NEW INDIA ASSURANCE CO. LTD Vs. TMT.DHANALAKSHMI
TAMIL NADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION
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K.SAMPATH, J. -
(1.) The Opposite party in COP No.60/2002 on the file of the District Consumer
Disputes Redressal Forum, Nagapattinam, is the appellant herein. One
Samikannu had taken a Group Insurance policy. He suffered 70% disablement
in an accident which took place on 5/7/2001. The opposite party refused
to pay the insurance claim on the ground that it was not a case of 100%
disability in which event alone the insured amount was payable. It would
appear that the insured died subsequently and his legal representatives
filed the complaint. With regard to insurance, the deceased being an
insured under the Group Insurance Scheme is not disputed. If his claim
were to be admitted, he would be entitled to 70% of the insured amount.
As already noted, according to the opposite party it was not a case of
permanent disability: there was no loss of vision, amputation of hand or
leg and as per the terms of the policy it was a condition precedent that
the victim should have suffered such a disability and in the case of any
other disablement like fracture, injuries, etc., the contract of
insurance would not and did not apply. The District Forum accepted the
case of the complainants and by order dated 28/5/2004 allowed the
complaint directing the opposite party to pay a sum of Rs.1 lakh with
interest at 9% p.a. from the date of death on 25/7/2002, Rs.10,000/-
towards compensation for mental agony and Rs.1,000/- as costs. It is as
against that the present appeal has been filed.
(2.) On behalf of the opposite party/ appellant, it was vehemently
contended that unless there was 100% disability like loss of limb, loss
of vision, amputation of hand or leg, there could be no liability
fastened on the insurance company. Counsel also relied on a judgment of
the National Commission in Ajay Kumar vs. LIC [2007-1-CPJ-230].
(3.) Per contra, learned counsel for the complainants submitted that it was
a case of 70% permanent disability and the District Forum had rightly
granted relief to the complainant and no exception could be taken to the
same. Counsel also relied on a decision of the National Commission in
another case in LIC vs. Ramsingh Tanwar [(I) 2007 CPJ 48(NC)].;
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