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2009 DIGILAW 341 (HP)

L. I. C. of India v. Hira Lal

2009-04-17

R.K.BATTA, S.K.NAIK

body2009
ORDER Mr. R.K. Batta, Presiding Member - The complainant had taken a policy on 28.4.1993 for a sum of Rs. 1,00,000. It was 20 years Money Back Policy including accidental benefits. The complainant reported to the Manager, LIC, Sunder Nagar Branch that the vision of his eyes diminished all of a sudden in the year 2000 due to snow light even in spite of use of black goggles. The vision continued to diminish and he has ultimately lost vision of the eyes completely. He also asked in the said letter that in case, if advised, he will' get the eyes checked from Medical Board and that on account of the said fact he has not been able to pay the installment of the policy. The Insurance Co. asked the complainant to furnish total disability certificate from the Medical Board in order to avail the benefits of the Policy. The complainant appeared before the Medical Board and he was issued 100% disability certificate by the Medical Board. However, the complainant was not paid any benefit under the said policy and he approached the District Forum seeking policy amount as also compensation. 2. The District Forum on the basis of material available on record came to the conclusion that the complainant had failed to prove that the loss of eyesight was due to an accident or was the result of snowlight. On the contrary, the District Forum held that the complainant suffered from Retinitis Pigmentosa with Bi-lateral Optic Atrophy, which was result of hereditary phenomenon. The District Forum thus held that there was no deficiency on the part of the Insurance Co. and dismissed the complaint. 3. The complainant challenged the said order of the District Forum before the State Commission. The State Commission dealt at length the dictionary meaning of 'Accident' and came to the conclusion that the case of the complainant falls within the scope and ambit of accident resulting in blindness on account of snowlight. This order is subject matter of challenge before this Commission. 4. Learned counsel for the petitioner argued before us that in this case neither accident, nor injury has been proved; Dr. K.P. Chaudhary, Professor & Head, Department of Ophthalmology, I.G.M.C. & Associated Hospitals, Shimla has stated that the Board on examination of the complainant has opined that the disease in question from which the complainant was suffering is acquired in nature and not hereditary. K.P. Chaudhary, Professor & Head, Department of Ophthalmology, I.G.M.C. & Associated Hospitals, Shimla has stated that the Board on examination of the complainant has opined that the disease in question from which the complainant was suffering is acquired in nature and not hereditary. The complainant is blind to the extent of 100%. permanently. In cross-examination he has stated that there is no doubt that opinion expressed by the Board that disease was acquired in nature means that it can be due to any reasons subsequent to the birth, such as infection and auto-immune diseases. He admitted that the blindness in the present case is not the result of any injury or accident. Learned counsel for the petitioner further submitted that the word 'Accident' has to be interpreted in its ordinary sense in which it is understood and 'no outside help can be taken unless the meaning is ambiguous. He placed reliance on the judgment of the Apex. Court in the case of United India Insurance Co. Ltd. v. M/ s. Harchand Rai Chandan Lal, AIR 2004 SC 4794 = 2004(2) CPC 686 S.C. He pointed out that the Apex Court has clearly held in the said ruling that for interpreting documents relating to a contract of insurance, the duty of the court is to interpret the words in which the contract is expressed by the parties, because it is not for the court to make a new contract, howsoever reasonable, if the parties have not made it themselves. It is further pointed out that it is a settled law that the terms, of the policy shall govern the contract between the parties; they have to abide by the definition given therein and all those expressions appearing in the policy should be interpreted with reference to terms of the policy and not with reference to definition given in other laws. He also relied upon judgment of this Commission in LIC of India v. Ramesh Chandra, 11(1997) CPJ 45 (NC) = 1972(2) CPC 126 N.C. wherein. it has been held that accident benefit under Clause 10(a) of the policy is available to the assured only if he is involved in an accident resulting in total and permanent disability as defined in the said clause and that disability must be the result of accident and it should be total and permanent. it has been held that accident benefit under Clause 10(a) of the policy is available to the assured only if he is involved in an accident resulting in total and permanent disability as defined in the said clause and that disability must be the result of accident and it should be total and permanent. He also pointed out that it has been held in the judgment of this Commission that accidental injuries, which independently of all other 'causes and within 120 days from happening of such accident result in the irrecoverable loss ,of the entire sight of both eyes, would only constitute such disability. He, therefore, contends that the State Commission erred in ordering payment of policy amount of Rs. 1,00,000 with 12% interest thereon from 20.4.1993 with compensation of Rs. 50,000 and litigation cost of Rs. 10,000. 5. On the other side, learned counsel for the complainant placed reliance on a judgment of this Commission in Rita Devi @Rita Gupta v. National Insurance Co. Ltd. & Ors., 2008 CTJ 22(CP) NCDRC= 2008(1) CPC 176 N.C. Relying upon the observation in the said judgment and particularly paragraph 16 it was argued that the complainant is entitled to payment under the policy and that the revision is liable to be dismissed. Paragraph 16 of the said judgment read as under : "16. From the aforesaid law developed in other countries and in this country, it is clear that the injury or death caused by lightening, sun-stroke or earthquake has been held to be accidental. Further, where a man in the course of his work is exposed to excessive heat coming from a boiler and becomes exhausted and death occurs, it would be an accidental death. Similarly, a person working in icy cold water and thereafter, sustains pneumonia, which causes his death, such death is also considered to be an accidental death. Similarly, if the assured is seized by a fit and drowns or falls in front of a train and killed, death is due to external cause and is an accidental death. Death resulting from the threats by miscreants is also considered to be an accidental caused by external violence and visible means. In substance, death which does not occur in the ususal course or natural course of events or events/ causes which could not be reasonably anticipated is considered to be accidental one. Death resulting from the threats by miscreants is also considered to be an accidental caused by external violence and visible means. In substance, death which does not occur in the ususal course or natural course of events or events/ causes which could not be reasonably anticipated is considered to be accidental one. Death due to cold wave is not natural and it would be accidental because all the persons may not get the same effect and it is by natural external violent force. Further, 'cold wave' is an untoward event which is not expected or designed, and an ordinary man could not expect the occurrence." 