LIFE INSURANCE CORPORATION OF INDIA Vs. G.N.SHOJARAJU GUPTA

JUDGEMENT

(1.) S . Parvatha Rao, President Heard the learned Counsel on both sides. They are agreed that the appeal itself shall be disposed of in view of the fact that the question raised in this appeal is covered by a direct decision of the National Commission in L.I.C. of India v. Ramesh Chandra, II (1997) CPJ 45 (NC)=1997 (2) CPR 8 (NC). The appeal has been preferred by the opposite parties in C.D. No. 259/1993 questioning the order of the Anantapur District Forum therein dated 6.1.1998. The complainant is the respondent in the appeal.

(2.) THE facts that the respondent took money back policy from the Life Insurance Corporation of India ( ˜LIC for short) and that the accident in which the respondent was involved resulted in loosing his left leg above the knee are not in dispute. The only question is whether the loss of one leg above the knee would amount to total and permanent disability to entitle the respondent to the accident benefit under the policy. In the counter of the appellants it was contended that the accident benefit clause of the policy stated as follows : The disability above referred to must be disability which is the result of an accident and must be total and permanent and such that there is neither then nor at any time thereafter any work, occupation or profession that the Life Assured can ever sufficiently do or follow to earn or obtain any wages, compensation or profit. Accidental injuries which independently of all other causes and within 90 days from the happening of such accident, result in the irrecoverable loss of the entire sight of both eyes or in the amputation of both hands at or above the wrists, or in the amputation of both feet at or above ankles or in the amputation of one hand at or above the wrist and one foot at or above the ankle, shall also be deemed to constitute such disability.  That provision occurs in Clause 10 of the policy.

(3.) THE District Forum held that the loss of one leg below knee would amount to disability defined in that provision in Clause 10, and on that basis directed the appellants to pay Rs. 60,000/ - to the respondent/complainant with interest at 12% per annum from the date of the accident till realisation. The said provision was interpreted by the National Commission in Ramesh Chandras case where the accident resulted in the amputation of the right hand. The National Commission held as follows : The question is whether the amputation of right hand suffered by the complainant is a specified event and constitute disability entitled to an accident benefit under Clause 10(a) of the policy bond. The accident benefit is available to the assured only if he is involved in an accident resulting in total and permanent disability as defined in Clause 10. The disability referred in the said clause must be disability which is the result of accident and must be total and permanent. The 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 or in the amputation of both hands at or above the wrist or in the amputation of feet at or above ankles, or in the amputation of one hand at or above the wrist and one foot at or above the wrist only constitute such disability. The case of the complainant is not of the amputation of both hands at or above the wrists or in the amputation of feet at or above ankles. The case of the complainant is the amputation of one hand at or above the wrist but that is not independently deemed to be a disability as is covered since the coverage in the clause is only in cases of amputation of one hand at or above the wrist and one foot at or above ankle. It bears repetition that the deeming clause constituting the disability will get attracted only if there was the amputation of one hand at or above the wrist and one foot at or above the ankle. If it is the amputation of one hand at or above wrist or the amputation of one foot at or above the ankle, then it des not by the fiction of the Clause 10(a) constitute disability. The construction of the policy bond which is the basis of the contract of insurance, is a question of law and its true and correct interpretation would give jurisdiction to the FORA to pronounce upon the deficiency in service, if any. The District Forum as well as the State Commission had no jurisdiction to go beyond the terms and conditions of the policy bond and could only order the payment of the disability benefit if it was specified event covered under Clause 10 of the conditions of policy. The amputation of only one hand des not fall within the deeming definition constituting disability in terms of Clause 10(a) of the policy bond and thus the impugned orders suffer from serious illegalities. 