United India Insurance Company Ltd., Neyyattinkara Branch, Rep. by Asst.Manager Vs. R. Satheesan - Court Judgment

SRI. M.V. VISWANATHAN: JUDICIAL MEMBER

The above appeal is preferred from the order dated.6.10.03 of the CDRF, Thiruvananthapuram in OPNo.642/2000. The complaint in OP.642/00 was filed by the respondent herein as complainant against the appellant as opposite party claiming the insurance claim of Rs.1,50,000/-and a compensation of Rs.10,000/- for the deficiency in service on the part of the opposite party Insurance company. The claim was repudiated by the opposite party and limited the claim at Rs.6571/-. The Insurance Company relied on the investigation report received by them from their private investigator. But the lower forum accepted the case of the complainant and thereby the opposite party/Insurance company is directed to pay the complainant a sum of Rs.75000/- as Insurance claim with Rs.10,000/- as general compensation and a cost of Rs.1000/-. Aggrieved by the said order, the present appeal is preferred by the opposite party therein.

2. We heard the counsel for the appellant/opposite party and the respondent/complainant. The learned counsel for the appellant much relied on the investigation report submitted by private investigator K.N.Krishnan Nair who was appointed by the appellant Insurance Company for the purpose of making an enquiry regarding the dis-ability of the respondent/complainant. It is also submitted that the lower forum has awarded Rs.75000/- as Insurance claim without any supporting materials or documents. Thus, the appellant/Insurance Company requested for setting aside the impugned order passed by the lower forum. On the other hand, the learned counsel for the respondent/complainant much relied on P4 disability certificate issued by Doctor attached to the Government hospital, Neyyatinkara and also P5 discharge certificate issued from the Government Hospital, Neyyatinkara and thereby supported the findings and conclusions of the lower forum. Thus, the respondent requested for dismissal of the present appeal.

3. The points that arise for consideration are:-

1. Is there any deficiency in service on the part of the appellant/opposite party (Insurance Company)?

2. Whether the lower forum can be justified in awarding a sum of Rs.75000/- as Insurance claim with a general compensation of Rs.10000/- and cost of Rs.1000/-?

4. POINTS 1 AND 2

There is no dispute that the respondent/complainant took personal accident Insurance policy which was issued by the appellant/opposite party. The policy was valid at the time of the accident involved in this case. Thus, it is an admitted fact that the respondent/complainant had an insurance coverage at the time of the accident in which he sustained injury to his left eye. P5 discharge certificate issued from the Government hospital, Neyyatinkara would make it clear that the complainant/insured was in that hospital on 22.5.2000 and that he was discharged on 16.6.2000. It would also reveal the fact that the complainant/insured sustained corneal injury to his left eye. Ext.P4 discharge certificate issued by the eye specialist attached to the Government hospital, Neyyatinkara would show that the insured sustained a permanent partial dis-ability of 10% due to the injury sustained to his left eye. Thus, there can be no doubt that the respondent/ complainant/insured is entitled for the Insurance claim.

5. The next aspect for consideration is regarding the quantum of the insurance claim legitimately due to the complainant/insured. The complainant has claimed Rs.1,50,000/- as insurance claim with a compensation of Rs.10000/-. Lower forum awarded Rs.75000/- as insurance amount with general compensation of Rs.10000/- and cost of Rs.1000/-. The appellant/opposite party insurance company (insurer) has offered only Rs.6571/-. That offer was based on the investigation report submitted by the private investigator K.N.Krishnan Nair who was appointed by the Insurance Company. It is strange enough to note that the so-called investigation report has not been proved by examining the author of the report. In this case, even without marking that document; the lower forum has made reference to the investigation report which was simply produced from the side of the opposite party/Insurance Company. No reliance can be placed on the investigation report which was not marked before the lower forum. No supporting evidence is available to rely on the aforesaid investigation report. On the other hand, the other admitted evidence on record would show that the amount of Rs.6571/- assessed by the investigator is without any basis and the same cannot be accepted for the purpose of assessing the quantum of the insurance amount legitimately due to the complainant/insured.

6. The subject matter of the policy of insurance would make it clear that the insured sum was Rs.2 lakhs. The policy would show that on lost of one eye, the insured is entitled to get 50% of the capital of sum insured. Thus, on lost of one eye the insured is entitled for Rs.1 lakh. But in the present case, the complainant is having 10% permanent (Residual) disability to his left eye. If we go by with the aforesaid calculation the complainant is to be given Rs.10000/- as the insurance claim amount. There can be no doubt that there will be some disablement for the complainant to do his work. We are of the view that the complainant/insured is to be given a minimum of Rs.10,000/-as his insurance claim.

7. P5 – Discharge certificate would make it clear that the complainant was in the hospital as an inpatient for a period of 25 days. The case of the complainant is that as a worker he was getting Rs.250/- per day. So, the complainant is to be given the aforesaid amount ie., 250 X 25 = Rs.6250/-. We are of the view that the aforesaid sum of Rs.6250/- is also to be awarded as the compensation to the complainant.

8. The complainant as the insured approached the opposite party to settle the insurance claim, but the opposite party offered only a sum of Rs.6571/-. Thereby the complainant was compelled to file this complaint before the lower forum. The facts and circumstances would give clear indication that there was some sot of deficiency in service on the part of the opposite party/Insurance Company. We are of the view that a sum of Rs.5000/- is to be awarded as compensation for the deficiency in service on the part of the appellant/opposite party Insurance Company. Thus, the total compensation due to the complainant is fixed at Rs.21250/-. The complainant is also entitled for his cost in the proceedings. So, the complainant is awarded a sum of Rs.1000/- as cost. The impugned order passed by the lower forum is modified as indicated above. These points are answered accordingly.

In the result, the appeal is allowed partly. Impugned order dated. 6.10.2003 passed by the lower forum in OP.642/00 is modified. Thereby the appellant/opposite party is directed to pay the respondent/complainant a sum of Rs.21250/- as the Insurance claim with a sum of Rs.5000/- as compensation for the deficiency in service on the part of the appellant/opposite party. The respondent/complainant is also entitled for a cost of Rs.1000/-. As far as the present appeal is concerned, the parties are directed to suffer their respective costs.