Research › Search › Judgment

Chhattisgarh High Court · body

2006 DIGILAW 465 (CHH)

ORIENTAL INSURANCE CO. LTD. v. NANDAKUMAR VERMA

2006-10-10

R.S.AWASTHI, V.K.AGARWAL, VEENA MISRA

body2006
ORDER As per Hon’ble Shri V.K. Agarwal, President:- 1. This appeal, under section 15 of the Consumer Protection Act 1986 is directed against the order dated 25-4-06 in complaint No.76/04 by District Consumer Disputes Redressal Forum, Durg (hereinafter called the District Forum for short) directing the appellant/insurer to pay to the complainant/respondent Rs, 5,00,000/- with interest etc. under the Group Insurance Janta Personal Accident Policy ('Janta Policy' for short), issued by the appellant in favour of the complainant/respondent. 2. Indisputably the complainant /respondent, is an employee of Bhilai Steel Plant, as a Senior Technician (Electrical). It is also not in dispute that the appellant insurer had issued a Janta Policy in which an assured amount of Rs.5,00,000/- was payable in case the insured member suffered total permanent disablement as a direct result of external violent visible means. 3. The complainant averred that on 28.6.2000 while he was climbing on Rose-apple (Jamun) tree, he fell down and sustained severe injuries below his waist. Though he was treated for the said injuries, it resulted in his permanent disablement and his limbs below waist became senseless, He therefore, claimed the amount under the policy. However, since the claim was not paid by the appellant/ insurer, he approached the District Forum. 4. The complaint was resisted by the appellant/insurer. It was averred that the terms of the policy did not entitle the complainant to receive the claim amount. It was also averred that there was great delay in lodging the claim with the appellant/ insurer. 5. District Forum, however, did not feel impressed by the contentions of the insurer and held that the complainant suffered from Traumaric Paraparesis as certified by Govt. Surgeon, Bhilai. It was therefore, held that he suffered from total disability due to accident and was therefore entitled to the claim, as prayed by him. 6. Learned counsel for the parties were heard. Record perused. 7. The main question which was raised during arguments by the learned counsel for appellant is that the complainant/respondent failed to prove that he Oriental Insurance amount, under the policy. As noticed earlier, the policy admittedly covered the risk of total disability of both limbs on account of accident by external visible means. In the instant case, there is material on record to show that the complainant fell down from the tree and thus met with an accident. As noticed earlier, the policy admittedly covered the risk of total disability of both limbs on account of accident by external visible means. In the instant case, there is material on record to show that the complainant fell down from the tree and thus met with an accident. His treatment papers show that he had to take extensive treatment on account of the above accident in Sector-9 hospital of BSP. It further appears from the documents placed on record that the complainant was certified to have suffered from Traumaric Paraparesis. As an abundant caution as to whether the insured complainant as to who really suffered permanent disability of irreversible nature, we had directed that the complainant be examined by the District Medical Board, Durg. The complainant was so examined on 3.10.2006 and a certificate from the District Medical Board has been produced before us. The said certificate clearly confirms that the complainant suffered from permanent disability and that his disablement was not treatable and was thus irreversible. In view of the above material on record, it appears that the complainant/respondent was under the terms of policy, entitled to the assured amount of Rs.5,00,000/-, as was awarded by the District Forum. The finding as above of the District Forum is affirmed. There is no reason for interference in the impugned order. 8. This appeal has no substance. It is accordingly dismissed. The impugned order is affirmed. The appellant shall bear its own cost and shall pay that of the complainant/respondent, which is quantified at Rs.2,000/- (Rupees two thousand) only. Appeal Rejected.