disability, amounting to 10% of the sum assured, which is Rs.2,50,000/-. However, the Opposite Parties (the OP-insurer) have disbursed only Rs.30,000/-, which the Complainant claims is insufficient and not aligned with the terms of the policy. Being aggrieved, he filed a Consumer Complaint before the learned District Forum seeking balance compensation of Rs.2,20,000/- as part of his claim, along with additional Rs.50,000/- as compensation for hardship endured due to accident, and Rs.5,500/- towards costs. 3. In Reply, the Opposite Party (OP) No. 1 & 2 acknowledged that the Complainant obtained the policy through OP-3 and suffered injuries resulting in the dismemberment of his middle and ring fingers. The Complainant had opted for specific type policy coverage such as "Accidental Death & Dismemberment" and "Weekly Indemnity Up to 52 Weeks" by paying the corresponding premium. The "Accidental Dismemberment" coverage under the policy only applies to the loss of thumb and index finger, not the middle finger and ring finger that he lost. Therefore, he is not entitled for compensation under the policy for loss of his middle and ring fingers. OP-1&2 stated that he has already been compensated for the "Weekly Indemnity" as per the policy terms and is not eligible for any further amount beyond what has been paid. They alleged that the Complainant is attempting to benefit from a section of the policy ("Permanent Total Loss of Use") that he did not opt for and did not pay premiums towards. The Complainant misrepresented the facts before the District Forum. OP-1 & 2 requested the dismissal of the complaint under Section 26 of the Act, citing that the complaint is false, frivolous, and based on concealed material facts. 4. The learned District Forum, vide order dated 12.02.2014, allowed the complaint and directed the OP-1 and 2 as under: “6. The undisputed facts of the parties are that the complainant has purchased one accident guard policy bearing No.0200114697 00 of the opposite party Nos.1 and 2 with client ID No.6554431, w.e.f 28.12.2012 to 27.12.2013 against the principal sum assured of Rs.25 lacs, in his name, from the opposite party No.3 and deposited the premium of Rs.3170/-. As per the terms and conditions of the abovesaid policy, the complainant is entitled to the compensation in case of any accident. The complainant met with an accident while cutting the fodder for the cattle, due to this his right hand came in the fodder cutting machine, resulting in crushing of his middle and ring finger of the right hand on dated 6.3.2013. The complainant lodged the claim with the opposite parties No.1 and 2 through the opposite party No.3, they have paid him the claim amount of Rs.30,000/- only. 7. The disputed facts of the parties are that as per the disability certificate issued by Dr.Dhiraj Goyal, MBBS, MS (Ortho), Civil Hospital, Bathinda, the complainant has become a disabled person upto the extent of 8%. The complainant is entitled for the compensation from the opposite party Nos.1 and 2 atleast 10% of the principle sum assured of Rs.25 lacs i.e. 5% for one joint each. The complainant is entitled for the accidental claim of Rs.2.50 lacs, out of Rs.2.50 lacs, the opposite party Nos.1 and 2 have paid him the claim amount of Rs.30,000/- and withheld the amount of Rs.2,20,000/-. As per the terms and conditions of the abovesaid policy the complainant is entitled for the compensation to the tune of 7.5% of the sum assured for two joints as per Clause No.12 under heading Coverage C-3, Permanent Total Loss of Use. 8. A perusal of Ex.C4 shows that the second and third finger of right hand cut by sharp, stitching and dressing done'. Vide Ex.C8, Disability Certificate (Obvious Disability) i.e. a valid certificate has been issued to the complainant, the columns No.B and A of this certificate shows The diagnosis in his/her case is Amputation of Right middle and ring finger and He/She has 8% (in figures) eight percent (In words) permanent physical impairment/ blindness/ hearing in relation in his/her (Part of body) as per guidelines notified by Ministry of Social Justice and Empowerment No.16-18/97-NI, I, New Delhi dated 1st June 2001 and amended from time to time'. The opposite party Nos.1 and 2 have placed on file Accident Guard-SL Schedule of Insurance, Ex.OP1/2. While settling/paying the claim to the complainant, the opposite party Nos.1 and 2 