SUPREME COURT OF INDIA

Sandeep Kumar Chourasia …Appelant

versus

Divisional Manager, the New India Insurrance Company Ltd and another …Respondents

Facts –

 The appellant, Sandeep Kumar Chourasia was covered by an accident insurance. The
appellant was playing when he fell down and sustained injuries in the right portion of his
head and the right eye.
 He was initially treated in a government hospital and then a private hospital where he was
issued a medical certificate mentioning that on the account of the injury caused to his
right eye, the appellant suffered total loss of vision in the right eye and severe loss of
hearing in the both ears. The District Medical Board, Durg issued certificate dated
27.10.2005, which shows that the appellant had suffered 100% disability in the right eye.
 The appellant’s father then lodged a claim for compensation which was rejected by the
respondents on the ground that the same wasn’t covered in the policy. The appellant then
filed a complaint for award of compensation for Rs. 7,00,000/- with interest at the rate of
18% to 25% and cost.
 The respondents filed separate written statement to contest the complaint stating that the
right eye of the appellant was inflicted with Phthisis Bulbi and he was hard of hearing
since birth.
 After considering the pleadings of the parties and affidavits, the State Commission
decided to call for an expert opinion. The Medical Board after examination of the
appellant submitted a report which disclosed that there is no total loss of vision in the
right eye and further stated that there was Pathological Myopia for which Radial
Keratoomy Surgery had been done earlier and “that the loss of vision could have been
caused by fall while playing playing.” Therefore the State Commission passed order
dated 18.05.2006 and dismissed the complaint.
 Feeling aggrieved by the order of the State Commission, the appellant filed an appeal
under Section 21 of the CPA, 1986 but couldn’t convince the National Commission to
entertain the plea for award of compensation. The National Commission discarded the
certificate of Dr. Jaishri Gopinath and opined that the statement made by the appellant
about the loss of hearing was falsified.
Issues –

 The main issue was that the State Commission and the National Commission
dismissed the complaint on the reading of the Medical Board report that the
appellant lost his vision due to the disease Phthisis Bulbi but both the fora didn’t
appreciate the Medical Board’s opinion that the disease could also be caused by
accidental fall.

Ratio –

 The most important reasoning of the case is appreciation of the evidence.

 The Supreme Court held that both the State Commission and the National
Commission committed serious error by dismissing the complaint by assuming
that his right eye was inflicted with the disease thereby completely ignoring the
report of the Medical Board.
 The State Commission had sufficient evidence that the right eye was injured dur
to the accidental fall and there is no escape that the appellant’s case was covered
by the policy issued by the respondents and both the consumer fora committed
serious error by rejecting the claim.