6. Paragraph 10 of the policy deals with accidental benefits. It states that the disability should not only be total and permanent but it should be on account of accident due to which the insured is not able to work or follow any business or profession. It also provides that the accidental injury which independent of all other causes and within 120 days of happening of, such accident result in irreparable loss of entire sight of both eyes, which would constitute such disability. The case of the complainant his, therefore, be examined with reference to Clause 10A of the policy dealing with accidental benefit. The word used is "accident" and the plain meaning of the same is bad incident/untoward mishap, which would include accident and which does not happen in normal course of events and is not reasonable anticipated or expected. It may be said to be an occurrence, which is unforeseen and not designed. The complainant had stated in his application to the Insurance Company that in the beginning of the recent winter his eyesight had started diminishing and he thought it was due to snow light on account which, he started using black goggles and even after taking medical treatment, the vision continued to diminish and the eyesight has been totally lost. The complainant did not place the papers relating to any treatment taken by him. He, however, produced a certificate from the Medical Officer, Mandi that the complainant is a diagnosed case of blindness due to Retinitis Pigmentosa with Bilateral optic Afaophy; the disability is permanent in nature and total, extent of disability is 100% as per officer record dated 22.6.01 of the Chief Medical Officer, Mandi. He, however, produced a certificate from the Medical Officer, Mandi that the complainant is a diagnosed case of blindness due to Retinitis Pigmentosa with Bilateral optic Afaophy; the disability is permanent in nature and total, extent of disability is 100% as per officer record dated 22.6.01 of the Chief Medical Officer, Mandi. He further stated that the blindness is not due to any accidental injury but can result from snowlight radiations. The complainant had also produced the said certificate, which is referred to in the certificate issued by the Medical Officer, Mandi on the basis of which, the said certificate was issued. The State Commission had directed the complainant to be examined by the Medical Board of I.G.M.C. & Associated Hospitals, Shimla for opinion as to the cause of complainant's eye problem, namely; whether it is hereditary or he has suffered it in the ordinary course or it is due to any of the reason. The Medical Board had given its opinion that the disease in question is acquired in nature and not hereditary. The complainant was blind to the extent of 100% permanently. In this connection, Dr. K.P. Chaudhary, Professor and Head, Department of Ophthalmology, I.G.M.C. & Associated Hospitals, Shimla, was examined in the State Commission. He categorically stated that there is no doubt that opinion expressed by the Board that the disease was acquired in nature means that it can be due to any reasons subsequent to the birth such as infection and auto-immense diseases. He has, however, stated that it is correct that blindness in the present case is not the result of any injury or accident. 7. At this stage, we would like to point out that though the complainant was referred to Medical Board and Dr. K.P. Chaudhary was also examined in the Commission, yet, neither the Commission, nor the Counsel for the complainant, or Counsel for the Insurance Company ascertained from him as to whether loss of eyesight could result from snow-light radiations on the basis of which, the complainant had put up his claim for accidental benefit, In view of this, certificate of Chief Medical Officer, Mandi assumes considerable importance wherein it was stated that the blindness could result from snow-light radiations. It is true that the Chief Medical Officer, Mandi as also Dr. K.P.Chaudhary had stated that the blindness was not due to accidental injury. It is true that the Chief Medical Officer, Mandi as also Dr. K.P.Chaudhary had stated that the blindness was not due to accidental injury. It appears that both of them had expressed this view after taking literal meaning of expression accidental injury as injury directly due to accident. An accident can be either a sudden happening or a slowly evolving process like percolation of harmful substances affecting the human body. In the case under consideration, it appears that it is a case of, snow-light radiations affecting the eyes gradually resulting in blindness. At this stage, we would like to refer to the judgment of this Commission in Rita Devi @ Rita Gupta v. National Insurance Co. Ltd. Ors. (supra) wherein, this Commission had considered case of death due to cold wave. After considering exhaustively, the meaning of expression 'accident' and 'accidental death' in Halsbury's Laws of England, it was noticed that it covers any unlooked for mishap or untoward incident which is not expected or designed or any unexpected personal injury resulting from any unlooked for mishap or occurrence. It was also noticed after referring to exposure to elements that injury or death caused by lightening sun-stroke or earthquake had been held to be accidental and similarly a man in the course of his work is exposed to excessive heat coming from a boiler and exhausted or has to stand in icy cold water and sustains pneumonia or sustains sub-acute rheumatism as a result of baling out of a flooded mine, his injury has been held as accidental. In the said case before the Commission, because of cold wave a number of persons died and it was held that death due to cold wave is not natural, but is accidental as it is by natural external violence force, It was also held that cold wave is an untoward event' that cannot be anticipated by anybody, Hence, the insured was held to be covered in accidental benefit policy, namely; Janta Accidental Insurance Policy. The rato of the said decision of the Commission can be applied to the case under consideration where blindness of the Complainant was due to external violent ant. In these circumstances, we are of the opinion that accidental benefit-can be extended under the policy to the applicant. 8. For the aforesaid reasons, the revision petition is hereby dismissed with no order as to costs. M.R.B.