BEFORE THE DISTRICT FORUM:KURNOOL

Present: Sri.P.V.Nageswara Rao,M.A.,LL.M., President(FAC)

And

Smt. C.Preethi,  M.A.LL.B., Lady Member

And

Sri. M.Krishna Reddy, M.Sc.,M.Phil., Male Member

Thursday  the 24^th  day of September, 2009

C.C. 132/08

 Between:

H.Abdul Gafoor, S/o. Kaja Hussain

R/o. Pyalakurthy(v), Kodumur(M), Kurnool District.                        

                …Complainant

-Vs-

1.             The Sr. Divisional Manager,

          LIC of India, D.No. 1-55, Post Box No. 10, Jeevan Prakash,           College Road, Kadapa - 516 002

2.       The Branch Manager, LIC of India Yemmiganur Branch,

          D.No.1/1295,  Yemmiganur - 518 360,      Kurnool District.

3.       The Branch Manager,  LIC of India Kurnool Branch,

          D.No.40-36-3, River View Colony, Kurnool - 518 001.

                      …Opposite Parties

                          This complaint is coming on this day for orders in the presence of Sri. K.Lokeswara Rao , Advocate, for the complainant , and Sri. I.Ananta Rama Shastry, Advocate for opposite parties and upon perusing the material papers on record, the Forum made the following.

ORDER

(As per Sri. M.Krishna Reddy, Male Member)

C.C.132/08

1.     The complaint had been filed U/s 12 of C.P Act, 1986 seeking direction  against opposite parties for the payment of claim, claimed under different heads.

2.     The case in brief, the complainant Abdul Gafoor insured his life with opposite parties 2 and 3 taking five policies as under.

S.NO.      P.No.       Sum Assured          DOC         OP.No.        Table

1.       652588419    Rs.1,00,000/-      28.08.2001     2           75-20

2.       652575844   Rs.25,000/-          28.03.2000     2           14-10

3.       652588832   Rs.1,00,000/-       28.05.2001     2           106-15

4.      651401921    Rs.25,000/-          24.10.1994     3            75-20

5.       660329957    Rs.10,000/-         28.03.1994     3             91-15

3.  The complainant stated that he paid premiums regularly without any default any time. Unfortunately on 01-11-2004 he met with an accident while travelling in a lorry and sustained multiple grievous injuries alol over the body crush injury to his left leg.  Later his lefu leg was amputated above the knee in government General Hospital, Kurnool. He submitted that the District Medical Board, Kurnool, also iddued a disability certificate to him stating 80% disability. The complainant avered that an account of his permanent disability he is entitled for additional sum assured payable in 10 monthly installments  spread over 10 years and is also exempted from payament of future premiums.  HE submitted that he preferred his claim in the yeat 2005 claiming refund of sum assured under accordingly submitted all necessary documents as required by O.P. NO.2 and O.P No.3 with claims so far. Hence the complainant get legal notice dated 11-07-2007 issued  to O.P No.1 to settle claim under above five policies.  He verred that the two policies 651401921 and 6603291957 were surrenderes by the  complainant in the month of September 2006 and December 2007 respectively by receiving the paid up value. The complainant stated that he never intended to surrender his policies as he has already put the claims, claiming the benefits on account of his permanent disability. The version of O.P No.3 that he is not liable to ay anything to the complainant is absolutely false and intended to avoid his liability. Pertaining to the policies of Yemmiganur branch O.P.No.2 or O.P.No.1 did not give any reply. Therefore the callous and apathetic bonus as per the terms and conditions, policies compensation for mental agony.

4.     Persuant to the  receipt of the notice of this forum, the opposite parties made their appearance through their counsel and contested the case filing written arguments denying the liability to the complainants claim and seeking dismissal of the complaint.

5.     The O.P.NO. 1 in his written arguments resisted the claim of the complainant and the defence set out in brief as follows.

6.   The opposite parties admitted the taking of five policies and also involving in the accident by the complainant on 01-11-2004.  They also admitted the amputation of left leg of complainant and sustaining 80% disability. But the opposite parties contended that as per policy conditions clause 10 (A) the amputation of one leg does not constitute permanent disability.  They also alleged that the two policies of Kurnool branch bearing Nos.651401921 and 660329957 were surrendered by the complainant on 01-09-2006 and 21-12-2006 respectively receiving cheques which were encashed by the complainant. The opposite parties agreed that the three policies if Yemmiganur branch bearing Nos. 652588419 (Rs.1 lakh), 6525575844 (R.s25,000) and 652588832 (Rs.1 lakh) are in force. But they pleaded that the disability certificate  and the evidence of the doctor will not give any protection to his claim.  Hence there is no arguments of O.P.No.1 was adopted by O.P No.2 and O.P No.3.

