MAHENDRA AGARWAL Vs. ORIENTAL INSURANCE CO LTD

JUDGEMENT

(1.) Petitioner Mahendra Agarwal had obtained a Personal Accident Insurance Policy for a sum of Rs.1.00 Lakh from the respondent-Oriental Insurance Company Limited, which was valid from 05.05.1992 to 04.05.1993. During the currency of the period of insurance, he met with an accident on 8th of June, 1992 and sustained severe injury to his right eye. Alleging total loss of vision despite best medical treatment, he lodged a claim with the respondent-Insurance Company for Rs.55,000/- as per the terms of the policy for having lost the total vision in one eye. The respondent-Insurance Company, however, admitted the claim only for a sum of Rs.30,000/- and paid this amount towards the full and final settlement of the claim. Contending that he had received the amount of Rs.30,000/- under protest, he filed a consumer complaint before the District Consumer Disputes Redressal Forum, Bulandshahar (District Forum for short) seeking direction to the respondent-Insurance Company to pay him the balance amount of Rs.25,000/- with interest and damages of Rs.30,000/- and in addition a sum of Rs.5000/- towards the litigation expenses. The complaint was resisted by the respondent-Insurance Company on the ground that the petitioner-complainant having received the amount of Rs.30,000/- towards the full and final settlement of the claim was debarred from agitating the matter before the consumer fora. It was explained in the written statement that the claim had been settled in terms of the policy and on the basis of medical report of Dr. R. P. Centre, All India Institute of Medical Sciences, New Delhi. The District Forum, however, was not convinced with the defence advanced by the respondent-opposite party-Insurance Company and allowed the complaint directing them to pay a sum of Rs.25,000/- with 12% interest per annum w. e. f.10th of July, 1993 till the date of payment within a month. It also awarded a sum of Rs.2500/- towards cost and compensation. Aggrieved with the order of District Forum, that the respondent-Insurance Company filed an appeal before the U. P. State Consumer Disputes Redressal Commission, Lucknow (State Commission for short), who vide the order impugned accepted their appeal and set aside the order of the District Forum resulting in the dismissal of the complaint of the petitioner. It is in this background that the complainant is before us in this revision petition seeking restoration of the order of District Forum.

(2.) We have heard the learned counsel for the parties and perused the records of the case.

(3.) The short point for consideration is as to whether the petitioner-complainant who claims to have suffered total and permanent loss of vision in his right eye would be entitled to only 30% of the sum assured? In this case, the respondent-Insurance Company has relied upon the medical report of the petitioner-complainant issued by Dr. R. C. Anand, Additional Medical Superintendent of Dr. R. P. Centre of the AIIMS, New Delhi. Paras 7 and 8 of the said report, which are relevant for the proper adjudication of the matter are reproduced below:-