Justice M.B. Shah, J. - (1.) President-Admittedly, the Complainant has taken a policy under Personal Accident Scheme for a period from 12.2.2003 to 11.2.2004. On 15.8.2003 a quarrel/fight took place between him and others and the Complainant was injured. It is his contention that he has lost his palm. He filed a claim with the Insurance Company on 29.9.2003. He also furnished a medical certificate dated 5.11.2003 issued by the Civil Surgeon, Ahmednagar, wherein it was mentioned that disability of the insured is to the extent of 60%. After some harassment and visiting the office of the Insurance Company again and again the Complainant was paid an amount of Rs. 3,30,750 towards the settlement of his claim which according to the Complainant was grossly inadequate but the same was accepted by him due to delay in settling the claim. Thereafter, Consumer Complaint No. PDF-282/2004 was filed before the District Forum, Pune, Maharashtra.
(2.) The District Forum considered the facts that the sum assured was Rs. 7,35,000 and the Insurance Company paid Rs. 3,30,750 on the basis that the disability was to the extent to 45% in terms of the break up that was given in the written version to the effect that 10% for the loss of index finger, 20% for the loss of thumb and 15% for the loss of other three fingers. This was on the basis of partial permanent disability clause provided in the policy. The District Forum, however, considered that there was total amputation of hand from the level of wrist and it should be held that loss of hand at the wrist as a whole. Thereafter, the District Forum relying on a disability table held that the Insurance Company is required to pay 55% of the sum assured, thereby arriving at the conclusion that the Complainant was entitled to Rs. 4,04,250 instead of Rs. 3,30,750. Hence, the District Forum directed the Insurance Company to pay the remaining amount of Rs.73,500 with interest thereon @ 9% per annum from the date of filing of the complaint i.e. 7th August, 2004 till realization of the amount and costs of Rs. 500.
(3.) Against that order, the Complainant preferred Appeal No. 2000/2005 and the Insurance Co. also preferred First Appeal No. 103/2006. Both the appeals were dismissed by the State Commission by order dated 21st March, 2006.;