NATIONAL INSURANCE CO LTD Vs. RAJA TUKARAM SHINDE

JUDGEMENT

(1.) The present revision petition has been filed by National Insurance Co. Ltd. (hereinafter referred to as the 'Petitioner') against the order of the State Consumer Disputes Redressal Commission, Maharashtra (hereinafter referred to as the State Commission') in favour of one Raja Tukaram Shinde (hereinafter referred to as the 'Respondent') who was the original complainant before the District Forum.

(2.) The brief facts of the case are that the Respondent was a Member of the Maharashtra State Electricity Board Staff Welfare Committee which had obtained a Janta Personal Insurance Policy to cover their member/employees for a total sum of Rs. 2 lakh for a period of 12 years w.e.f. 26.2.1998. As per the provisions of this policy, if an injury occurred to an insuree within one calendar year of its occurrenc e which was the sole and direct cause of total and irrecoverable loss of sight of one eye, or total or irrecoverable loss of use of hand or a foot, 50% of the capital sum insured would be given to the insuree. In the instant case the Respondent on 14.7.1998 during the course of his duties while working on an electricity pole, fainted and fell down sustaining serious head injuries and was hospitalized from 14.7.1998 to 3.8.1998. As a result of this accident, Respondent lost vision of his left eye and a certificate to this effect was issued by the medical officer of General Hospital, Latur. In terms of the insurance policy the Welfare Committee forwarded the necessary papers to the Petitioner-Insurance Company on 8.9.2000 and requested that the insurance claim due to the Respondent because of loss to his eye be paid directly to him. However, the claim was contested by the Petitioner-Insurance Company on the grounds that the claim was filed beyond the period of limitation of one calendar year and further as per one of the two medical certificates issued by the same hospital the loss of vision of the left eye was not complete but stated to be only 30%.

(3.) Aggrieved by this, Petitioner filed a complaint before the District Forum which accepted the complaint on the grounds that there was adequate evidence on record that the Respondent had lost vision in his left eye rendering it completely useless and that even second medical certificate which stated that the loss of vision in the left eye was upto 30% has certified that there is permanent privation of sight of the left eye. The District Forum, therefore, directed the Petitioner to pay the Respondent Rs. 1 lakh as insurance benefit together with interest @ 9% per annum within 30 days from the date of receipt of the order.