7.     To prove the case of the complainant Dr.Umanatha Rao, Orthopedic Surgeon, who treated he complainant in Govt., General Hospital, Kurnool from 03-11-2004 to 13-01-2005 was examined as PW.1 and these documents the complainant also had got marked Ex.A6 to A10 to support his case.

8      On behalf of opposite parties to support their case the affidavit and documents marked as Ex.B1 to B4 were filed.

9.  Now the point for consideration is whether disability sustained by the complainant comes under permanent disability or not? And whether the complainant is entitled for the benefits available in the policies under permanently disability category ?

10.    The complainant contended that he suffred multiple injuries including crush injury of his left leg, fracture of left shoulder region and fracture of right leg in a road accident on 01-11-2004. The left leg was amputated above the knee at Govt., General Hospital, Kurnool and (Ex.A5),disability certificate with 80% disability was issued to him by District Medical Board, Kurnool. In addition to 80% disability  (Ex.A5), Ex.A1 to A4, Ex.X1 and the evidence of P.W.1 stating that the complainant suffered fracture in left  hand and fracture in complainant is unable to walk and not able to do any work and would also support that he is permanent and totally disable.

11.    The counsel for complainant relied on authorities (2009) CPJ 246, (2007) CPJ 48 (NC) and (1998) CPJ 498 and submitted in support of his case.  In the above authorities it was stated that if there was ambiguilty interms of policy that should be interpreted infavour of the insured. It was futher stated that the condition (10) of the policy should be interpreted for the benefit of the assured as it would serve the purpose and object of getting  insurance coverage. It was also pointed the necessity of officers of LIC to change their negative also pointed the necessity of officers of LIC to change their negative approach in dealing with the claims of this  type and avoid litigation. It was also averred that permanent disability is permanent reduction of the injured persons power to earn money resulting from injury. If one limb in amputated the person cannot do the job the same. Same manner as a person having both limbs. Therefore these would be a reduction in his power to earn and for that aspect the case of amputation of one limb should be treated as  a case of permanent loss of disability.

12.   In the present case also the complainant lost his left leg and suffered fractures in left shoulder and in right leg. He cannot sufficiently do the work for getting his livelihood as he was doing before the accident. The opinion  of LIC that the present case was not case of amputation of both legs and thus the present case was out side the preview of accident benefit clause (10) could not be appreciated. For the reasons stated above the disability sustained by the complainant comes under permanent disability and thus entitled for for the benefits available  in the policies  under disability category.

13.     Accordingly the claim of the complainant is allowed. But the entitlement of claim of the two policies of Kurnool branch bearing Nos.651401921 (Rs.25,000) and 660329957 (Rs.10,000) which were supposed to be surrendered by receiving paid up value was not supported by any evidence except the denial of the surrender by the complainant with regard to these policies of Yemmiganur branch viz Rs.1,00,000/- of P.No.652588419, Rs.25,000/- of P.No.652575844 and Rs.1,00,000/- of P.No.652588832 summing of Rs.2,25,000/- the  claim is deserved as they are inforce.

14.     In result the opposite parties are directed to pay Rs.2,25,000/- with bonus available under permanent disability benefit, Rs.15,000/- for mental agony and Rs.2,000/- towards the cost of the case. The claim regarding the two surrendered policies of Kurnool No.651401921 and 660329957 is disallowed.

Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 24^th day of September, 2009.

LADY MEMBER              PRESIDENT FAC)     MALE MEMBER

APPENDIX OF EVIDENCE

Witnesses Examined

For the complainant :                      For the opposite parties :Nil

P.W.1 Desposition of P.W.1

Dr. (Umanatha Rao)

List of exhibits marked for the complainant:-

    Ex A-11            Premium reminder letter of  policy  NO.652575844.

    Ex A-12            Renewal premium receipt of policy No.652575844.

                            Dated. 30-07-2009      

    Ex A-13              LIC renewal premium receipt policy No.652575844

    Ex A-14             Renewal premium receipt policy No.652588419

    Ex A-15              LIC renewal premium receipt of policy No.6525884

                              Dated 19-02-2009.

    Ex A-16              Revive-Easy-Letter from LIC branch Yemmiganur of

                             Policy No.652588832  dated 16-06-2009

     Ex A-17             Letter of LIC Yemmiganur non payment of premium                                 due from 11/2005 of policy No.652588832.

    Ex A-18               Letter of LIC Yemmiganur dated 16-06-2009 advised

                                Pay premium of policy No.652588832 due from

                                11/2005.

        Ex X-1            Case sheet.

 List  of exhibits marked for the opposite parties:   

LADY MEMBER            PRESIDENT (FAC)               MALE MEMBER           

// Certified free copy communicated under Rule 4 (10) of the

A.P.S.C.D.R.C. Rules, 1987//

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Complainant and Opposite parties

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