have relied upon Coverage C-2 Accidental Dismemberment, whereas as per the version of the complainant, he falls under Permanent Total Loss of Use i.e. Coverage C-3, in this coverage Clause 12 is mentioned as:- "Permanent Total Loss of Use of Fingers of either, hand a) Three Joints 10% b) Two Joints 7.5% c) One Joint 5%" A perusal of medical record placed on file shows that the complainant has suffered the loss of two joints i.e. one joint of each middle finger and ring finger of his right hand, meaning thereby his two joints of right hand have been cut. The disability certificate shows that 8% disability has been suffered by the complainant, thus he is covered under Clause 12 of Permanent Total Loss of Use of Fingers of either hand, which shows 'Two Joints:-7.5%. The policy so issued to the complainant is of the principal amount of Rs.25 lacs and he has suffered the loss of two joints. As per the Coverage C-3 of 12(B), he is entitled for the amount of Rs.1,57,500/-(7.5% of Rs.25 lacs = Rs.1,87,500/- minus Rs.30,000/- as the amount of Rs.30,000/- has already been paid to the complainant) from the opposite parties. 9. Therefore in view of what has been discussed above there is deficiency in service on the part of the opposite parties in not paying the claim amount to the complainant well within time. Hence this complaint is accepted with Rs.20,000/- as cost and compensation against the opposite parties. The opposite parties are directed to pay the amount of Rs.1,57,500/- to the complainant. 10. The compliance of this order be done within 45 days from the date of receipt of the copy of this order. 11. In case of non-compliance the interest @ 9% per annum will yield on the amount of Rs.1,57,500/- till realization.” 5. Being aggrieved by the impugned order, the Respondents No.1&2/ OP-1&2 filed an Appeal and the learned State Commission, vide order dated 08.10.2015 allowed the Appeal and set aside the order of the District Forum with following observations: “5. We have heard learned counsel for both the sides and have carefully gone through the records of the case. 6. It was submitted by the learned counsel for the appellants/ opposite party Nos. 1 & 2 that the District Forum committed an illegality, while wrongly invoking Section C-3 of the terms and conditions of the Policy; which deals with Permanent Total Loss of Use". It is very much clear from the Coverage, as mentioned in Para No.1 of that Insurance Policy Ex.C-2/Ex.OP-1/2 that he was entitled to the benefits of "Accidental Death", "Accidental Dismemberment" and "Weekly Indemnity". "Weekly Indemnity" had already been paid to him. The amputation of the middle and ring finger of the hand was not covered under the "Accidental Dismemberment" and, as such, he was not entitled to any such 10% of the total sum assured under the Policy. Such a finding recorded by the District Forum is liable to be set aside. 7. On the other hand, it was argued by the learned counsel for the complainant that no such illegality was committed by the District Forum, by recording the finding in favour of the complainant, who was entitled to the benefits, as per the terms and conditions of the Policy, which provided for 10% of the sum assured for the amputation of two fingers. There is no ground for upsetting that finding 8. A perusal of the Insurance Policy, which was proved on the record by the complainant as Ex C-2 and by the opposite parties as Ex. OP-1/2, shows that the complainant was covered for a sum of Rs.2,50,000/- in respect of "Accidental Death" and "Accidental Dismemberment" and was not covered for the "Permanent Total Loss of Use". The coverage of "Accidental Death" and "Accidental Dismemberment" is mentioned in Part-D of the terms and conditions of the Insurance Policy, proved on the record as Ex.OP-1/3. It is not being disputed that the complainant lost his middle and ring finger, while operating the "Fodder Cutting Machine". Under the Dismemberment", the following losses are mentioned:- "Accidental 158500, a) Loss of both hands or both feet, b) Loss of sight of both eyes; c) Loss of one hand and one foot, d) Loss of either hand or foot and sight of one eye; e) Loss of speech and hearing in both ears; f) Loss of either hands or feet; g) Loss of sight of one eye; h) Loss of speech; i) Loss of hearing in both ears; and j) Loss of thumb and index finger of same hand. It becomes very much clear