NEW INDIA ASSURANCE COMPANY LIMITED Vs. ABDUL JABBAR

JUDGEMENT

(1.) This is an appeal against the judgment and order dated 22.8.2001 passed by District Consumer Forum, Bareilly II in Complaint Case No.64 of 2000.

(2.) Briefly stated the facts of the case are that the complainant, Abdul Jabbar, resident of Banjara Inayatganj, Bareilly, had taken a Janta Personal Accident Insurance Policy No.4216010007314 on 30.4.1996. The capital sum assured was Rs.2,00,000/- and the period of insurance covered under the policy was in force from 30.4.1996 to 29.4.2006. The risk covered under the policy was to indemnify the complainant upto Rs.2,00,000/- in case of permanent disability. At the time of the insurance the complainant had normal eye sight and normal hearing capacity. On 20.12.1998 at Bareilly Bye-pass Road when the complainant was getting his truck repaired, he was all of a sudden hit by a speeding Army vehicle which was driven rashly and negligently. This caused injury to the eyes, ears, face, mouth and feet of the complainant. The injuries were so serious that the complainant became unconscious for quite some time. After becoming conscious the complainant lodged an F. I. R. with the Police Station, Baradari at Bareilly and also intimated the fact of accident to the opposite party. He was given a claim form by opposite party which was filled up and submitted. He spent an amount of Rs.20,000/- for the treatment of the eyes, fee etc. and remained under treatment of qualified doctors. As a result of the above injury the eye sight of the complainant was diminished permanently and his hearing capacity was also dismished permanently to the extent of 50%. The result is that the complainant is unable to lead a normal life and cannot drive scooter, motor cycle, car etc. nor can he hear until and unless spoken loudly. The claim for compensation of Rs.2 lacs was lodged with the opposite party which was not accepted although enquiry and investigation in the case had been made and the Investigator had come to the conclusion that the complainant suffers from disability. The claim was not sanctioned on the ground that disability is not 100%. The opposite party committed deficiency in service as the complainant is a consumer. The repudiation was made on 14.4.1997 and, therefore, the complaint was lodged before the District Consumer Forum for recovery of a sum of Rs.2,00,000/- as compensation alongwith damages of Rs.10,000/-. Cost of treatment amounting to Rs.20,000/- was also claimed.

(3.) In the written statement before the District Consumer Forum, the opposite party, New India Assurance Company Limited, admitted the insurance but stated that the claim made was false and the complaint is barred by the provisions of Sections 2 (o) and 2 (d) of the Consumer Protection Act. The complainant had failed to establish his losses and the expenditure he has alleged to have incurred. The claim is exaggerated and has been on concoeted and fictitious grounds. It is wrong to say that the complainant had become permanently disabled due to the alleged accident and his eye sight and hearing power has been diminished permanently to the extent of 50%. The complainant could not produce positive medical evidence to show that a genuine claim has been made as per terms and conditions of the policy. The company is liable to pay the compensation in case any injury is suffered within one calendar year of the occurrence which is the direct cause of the total and irrecoverable loss of sight of both the eyes. In that case the payment of Rs.2 lacs was payable and in case any injury occurs within one calendar year resulting into irrecoverable loss of sight of one eye, 50% of the capital sum of the insurance amount was payable, subject to terms and conditions of the policy. There is no total and irrecoverable loss of sight and, therefore, no claim under the policy is payable. The mandatory notice as required under the terms and conditions of the policy was not given to the opposite party by the complainant. The claim was, therefore, fraudulent and was not payable. Letters and reminders to the complainant were sent to produce the related medical reports and bills etc. of treatment which were not furnished. In the F. I. R. lodged by the complainant details of the number or make of the vehicle have also not been furnished. After considering all the facts and circumstances and the investigation report, the Insurance Company repudiated the claim of the complainant. The disability certificate produced by the complainant is not conclusive proof of his disability of blindness and deafness. The claim was, therefore, not sustainable.