NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
(from the order dated 26.8.99 in Appeal No.553/96 of the
Dr.Mahadeo Narayan Kapse
Injbav, Tal. Man
Distt. Satara. (
New India Assurance Co. Ltd.
403 Guruwar Peth
HONBLE MR.JUSTICE M.B. SHAH, PRESIDENT
DR. P.D. SHENOY, MEMBER
For the Petitioner : Mr. S.V. Chitale, Advocate
For the Respondent : Ms. Pankaj Bala Verma, Advocate
Heard the learned counsel for the parties. This Revision Petition is filed against the
order dated 26.8.1999 passed by the State Consumer Disputes Redressal
The Personal Accident Insurance (individual) Policy specifically provides that if at any point of time during the currency of the policy, insured sustains any bodily injury from an accident, the insurance company shall pay to the insured the sum as mentioned in Clause-F which reads thus :
If such injury shall be the sole and direct cause of temporary total disablement, then so long as the insured shall be totally disable from engaging in any employment or occupation of any description whatsoever, a sum at the rate of one percent (1%) of the Capital Sum insured stated in the Schedule hereto per week but in any case not exceeding Rs.1,500/- per week in all, under all Policies.
Provided that the compensation payable under the foregoing Sub-Clause (f) shall not be payable for more than 104 weeks in respect of any one injury calculated from the date of commencement of the disablement and in no case shall exceed the Capital Sum Insured.
The District Forum has awarded Rs.33,000/- to the doctor towards compensation for loss of practice.
In this case, it is undisputed that a medical practitioner (complainant), Dr. Mahadeo Narayan Kapse, was driving a motor cycle on 4.10.1994 and accident took place. During that time, the insurance cover which petitioner had taken was in force. The District Forum and the State Commission accepted the contention of the petitioner that petitioner has suffered due to that accident. The District Forum passed an award on the basis of the complaint filed by the insured. Against that order, the insurance company preferred an Appeal before the State Commission. Without assigning any reason, the State Commission reversed the order passed by the District Forum awarding an amount of Rs.33,000/- on the basis of Clause-F quoted above. To arrive at this conclusion, the District Forum has considered at length that petitioner was not in a position to discharge his duties as a doctor for 154 days. The fracture suffered by the petitioner was serious. He was required to be kept in ICCU for a number of days. The State Commission erroneously arrived at a conclusion that the loss on account of his being sick for 154 days cannot be compensated as the same is beyond the terms and conditions of the policy. It appears that terms and conditions of the policy were not properly pointed out to the State Commission.
In this view of the matter, impugned order passed by the State Commission reversing the order passed by the District Forum granting Rs.33,000/- on the basis of the loss suffered by the complainant due to loss of practice is set aside. The order passed by the District Forum is restored.
Admittedly, the insurance company has not paid the amount as directed by the District Forum. Considering this and the fact that the accident took place in 1994 and that the State Commission has passed the order on 26.8.1999, the insurance company shall pay the amount payable to the complainant/petitioner with interest at the rate of 9% p.a. from the date of order passed by the State Commission. The insurance company shall also pay costs of Rs.10,000/- to the complainant.
The Revision Petition stands disposed of accordingly.
(P. D. SHENOY)
/sra/ 20 /Court-I