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Issue: Real Estate
–Deficiency in Service (Insurance Sector)
Court:- NATIONAL
CONSUMER DISPUTES REDRESSAL COMMISSION
Appeal No:-3446 OF 2006
Date Of Judgement:- 28.11.2006
Life Insurance Corporation of India
Vs.
Ram Singh Tanwar
Brief Facts:-
Unfortunately, the Life
Insurance Corporation of India (the LIC) which was established by
an Act, as interpreted by the Apex Court as social welfare institution
[LIC of India Vs. Anuradha (2004) 10 SCC 131], is litigating for
a sum of Rs.25,000/- which is directed to be paid by the District
Forum and the State Commission, on the basis of an endowment insurance
policy with profit taken by the complainant on 28.3.1994. Complainant
paid the premium regularly. He was employed as a driver and when
he was driving a truck from Pali to Jaipur, he met with an accident
and sustained injury on his right leg. Thereafter, his right leg
was required to be amputated so that he may survive. The LIC repudiated
the claim on 12.3.2001 by contending that amputation of one leg
was not sufficient for paying the sum assured. The State Commission
thereafter referred to the fact that a Medical Board was set up
by the Government of Rajasthan at SMS Hospital, Jaipur and that
Board has certified that the right leg of the complainant below
knee was amputated on 25.12.2000. The State Commission also noted
that complainant was not educated and cannot be gainfully employed
because he is not a normal person. On the said basis, the State
Commission confirmed the order passed by the District Forum directing
the LIC to pay the sum assured. Against that order, this revision
petition is filed.
Unmindful of the fact that
the entire purpose of LIC was to see that such persons should get
the assured amount in their difficult days and there is no harassment
and delay in paying the amount to the insured or they are not required
to spend in litigation. the approach of the Corporation in the matter
of repudiation of the policy, admittedly issued by it, should be
one of extreme care and caution. It should not be dealt with in
a mechanical and routine manner.
As regard the insurance
policy ,first part of the condition, inter alia, provides that in
the accident there must be total and permanent disability so that
assured can never sufficiently do or follow to earn or obtain any
wages, compensation or profit. Second part deals with accidental
injuries which independent of all other causes, result in loss of
limbs as mentioned therein. Such loss of limb is also deemed to
constitute permanent disability. To illustrate, a businessman can
do his work even if there is amputation of one hand and/or above
the wrist and one foot and/or above the ankle. The court held that,
this would be the reasonable interpretation and in conformity with
the principle that if the terms of the policy are vague it should
be interpreted for the benefit of the assured as it would serve
the purpose and object of getting insurance coverage In the present
case, the Complainant is an illiterate person whose only job was
driving a vehicle and he lost his one leg and become unfit for driving
the vehicle then it cannot be said that he can sufficiently do the
said work for getting his livelihood or to obtain any wages, compensation
or profit by doing the said job. May be that by begging he may get
some amount but that cannot be said to be a business or occupation
and that such an interpretation is to be avoided Finally, court
observed that it is necessary for the officers of the LIC to change
their negative approach in dealing with such claim and the insurance
coverage should not be nullified by backward looking interpretation
of the Act and in some cases litigation could be avoided These must,
therefore, be interpreted in the spirit in which the same have been
enacted accompanied by an anxiety to ensure that the protection
is not nullified by the backward looking interpretation which serves
to defeat the provision rather than to fulfill its life-aim. . What
the Legislature has given, the Court cannot deprive of by way of
an exercise in interpretation when the view which renders the provision
potent is equally plausible as the one which renders the provision
impotent”. Hence, the court observed that , the impugned order
passed by the State Commission does not call for any interference.
And , the revision petition was dismissed.
For
Full Judgment |
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