Lic of India Nashik City Branch No.2, Nashik and Another Vs. Shri Sanjay Sudhakar Poojary Panchawati, Nashik - Court Judgment

Excerpt:

Judgment:

Per Shri S.R. Khanzode, Honble Presiding Judicial Member

This appeal arises out of order/award dated 30/09/1998 passed in consumer complaint No.204/1995, Sanjay Sudhakar Poojary V/s. Life Insurance Corporation of India Ltd., Nashik City Branch No.2, by District Consumer Disputes Redressal Forum Nashik (‘Forum below in short).

Undisputed facts are that respondent/org. complainant-Sanjay Sudhakar Poojary (hereinafter referred as ‘complainant) is covered by two Jeevan Mitra double cover endowment plan with profit (with accident benefit) insurance policies issued by appellant/org. O.P. (hereinafter referred as ‘LIC). First policy bearing No.967081687 dated 28/03/1989 giving cover of Rs.30,000/- and another policy bearing No.967859123 dated 28/03/1994 giving additional cover of Rs.15,000/-. Complainant when was serving as Quality Controller in Classic Foods Ltd. Company, Satpur, Nashik, on 29/07/1994 his right hand palm crushed under the Crusher machine as a result of which his middle, ring and little fingers were required to be amputated and other two fingers became motionless. The Civil Surgeon of Civil Hospital Nashik duly issued certificate that complainant is declared as physically handicapped due to such injuries to right hand fingers above wrist. Under treatment certificate dated 21/09/1994 issued by treating doctor also confirmed the same. Based upon these facts, insurance claim was made under the policies referred above. LIC got filled in claim form and disability claim questionnaire from the complainant in prescribed form No.5278 on 08/03/1995. Subsequently, the claim stood repudiated by the LIC as per their letter dated 25/05/1995 stating that as per clause 10(b) of the insurance policy, complainant cannot get the benefit. Feeling aggrieved thereby this consumer complaint was filed.

LIC resisted the insurance claim as per written statement in tune with their repudiation letter, supra. Forum below after hearing both the parties, allowed the complaint and directed to pay amount of Rs.30,000/- under first policy and Rs.15,000/- under second policy, total amounting to Rs.45,000/- along with interest @ 18% p.a. with effect from 29/06/1995 and also granted compensation of Rs.2,000/-. Feeling aggrieved by said order/award, LIC preferred this appeal.

We heard Mr.Rajiv Chavan, Advocate for the appellant/LIC and Mr.U.B. Wavikar, Advocate for the respondent/complainant. Perused the record.

Appellant/LIC referred to clause 10(b) from the policy condition and which is even reproduced in their written statement in paragraph-3. We reproduce the same from the written statement itself:-

“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 not 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 of both eyes or in the amputation of both hands at or above the wrist, 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.” [Underline provided]

Thus, it could be seen that (referring to the underlined portion) after the word “the wrist there is coma and then further matter, “and one foot……,”appears. Appellant tried to say that this coma is not there and Forum below misread the provision. Perhaps, the truth is otherwise. This particular part of the provision described disability to various parts of the body which are to be considered individually. Admittedly, amputation of three fingers following crash injury in the accident has taken place within period of 90 days from happening of such accident (refer to under treatment certificate dated 21/09/1994 issued by Dr.Dhadiwal). In the later part of above referred clause such disability is described with reference to amputation of both hands at or above the wrist and also separately in the amputation of one hand at or above the wrist. Further, amputation of one foot at or above ankle is also described. Relevant portion to this effect, “or in the amputation of one hand at or above the wrist, and one foot at or above the ankle” must be read referring to amputation of single organ i.e. one hand at or above the wrist. Whether there is coma or not after the word ‘the wrist is irrelevant in this context. The fact as stated earlier and particularly with reference to the reproduction of clause in the written statement and from copy of the insurance policy shows that there exists such coma. Therefore, applying the rule of harmonious construction as well as mischief rule of interpretation, one has to read that part of clause referring to the amputation of single organ either one hand at or above the wrist or one foot at or above the ankle. It is not that to cover the disability for which insurance claim could be awarded, there should be simultaneous amputation of one hand at or above the wrist and one foot at or above the ankle. Under the circumstances, we find reasoning given by the Forum below is proper and there is no error committed by it. We find no fault with the impugned order/award. As such the appeal being devoid of any substance liable to be dismissed. Hence, the order:-

Order:

1. Appeal stands dismissed with cost of Rs.5,000/-.

2. Decreetal dues may be adjusted from the deposited amount partly or fully.

3. Copies of the order be furnished to the parties.