NATIONAL INSURANCE CO LTD Vs. PREMJIBHAI LAXMANBHAI MOTKA

JUDGEMENT

(1.) The present revision petition has been filed by the National Insurance Co. Ltd. (hereinafter referred to as the 'Petitioner') being aggrieved by the order of the State Consumer Disputes Redressal Commission, Gujarat (hereinafter referred to as the 'State Commission') in favour of Shri Premjibhai Laxmanbhai Motka (hereinafter referred to as the 'Respondent').

(2.) The facts of the case according to the Respondent who was the original complainant before the District Forum are that he had taken a Group Janata Personal Accident Insurance Policy from the Petitioner Insurance Company for a sum of Rs.10 lakhs and this policy was valid for the period from 01.04.1999 to 31.03.1999.

(3.) One of the terms and conditions of the above policy was that in case the policyholder loses one eye or one limb due to an accident then he would be entitled to claim 50% of the sum assured. According to the Respondent on 06.02.2000 at about 7.00 p.m. he fell from a ladder and as a result of the fall he injured his left eye. He informed the police station about the accident and took treatment at M.G.S. Hospital at Surendra Nagar after which he consulted an Ophthalmologist, Dr.K.B.Jhala who gave the opinion that the Respondent had lost the vision in the left eye. He was thereafter referred to Dr.P.M. Nagpal a well known eye specialist in Ahmedabad who also confirmed that the Respondent had lost vision in the left eye. Respondent, therefore, filed a claim seeking 50% of the amount insured from the Petitioner Insurance Company as per the terms and conditions of the Janata Personal Accident Insurance Policy. Since, the Petitioner repudiated his claim, Respondent filed a complaint before the District Forum on the grounds of deficiency in service and claimed Rs.5 lakhs being 50% of the insurance amount together with 18% interest from the Petitioner.