Bajaj Allianz General Insurance Company Ltd. , through its Constituent Attorney v. Pooran Mal S/o Shri Babulal
2022-05-24
ANOOP KUMAR DHAND
body2022
DigiLaw.ai
JUDGMENT : 1. Instant appeal has been preferred by the appellant-Insurance Company under Section under Section 30 of the Workmen’s Compensation Act, 1923 (for short ‘the Act of 1923’) against the impugned judgment and award dated 30.07.2010 passed by the Court of Learned Commissioner Workmen’s Compensation Act, Jaipur District-II [for short ‘the learned Commissioner’] in case No. WCC/NF/434/2008 by which the claim petition filed by the claimant respondent was allowed and the appellant Insurance Company was directed to pay a compensation of Rs. 2,90,390/- to the claimant respondent. 2. Learned counsel for the appellant-Insurance Company submitted that without any basis the income of the claimant was determined by the learned Commissioner on the higher side while as per the statement of brother of the claimant NAW-1 which was recorded by the Instructor which clearly indicates that the claimant was receiving a salary of Rs. 2,000/- per month only and this fact was overlooked by the learned Commissioner while passing the impugned judgment. Counsel further submitted that the learned Commissioner has placed reliance on a permanent disability certificate issued by the Dhanwantri Hospital and Research centre, Mansarovar, Jaipur which indicates that the injured claimant has sustained 50.35% permanent disability while as per the medical record of the claimant, he has sustained amputation of three fingers only, so in any case the amputation of three fingers cannot be treated as 50.35% permanent disability. Counsel for the Insurance Company submitted that this Court while deciding a matter in the case of United India Insurance Co. Ltd. Vs. Vishnu and Ors. in SB Civil Misc. Appeal Nos. 6639, 6825 & 6112 of 2011 has held that a racket of hospitals are going on in the city for issuing bogus disability certificates on the basis of which disability of the claimants are assessed. Counsel further submitted that large number of cases were remanded to the learned Commissioner for fresh assessment of permanent disability of the claimants from a duly constituted Medical Board of a Government Hospital. Counsel for the appellant Insurance Company further submitted that under the facts and circumstances of the case, the matter requires reconsideration, so the matter be remitted back to the learned Commissioner for fresh adjudication. 3.
Counsel for the appellant Insurance Company further submitted that under the facts and circumstances of the case, the matter requires reconsideration, so the matter be remitted back to the learned Commissioner for fresh adjudication. 3. Per contra, learned counsel for the claimant-respondent opposed the arguments raised by the counsel for the Insurance Company and submitted that the Instructor of the Insurance Company was not produced in the witness box, hence, the learned Commissioner has rightly assessed the income of the claimant as Rs. 4,000/-on the basis of evidence produced by the claimant. Counsel further submitted that the disability certificate issued by the Dhanwantri Hospital and Research Centre, Mansarovar, Jaipur is a genuine certificate and no doubt can be raised on its genuineness. Lastly, counsel for the claimant-respondent argued that no illegality has been committed by the learned Commissioner in allowing the claim petition filed by the claimant respondent. 4. Heard. Considered the arguments raised by counsel appearing for the parties and perused the documents available on the record. 5. Perusal of the record indicates that there are contradictory evidence available on the record with regard to income/salary of the claimant-respondent. As per the statement of brother of the claimant himself, he used to give salary of Rs. 2,000/-per month to the claimant and the signature of the brother of the claimant was admitted by the claimant in his statement recorded before the learned Commissioner. But overlooking this aspect, the learned Commissioner has assessed the income of the claimant as Rs. 4,000/-per month. So far as the argument raised by the counsel for the appellant with regard to the genuineness of the disability certificate Ex.6 is concerned, the Co-ordinate Bench of this Court in the case of Vishnu (supra) has held as under:- “In some of the matters, this Court has passed the following detailed common orders, firstly in S.B. Civil Misc. Appeal No.6396/2011 (United India Insurance Co. Ltd. Vs.
Appeal No.6396/2011 (United India Insurance Co. Ltd. Vs. Smt. Kamla & Ors.) on 2/12/2011:- “Learned counsel for the appellant Insurance Company has argued that there is a racket going on in Dhanwantri Life Care Pvt. Ltd. 67/56-A New Sanganer Road, Mansarovar, Jaipur and S.K. Soni Hospital, Vidhyadhar Nagar, Jaipur, which is indiscriminately issuing bogus disability certificates assessing disability of the claimants much in excess of the actual disability and in some cases, even without any disability at all and the Tribunals/Workmen Compensation Commissioners on that basis have been liberally granting compensation. This is a serious allegation and such practice ought not to be therefore allowed to go on any further. Learned counsel has cited the Circular issued by the Medical & Health (Group-2) Department, Government of Rajasthan dated 29/6/2010 whereby, the Government of Rajasthan has issued instructions that such disability certificates can be issued only by the medical board consisting of three doctors of the government hospital. This direction has been issued in terms of the Notification issued by the Ministry of Social Justice & Empowerment Department, Government of India, New Delhi dated 30/12/2009. Counsel has also cited the letter issued by the Director Medical &Health Services, Government of Rajasthan, Jaipur dated 19/8/2011 whereby, those two hospitals have been directed not to issue any such disability certificates in future. It has been mentioned in those letters that the disability certificates issued by those two hospitals are being produced for filing claim petitions. Learned counsel has also invited the attention of the Court towards two more Circulars issued by the Government of Rajasthan to the same effect dated 25/5/2010 and 30/8/2010. These letters are taken on record. Issue notice, returnable by eight weeks. In the meanwhile, Tribunal at Shahpura, Jaipur is directed not to 3disburse the amount deposited by the insurance company under 'no fault liability' to the claimants and the insurance company may not be required to deposit the remaining amount in terms of the impugned-award and the amount so far deposited may not be disbursed to the claimants save with permission of this court. The Tribunal at Shahpura, Jaipur is also directed to get the claimants reexamined through the medical board to be constituted by the Superintendent SMS Medical College & Hospital, Jaipur to ascertain their disability.
