Bajaj Allianz General Insurance Co. Ltd. v. Namdeo Ramchandra Kadu Patil
2006-03-21
ANJALI DESHMUKH, B.B.VAGYANI
body2006
DigiLaw.ai
Justice Mr. B. B. V AGY ANI, Hon'ble President:- This appeal filed by the appellant/ org. O.P. is directed against the order dated 1612-05 passed by the District Consumer Forum Pune. Forum belw has directed the Insurance Co. to pay a sum of Rs.73,5001- to the respondent/org. complainant along with interest @ 9% p.a. 2. We heard Smt. Aarti BarveAdvocate for the appellant and respondent in person. 3. Original complainant has made serious grievance with regard to deficiency in service. He had taken insurance policy under Personal Accident scheme. During subistence of insurance policy, complainant met with an accident on 15-8-2003 at Shirdi. In the said accident be lost his left palm. However, the claim of the complainant was partially allowed. Insurance Co. paid an amount of Rs.3,30,7501to the complainant by way of full and final settlement. The complainant was not satisfied with the quauntum awarded to him. Therefore, he filed consumer complaint. 4. The said complaint was resisted by the Insurance Co. Insurance Co. took a stand that the disability is calculated to the extent of 45% as per PPD Table. The Forum below partly allowed the complaint and passed the impugned order. 5. Ld. Advocate Smt. Aarti Barve argued that the Forum below has completely lost sight of the fact that the complainant has signed the discharge voucher without any protest. She further aruged that the complainant has accepted a sum of Rs.3,30,750/- by way of full and final settlement of the claim and therefore, Forum below should not have allowed the complaint. On the other hand, the respondent has strongly supp0l1ed the award passed by the Forum below. 6. We gave anxious consideration to the rival submissions made at the bar. The short point that arises for consideration is as to whether the half fed, half-clad and half sheltered disabled person can negotiate effectively with the Insurance Company. The Insurance Co. has wrongly applied the PPD table. The Insurance Co. proceeded with the assumption that complainant lost his thumb, index finger and remaining fingers. Insurance Co. has not at all taken into consideration the loss of palm. The complainant conducted the matter personally before the lower forum. Lower forum noticed that the left hand was amputed at the wrist. As per PPD table in case of amputation of a hand at the wrist, the disability is calculated to the extent of 55%.
Insurance Co. has not at all taken into consideration the loss of palm. The complainant conducted the matter personally before the lower forum. Lower forum noticed that the left hand was amputed at the wrist. As per PPD table in case of amputation of a hand at the wrist, the disability is calculated to the extent of 55%. We also noticed that the respondent lost his hand at the wrist. As per PPD Table in the event of accidental bodily injury causing insured permanent, partial disability, the Insurance Co. is under contractual obligation to pay the percentage of the sum assured specified for each and every form of impairmant, mentioned in the at PPD Table. The Insurance Co. without minding the fact of amputation of the hand at the wrist, calculated the impairment to the extent of 45%. Calculation of percentage of impairment as done by the Insurance Co. in the present case is absolutely wrong. Insurance Co. has applied wrong percentage and has obtained the signature of the insured on the discharge voucher. Wrong calculation of permanent partial disability is a major kind of deficiency. 7. Supreme Court in the case of United India Vs. Ajmer Singh Cotton & General Mills, 1999-S0L-CASE No.442 : [1999(4) ALL MR 291 (S.C.)] has held that the mere execution of a discharge voucher would not always deprive the consumer from preferring the claim or consequently benefits arising out of the amount paid in default of service rendered. Despite execution of the discharge voucher, the consumer may be in a position to satisfy the Tribunal or Commission under the Act that such discharge voucher or receipt had been obtained from him under the circumstances, which can be termed as fraudulent or exercise of undue influence or by misrepresentation or the like. 8. The Supreme Court further observed that if in a given case the consumer satisfies the authority under the Act that the discharge voucher was obtained by fraud, representation, undue influence or the like, the exercise bargaining compelled by the circumstances, authority before whom the Complaint is made would be justified in granting appropriate relief. 9. Supreme Court further observed that whether such a discharge voucher is proved to have been obtained under any of the suspicious circumstances noted herein above, the Tribunal or Commission would be justified in granting appropriate relief.
9. Supreme Court further observed that whether such a discharge voucher is proved to have been obtained under any of the suspicious circumstances noted herein above, the Tribunal or Commission would be justified in granting appropriate relief. Under the circumstances, of each case mere execution of discharge voucher and acceptance of the Insurance Co. claim would not estop the insured from making further claim from the insurer only under the circumstances as noticed earlier. 10. Complainant has furnished all necessary particulars in the complaint as to how he was compelled to sign the discharge voucher. It is true that the complainant has not pleaded in the complaint that Insurance Co. committed fraud or misrepresentation or undue influence and coercion for having obtained discharge vourcher from him. Present case can definitely come under "like". We therefore at the very commencement of the order posed a question as to whether a half fed, half-clad and half sheltered disabled person can negotiate ably and effectively with the Insurance Co. when he is totally ignorant about PPD Table. In fact his hand is amputed at the wrist. He lost his fingers as well as palm. Insurance Co. however taken into consideration only loss of fingers. It is beyond our comprehension as to how the permanent partial disability comes to 45%. In fact that is a case of permanent partial disability to the extent of 55% as per PPD Table. We are constrained to observe that the Insurance Co. has played mischief with the complainant and took advantage of his ignorance and innocence and wrongly calculated the permanent partial disability to the extent of 45% instead of 55%. A penniless disabled person is tempted to accept whatever offered in terms of money. Sum of Rs.3,30,750/- is not a small amount for him. In order to get the said amount immediately the complainant appears to have signed the discharge voucher. Poverty should not be the curse. Insurance Company, which is in a dominating position cannot be allowed to deprive the legitimate benefits of a disable person as per PPD Table. We therefore, hold that the impunged order under challenge does not suffer from any illegality. No interference is called for. In the result, we pass the following order :- ORDER 1. Appeal stands dismissed. 2. Respondent (org.
We therefore, hold that the impunged order under challenge does not suffer from any illegality. No interference is called for. In the result, we pass the following order :- ORDER 1. Appeal stands dismissed. 2. Respondent (org. complainant) is allowed to withdraw the amount of Rs.25,000/deposited by the appellant in the Forum below, after a period of appeal is over. 3. Appellant is directed to pay remaining amount of award within a period of six weeks from the date of receipt of the order. 4. Pronounced and dictated in the open court. 5. Copies of the order be furnished to the parties. Appeal dismissed.