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Thursday, May 2, 2013

Apex Court on loss of vision due to fall / Phthisis Bulbi eye....

Poets have sung volumes on their power to attract ~ they are the most important organs….. ‘the eyes’….. eyes are organs that detect light and convert it into electro-chemical impulses in neurons. The optical system collects light from the surrounding environment, regulates its intensity through a diaphragm, focuses it through an adjustable assembly of lenses to form an image, converts this image into a set of electrical signals, and transmits these signals to the brain through complex neural pathways that connect the eye via the optic nerve to the visual cortex and other areas of the brain. There are some diseases which cause irreparable damage to eye and thereby the vision.

Heard of ‘Phthisis Bulbi Eye’ ? : Phthisis bulbi is an eye condition that occurs when an eye has undergone trauma or become damaged and lost all sight; it atrophies and calcifies, becoming nothing more than a lump of tissue. Not many of those who have problems have the resilience to fight it out – ‘the never say die spirit’…… !!

There are many policies offering Personal accident coverage and the simplest and perhaps of long origin are the ‘Janata Personal Accident and Gramin policy’ of Public Sector Insurance Companies.  In 1980s, Janata Personal Accident Policy [known as JPA] cost Rs.12/-  with Rs.25000/- as the Sum Insured.  There was a rule that one can have only one JPA [!]; subsequently it became that one can take policy in multiples of Rs.25000/-; the policy was to provide for Death and permanent total disability covers.  To make things much simpler and to reach out to the poorest of the poor, Gramin PA policy came into being……. It had SI of Rs.10000/- and premium of Rs.5/-…………..

Here is some excerpts of judgment in  the Civil Appeal no. 2759 of 2013 pronounced recently by the Supreme Court of India  involving Sandeep kumar Chourasia Versus New India Assurance Co.  This was an appeal made against the order of the National Consumer  Disputes  Redressal   Commission [NCDRC] and earlier State Forum at  Chhattisgarh State.  The cause of action arose under a ‘Janta  Gramin  Vyaktigat  Durghatna  Policy’   for Rs.7,00,000/- taken out in July 1997.  The policy covered death, PTD, loss of limbs / eye….

In Oct 1999, the son of the policy holder [also covered in the policy]  fell down and sustained injuries in the right portion of his  head  and  the right eye. He was initially treated in the Government hospital and  then  in the private hospital.  An Assistant  Surgeon at the Govt Hospital at Supela,  Bhilai  issued  medical  certificate stating that on account of injury caused to his  right  eye,  the appellant suffered total loss of vision in the right eye and severe loss  of hearing in both ears. The  boy despite a surgery to check further deterioration sadly suffered 100% disability in the eye.   

The appellant’s father lodged a claim for  compensation asserting that the loss of vision was due to accidental fall.    The Insurers after long correspondence, rejected the claim that it was not covered.  The appellant then agitated before the Consumer Forum.  The Insurers contended that the right  eye  of  the appellant was inflicted with Phthisis Bulbi  and  he  was  hard  of  hearing since birth.  The State Commission called for an expert opinion and constituted Medical Board in Raipur.  The Medical Board opined that : Phthisis Bulbi RE is the course of loss vision; there is total loss of vision in RE; the patient had pathological myopia  for  which  Radial  Kanatotomy  surgery head been earlier; the loss of vision could have  been  caused by fall while playing and the loss of vision in RE is irreversible.”

After receiving the report of the Medical Board, the State  Commission dismissed  the  complaint.  The Forum opined that the complainant is not entitled to benefit under the policy. Feeling aggrieved by the order of the State Commission, the  appellant filed an appeal but could not convince the National Commission to entertain his plea  for  award of compensation. The National Commission virtually copied the reasons recorded  by  the  State  Commission and dismissed the appeal filed by the appellant.

The Plaintiff filed appeal before the Apex Court which relied on the report of Medical Board which inter alia stated that loss of vision could have been caused by fall  while playing.  It was observed that in their pleadings, respondents had  not  contested  the  statement contained in the complaint, which was duly supported  by  the  affidavit  of Shri P.D. Chourasia, that while playing outside the residence his child  had an accidental fall and the consequential injury to the right eye led to  the loss of vision.

The Apex Court observed that the State & National Commission had committed serious error by dismissing the complaint of the appellant by assuming  that  his  right  eye was afflicted with the disease of Phthisis Bulbi and the same was the  cause of loss of vision. They completely ignored the report of the  Medical  Board which had opined that Phthisis Bulbi can be caused due to injury caused  due to fall. The Court then observed therefore that there is no escape from the conclusion that the appellant’s  case was  covered  by  the  policy  issued  by  respondent  No.1.

By this the Supreme Court allowed the appeal setting aside the earlier order of State Commission, upheld by the National Commission and directed the Insurers to pay compensation of Rs.7,00,000/- to the appellant with interest @ 6% per annum from the date of filing the complaint. The respondents were directed to pay the aforesaid amount within  a   period   of   eight   months   from   the   date   of receipt/production of copy of the judgment.

As they say, there is always lot to learn from every judgment.

With regards – S. Sampathkumar
27th April 2013.

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