The Tribunal at Shahpura, Jaipur is also directed to get the claimants reexamined through the medical board to be constituted by the Superintendent SMS Medical College & Hospital, Jaipur to ascertain their disability. All the Motor Accident Claims Tribunals at Jaipur and the Employee's Compenation Commissioner, Jaipur District-I, II & III as well as Jaipur City at Shanti Nagar, Opposite NBC Hasanpura, Jaipur are henceforth directed not to accept or rely on any such disability certificates issued by Private Hospitals including above referred to two hospitals in any claim petition and insist on the claimants to obtain the disability certificate from the duly constituted medical board of the government hospital as per the Circulars of the Government of Rajasthan dated 29/10/2010 and 19/8/2011 and the Notification issued by the Ministry of Social Justice & Empowerment Department, Government of India, New Delhi dated 30/12/2009. A copy of this order be sent to all the Motor Accident Claims Tribunals at Jaipur and The Employee's Compenation Commissioner, Jaipur District-I, II & III as well as Jaipur City at Shanti Nagar, Opposite NBC Hasanpura, Jaipur for immediate compliance. A copy of this order be also sent to the Labour Commissioners, Medical & Health Services, Government of Rajasthan, Jaipur. Connect with SBCMA Nos.6475/2011,6485/2011 and 6766/2011.” Subsequently, however, claimants in certain matters approached this Court for clarification/ modification of the order, whereupon this Court on 19/4/2012 passed the following detailed common order in appeals preferred by the United India Insurance Co. Ltd. i.e. SBCMA Nos.6396/11, 6485/11, 6474/11, 46766/11, 6793/11, 7294/11, 7006/11 & 7007/11:- “These matters come up on the applications filed by Shri Sandeep Mathur and Shri Vinay Mathur, learned counsel appearing for the claimant-respondents seeking clarification /modification of the order passed by this court on 2/12/2011.
Ltd. i.e. SBCMA Nos.6396/11, 6485/11, 6474/11, 46766/11, 6793/11, 7294/11, 7006/11 & 7007/11:- “These matters come up on the applications filed by Shri Sandeep Mathur and Shri Vinay Mathur, learned counsel appearing for the claimant-respondents seeking clarification /modification of the order passed by this court on 2/12/2011. This court on the aforesaid date taking note of the arguments that certain private hospitals are indiscriminately issuing disability certificates, where disability of the claimant has been assessed in excess of the actual disability sustained by the claimants and such certificates are being relied upon by the Motor Accident Claims Tribunals/Workmen Compensation Commissioners at Jaipur while passing the award of compensation, directed the Motor Accident Claims Tribunals/Workmen Compensation Commissioners at Jaipur not to accept or rely upon such disability certificates issued by the private hospitals and insist on the claimants to get themselves re-examined and obtain the disability certificate from a duly constituted medical board as per the Circulars of the Government dated 29/10/2010 and 19/8/2011 and notification issued by the Ministry of Social Justice & Empowerment Department, Government of India, New Delhi dated 30/12/2009 and directed for sending copy of the order dated 2/12/2011 to all the Motor Accident Claims Tribunals at Jaipur and the Employee's Compensation Commissioner, Jaipur District-I, II & III as well as Jaipur City at Shanti Nagar, Opposite NBC Hasanpura, Jaipur for immediate compliance. Learned counsel for the claimants have submitted respective application that the aforesaid order is causing difficulty in pending claim cases inasmuch as, two notifications issued by the Government of India supra as well as the notification issued by the Government of India published in the Gazette of India (Extraordinary) providing procedure forgetting the disability certificate from the medical board issued under the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation Act, 1995dated 30/10/2009. It was also submitted that the Insurance Companies insists on the claimants to declare whether they have not already obtained the disability certificates in the past and if such disability certificates are already obtained by the claimants, they do not normally issue any disability certificate. It is for this reason that learned counsel for the claimants submitted that there should be a specific order by the concerned Tribunal for issuance of any disability certificate.
