Heard learned counsel for both the parties.
2. Captioned appeal is filed u/s 15 of the erstwhile Consumer Protection Act, 1986 (hereinafter called the ‘Act’). Parties to this appeal shall be referred to with reference to their respective status before the District Forum.
3. The case of the complainant in nutshell is that the complainant was working as Junior Clerk in M.K.C.G. Medical College and Hospital, Berhampur and purchased a Personal Accident Individual (P.A.) Insurance Policy covering the period from 20.12.2008 to 19.12.2009 for the sum assured at Rs. 10,00,000/- (Ten Lakhs) from the opposite party. It is alleged that on 29.3.2009 at about 7.30 P.M. while the complainant was going on the left side of the road, a motor cycle came rashly and dashed against him for which he sustained injuries in his face and right side eyes. He remained in the M.K.C.G. Medical College and Hospital, Berhampur till 31.3.2009. During treatment, it is found that his right eye has been affected. So he was treated at L.V.Prasad Eye Institute, Bhubaneswar and Shankar Netralaya, Chennai. The report of Shankar Netralaya disclosed that he has lost total vision in his right eye. After return, the complainant filed claim petition before the opposite party who repudiated the claim of the complainant stating that the policy condition never allows such type of injury. Challenging the repudiation the complaint was filed.
4. The opposite party filed written version stating that during the currency of the policy the accident took place but the complainant has only sustained 30 to 40% loss in the vision of his right eye. As such, the complainant is not entitled to any compensation. They also found that the claim is a false one. As such, they have repudiated the claim and there is no deficiency in service on the part of the opposite party.
5. After hearing both the parties, learned District Forum have passed the following order:-
“ The complaint is allowed on contest against the opposite parties. The opposite parties are directed to pay Rs.500,000/- ( Rupees Five Lakhs) i.e. ( 50% of the sum assured of Rs. 10,00,000/- towards insurance claim of the complainant along with litigation cost of Rs. 1000/- (Rupees One thousand) for mental agony and harassment within one month from the date of receipt of this order failing which the total awarded amount would carry 9% ( nine percent) interest per annum till the realization of the same.
The order is pronounced in the open Forum on this 2nd day of September, 2013 under the signature and seal of the Forum. Copy of the order be served on the parties free of cost.”
6. Learned counsel for the appellant submitted that learned District Forum committed error in law by not going through the written version with proper perspectives. According to him, the policy condition prescribes permanent disability.
7. In the instant case, after investigation, they found that the complainant managed to get two disability certificates one from the District Medical Board of Ganjam, Orissa to the extent of 30% and another from the Professor of Opthomology, MKCG Hospital, Berhampur to the extent of 40% in the right eye. Since the policy condition allows only 50% damage, the complainant is not entitled any compensation for such damages. Further, he submitted that the investigator reported that the complainant being an employee of the MKCG Hospital, Berhampur managed to obtain those two medical certificates. Therefore, the entire allegation is false and fabricated one.
8. Learned District Forum ought to have considered all these facts and law. Therefore, the impugned order be set aside by allowing the appeal.
9. Learned counsel for the respondent submitted that the submission of the learned counsel for the appellant has no basis because the repudiation has been made not on the basis of argument advanced but on the basis that complainant has made some false allegations. He further submitted that learned District Forum has passed impugned order after considering the facts and law.
10. Considered the submissions, perused the impugned order and the DFR.
11. It is admitted that during the currency of the policy, the complainant has met with an accident and got his right side eye affected. It is not in dispute that he has been treated at L.V.Prasad Eye Institute, Bhubaneswar and thereafter in Shankar Netralaya, Chennai. It reveals from the medical certificate issued by the Professor of Opthomology, MKCG Hospital, Berhampur that the vision was lost to the extent of 40% in the right eye. Further Medical Board opined that there was damage to the extent of 30% in the right eye of the complainant.
12. From the above, we are of the view that he has got 30% and 40% disability in the vision of right side eye. The loss of vision in the eye not only makes a person disable, but also gives mental agony and permanent vision disability. In the instant case, we are of the view that 30% or 40% disability of the right side eye can be treated as 50% affective because a person cannot read or see the images or write up correctly. The learned District Forum has rightly passed the impugned order and there is nothing wrong in the impugned order. Accordingly, the impugned order passed by the learned District Forum is confirmed and the appeal has no merit and accordingly dismissed.
The awarded amount passed by the learned District Forum shall be paid within 45 days failing which it will carry 10% interest from the date of impugned order till the date of payment.
DFR be sent back forthwith.
Supply free copy of this order to the respective parties or the copy of this order be downloaded from Confonet or Website of this Commission to treat same as copy supplied from this Commission.
