ORDER
Rajyalakshmi Rao, Member
1. The revision petition arises out of the order dated 6th November, 2001 passed by the Gujarat State Consumer Disputes Redressal Commission partially upholding the order of the Banaskanta District Consumer Forum.
Brief facts of the case are :
1.0 The respondent, D.K. Panchal, obtained a “Twenty Year Money Back Policy with profits (with Accident Benefit)” for Rs. 25,000/- on 28th March, 1993. On 15th May, 1999, he had an accidental fall from the roof of the house where he was working, resulting in injury to his right thigh and he underwent surgery. A claim for reimbursement of the medical cost was made
on 28th May, 1999. He claimed Rs. 28,420/- as expenses towards doctors’ fee, medicines etc. (including Rs. 14,400/- on expenses for hired vehicle to go to the doctor every week) and also repayment of insured sum of Rs. 25,000/- i.e. in all Rs. 53,420/-. The operating surgeon mentioned in Form 528 (accompanying the claim) that the deformity is only 40% to 50%. In the column, “Time required to recover from the disability”, the doctor mentioned, Total bed rest 6 to 8 months”. The claim (Extended Permanent Disability Benefit) was repudiated on 29th July, 1999 on the ground that:
(a) the disability is not total and permanent;
(b) that there is only 40% to 50% disability; and (c) the insured is earning Rs. 1,000/- per month and able to do his usual work.
The District Forum which was approached by the insured, ordered, (a) payment of Rs. 25,000/- with interest at the rate of 12% p.a. from the date of accident and (b) repayment of amount of instalments paid by him.
On appeal by LIC, the State Commission struck down the portion “The complainant/petitioner has right to recover the net amount paid by him in instalments”, but otherwise confirmed the order of the District Forum. It is also recommended to the LIC that it should revive the policy of the insured after he pays the pending instalments due.
2.0 The argument of the appellant is that Clause 10 of the policy relates to Accident Benefit; and the Sub-clause (a) thereof refers to ‘Disability to the Life Assured’. According to this clause, “the disability must be total and permanent and such that there is neither then (as the time of accident) nor at any time thereafter any work, occupation or profession that the Life Assured can ever sufficiently do or follow to earn or obtain any wages, compensation or profit”.
3.0 Before concluding we would like to observe that the Form 528 prescribed by LIC and required to be filled in by the attending doctor is misleading. For instance, Column V(ii) reads “Do you consider that the patient is now incapacitated and follow his usual vocation, and if so please state”. Similarly, Column V(d) reads : “The time required for him to recover fully from the disability”. If a disability claim can only be accepted if the disability is total and permanent, there is no point in asking the above questions and LIC would do well to modify the form, so that the assured are not misled.
4.0 However, in view of the specific provisions in the insurance policy, unfortunately, the respondent would not be entitled to receive any disability benefit. The appeal is allowed and the order of the State Commission is set aside.