It is for this reason that learned counsel for the claimants submitted that there should be a specific order by the concerned Tribunal for issuance of any disability certificate. Learned counsel for the appellant-insurance companies however submitted that this court in number of such matters has directed re-examination of the claimants for assessing their disability again by a duly constituted medical board and lot of disparities have been found between the disability certificates issued by the newly constituted medical board and those of the private hospitals. The Government of Rajasthan taking note of the order passed by this court on 2/12/2011, has issued a general order on 1/2/2012 to all the government hospitals in the State for issuance of disability certificates for the purpose of obtaining compensation in the claim cases arising out of the accidents. It has been provided therein that no government hospital shall refuse to issue disability certificate and on receiving such application by any person would constitute a medical board consisting of experts and if a specialist in a particular subject not available in a government medical institute, such person shall be referred to the nearest district/sub divisional hospitals. Having regard to the specific order now issued by the Director Medical and Health Services, Government of Rajasthan, Jaipur on1/2/2012, it is clarified that if and when any such matter is brought before the Motor Accident Claims Tribunals and the Employee's Compensation Commissioner, they shall insist on the claimants to obtain certificate from duly constituted medical board in compliance of the above referred to order of the Government of Rajasthan dated 1/2/2012 and for that purpose, claimants may make appropriate application to the concerned Motor Accident Claims Tribunals and the Employee's Compensation Commissioner at Jaipur, which shall direct the hospitals/government medical institutes concerned for issuance of such certificates notwithstanding earlier certificate produced by the claimants from a private hospital. Applications are disposed of with the aforesaid clarification. Copy of this order be sent to all Motor Accident Claims Tribunals and the Employee's Compensation Commissioner, Jaipur District-I, II & III as well as Jaipur City at Shanti Nagar, Opposite NBC Hasanpura, Jaipur.
Applications are disposed of with the aforesaid clarification. Copy of this order be sent to all Motor Accident Claims Tribunals and the Employee's Compensation Commissioner, Jaipur District-I, II & III as well as Jaipur City at Shanti Nagar, Opposite NBC Hasanpura, Jaipur. Copy of this order be also sent to the Labour Commissioner, Government of Rajasthan and Director Medical and Health Services Rajasthan, Jaipur for compliance." Learned counsel for the appellant-insurance company have submitted that in all these matters already a direction has been issued by the court to the concerned Commissioner Workmen Compensation/concerned Motor Accident Claims Tribunals to get the claimants re-examined from a duly constituted medical board of a government hospital and in certain other matters, appellant-insurance company was given liberty to make a proper application before the concerned Commissioner Workmen Compensation and Motor Accident Claims Tribunals for re-examination of the claimants for the injuries sustained by them. This Court in some of the matters restrained the concerned Commissioner Workmen Compensation and Motor Accident Claims Tribunals from disbursing the amount of interim compensation to the claimants. In some of the matters however, such interim-order was not passed. All these appeals are therefore disposed of in the light of the submission made by the learned counsel appearing for the appellant-United India Insurance Co. Ltd. with a direction that disbursement of the amount of interim-compensation shall be dependent on the fresh assessment of the permanent disability of the claimants from a duly constituted medical board of a government hospital and further that payment of interim-compensation if be made, shall be subject to final outcome of the matter passed on newly obtained disability certificate on the basis of opinion of the medical board of the government hospital. Government should also issue the necessary instructions to all its hospitals/jurists/medical officers and especially to all major hospitals attached to Medical Colleges that whenever disability certificates are issued, they should indicate in the light of judgement of Supreme Court in Raj Kumar vs. Ajay Kumar & Anr.- (2011) 1 SCC 343 as to what is the percentile of disability of individual organ of the body and what is the extent of disability of whole body so that difficulty may not arise before the Tribunal/Workmen Compensation Commissioner in assessing the extent of disability. This would help in arriving at the correct conclusion regarding disablement.
This would help in arriving at the correct conclusion regarding disablement. If the disability certificate is categorical as to the extent of disablement in the context of whole body, necessity of summoning medical officers may be obviated, which otherwise causes inconvenience to them.” 6. No doubt in the instant case also, the injured has sustained amputation of three fingers for which 50.35% of permanent disability certificate has been issued by the Dhanwantri Hospital and Research Centre, Mansarovar, Jaipur. As per the judgment of Vishnu (supra) doubt has been raised about the genuineness of the disability certificate issued by this hospital. 7. In the opinion of this Court, the matter requires reconsideration by the learned Commissioner with a direction to the claimant to get a fresh disability certificate from a Government Hospital in view of the judgment of this Court in the case of Vishnu (supra). 8. Thus, the impugned judgment dated 30.07.2010 passed by the learned Commissioner is quashed and set aside. The matter is remanded to the learned Commissioner for fresh adjudication with a direction that disbursement of any amount of compensation shall be dependent on fresh assessment of the permanent disability of the claimant from a duly constituted Medical Board of a Government Hospital and further the payment of interim compensation, if already made, shall be subject to final outcome of the matter. 9. With the above observations, the appeal stands disposed of. 10. The parties are directed to appear before the learned Commissioner on 05.07.2022. 11. All pending application(s), if any, also stand disposed of. 12. Record of the case be sent back to the learned Commissioner forthwith.