that the "Accidental Dismemberment" of the ring finger and the index finger was not covered under the Policy. The District Forum committed an illegality, by taking into account Coverage C-3 of the terms and conditions of the Policy, which dealt with "Permanent Total Loss of Use". The complainant was not covered for that "Permanent Total Loss of Use", as he had not paid any premium for the same. Therefore, the finding recorded by the District Forum is liable to be set aside. The opposite parties did not commit any illegality, by not allowing any insurance amount for the cutting of the fingers and by allowing only "Weekly Indemnity", as per the terms and conditions of the Policy. 9. In the result, the appeal is allowed and the order passed by the District Forum is set aside. The complaint filed by the Complainant is dismissed. 10. The appellants had deposited a sum of Rs.25,000/- at the time of filing of the appeal. They deposited another sum of Rs. 1,85,151/-, vide receipt dated 30.09.2014, in compliance of the order dated 25.04.2014. Both these sums, along with interest which has accrued thereon, if any, shall be remitted by the registry to the appellants by way of a crossed cheque/demand draft after the expiry of 45 days of the sending of certified copy of the order to them.” 6. In his arguments, the Counsel for the Petitioner/Complainant reiterated the grounds in the Revision Petition and the Complaint and asserted that the Complainant is entitled the amount of 7.5% of sum assured of Rs.25 Lacs for compensation under Sub Clause 12 (b) of the Insurance Policy in question. He sought to set aside the order of the State Commission and uphold the order of the District Forum. 7. Learned Counsel for the OP-1 & 2 argued in favour of the impugned order passed by the State Commission. She admitted that the complainant had suffered injuries and dismemberment of the middle and ring finger of his right hand and that after he submitted the claim, the same was allowed to the tune of Rs.30,000/- only. The complainant had opted for “Accident Death & Dismemberment” and “Weekly Indemnity up to 52 Weeks” cover and had paid the premium accordingly. The “Accidental Dismemberment” provided cover only for the loss of thumb and index finger and not for the middle finger and ring finger. She further averred that the Complainant has already been paid the ‘Weekly Indemnity” and is not entitled to any further amount. She further contended that the complainant is trying to take benefit of Sub-Clause 12 (b) of the Insurance Policy in question which deals with “Permanent Total Loss of Use of fingers of either hand” which was never opted by him or any premium was paid for the same. She sought to dismiss the Revision Petition with costs. 8. Respondent No.3-Axis Bank Ltd. did not appear despite service and therefore it was placed ex-parte vide order dated 01.03.2017. 9. I have examined the pleadings and associated documents placed on record, including the reasoned orders of the learned District Forum and the learned State Commission and rendered thoughtful consideration to the arguments advanced by the learned Counsels for the Parties. 10. The main issue in the case revolves around the determination of compensation under the insurance policy for the injuries suffered by the Complainant, specifically the loss of ring and index fingers. 11. It is undisputed that OP-1 & 2 allowed a claim of Rs.30,000/- under the "Weekly Indemnity" component, which was in accordance with the terms and conditions of the policy. It is also undisputed that the insurance policy covered specific aspects such as ‘Accidental Death’, ‘Accidental Dismemberment’ and Weekly Indemnity. However, the loss of the ring finger and index finger does not fall under the coverage provided by the "Accidental Dismemberment" section of the policy. The Complainant did not pay any premium for coverage related to "Permanent Total Loss of Use", which is not covered under the insurance policy in question. 12. Based on the perusal of the terms and conditions and coverage of the insurance policy, the impugned order of the learned State Commission dated 08.10.2015 does not suffer from any illegality or impropriety and, therefore, upheld. Consequently, the Revision Petition No.295 of 2016 is dismissed. 13. There shall be no order as to costs. 14. All pending Applications, if any, stand disposed of accordingly. | 
