ORIENTAL INSURANCE CO LTD Vs. PAWAN KUMAR PANDEY

JUDGEMENT

(1.) Challenge in this Revision Petition, under Section 21(b) of the Consumer Protection Act, 1986 (for short "the Act"), is to order dated 25.6.2009 in First Appeal No. 652 of 2006 passed by State Consumer Disputes Redressal Commission, Bihar, Patna. By its impugned order, the State Commission modified the order of the District Forum and enhanced the amount to be paid by the Appellant/Insurance Company from ?44,283.36 to ?2,00,000/- together with costs of ?5,000/- to be paid within 45 days from the date of receipt of the order, failing which the amount would attract an interest of 9% per annum.

(2.) The brief facts as set out in the complaint are that the Complainant, a Bank Accountant, while coming out of his office, on 10.6.1999 at about 4.30 P.M., slipped from the staircase and sustained injury in his right leg. His colleague admitted him in Dr. M.K. Chaudhary's clinic where a surgery was performed on his ankle. The Complainant pleaded that on account of the injury sustained, he incurred heavy expenditure on the surgical procedure and medicines. It was averred by the Complainant that the Medical Board certified that he was partially and permanently disabled due to stiffness of right ankle on account of fracture which resulted from the injury. The Complainant stated that he was insured by Janta Personal Accident Insurance Policy covering the period 17.3.1998 to 16.3.2010; for a sum of ?10,00,000/- in case of total disablement/permanent disability. The Complainant filed a claim with the Insurance Company which was repudiated vide their letter dated 20.1.2000 on the ground that the Complainant had failed to fulfil Condition No. 3 of the terms of the Policy. Hence, the complaint seeking direction to the Insurance Company to pay an amount of ?4,75,000/- together with costs of ?25,000/-.

(3.) The Respondent/Opposite Party filed its written version and pleaded that the Complainant's claim was repudiated as it does not fall within the purview of condition-C of Janta Personal Accident Insurance Policy, which reads as follows: