KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD THIRUVANANTHAPURAM APPEAL NO:327/2006 JUDGMENT DATED :12.01.2010 PRESENT SRI.M.V.VISWANATHAN : JUDICIAL MEMBER SRI.M.K. ABDULLA SONA : MEMBER The National Insurance Company Ltd., Thrissur, Repd. by its Deputy Manager, : APPELLANT Regional Office, M.G.Road, Ernakulam. (By Adv: Sri.George Cheriyan) Vs. Gunasingh.V.K, Velekkat House, : RESPONDENT P.O.Vadakkummuri, Peringottukara, Thrissur. (By Adv: Sri.P.K.Sajeev) JUDGMENT SRI.M.V.VISWANATHAN: JUDICIAL MEMBER Appellant is the opposite party and the respondent is the complainant in OP:663/02 on the file of CDRF, Thrissur. The complaint therein was filed claiming the insurance amount under Jeevan Raksha Insurance Policy. Admittedly the aforesaid policy was issued by the appellant/opposite party to the respondent/complainant. In the said policy the sum insured was Rs.1,00,000/-. The aforesaid claim for Rs.1,00,000/- was repudiated by the opposite party/Insurance company on the ground that the said claim is not covered by the Jeevan Raksha Insurance Policy issued infavour of the complainant. The Forum below has also incorporated in the impugned order, the terms and conditions of the said policy. It would make it abundantly clear that the respondent/complainant who sustained or suffered permanent disability of 70% is not covered by the said policy to get the insurance amount of Rs.1,00,000/-. Ext.P2 is the medical certificate issued by Dr.M.C.Rajagopalan, Specialist in Physical Medicine attached to District Hospital, Thrissur. It is dtd:22..6..01. P2 certificate can be treated as a disability certificate issued by the Doctor who is specialist in physical medicine. As per P2 disability certificate (medical certificate) the complainant/insured suffered only permanent disability of 70%. The aforesaid disability is also categorized as moderate disability. Admittedly both the lower limbs of the complainant/insured became weak and he is not in a position to walk properly. But as per the policy namely; Jeevan Raksha Insurance Policy the insured is entitled to get the insurance amount only when there is permanent total/absolute disability. In other words, the disability must be 100%. But in the present case the complainant suffered only 70% disability. The terms and conditions of the said policy would make it clear that the injury or disability sustained by the complainant is outside the purview of the Jeevan Raksha Insurance Policy. 2. The Forum below has not properly appreciated the conditions of the Jeevan Raksha Policy. The Forum below failed to appreciate P2 disability certificate in its correct perspective. Unfortunately the Forum below made 70% permanent disability as one of 100% disability. It is further to be noted that no evidence is forthcoming from the side of the complainant to show that he has suffered permanent total disability. The doctor who issued P2 disability certificate has not been examined to substantiate the case of the complainant that the disability he suffered is of permanent and total. Thus, in all respects, the Forum below cannot be justified in directing the opposite party/insurance company to pay the insurance amount covered by Jeevan Raksha Insurnce policy. The impugned order passed by the Forum below in OP:663/02 is liable to be quashed. 3. Admittedly the respondent/complainant had taken Janatha Accident Policy and he obtained the insurance amount covered by the aforesaid Janatha Accident Policy. It is also to be noted that the respondent/complainant has already received the treatment expenses of Rs.25,000/-. So, the treatment expenses under the Jeevan Raksha Insurance Policy cannot be awarded. Thus, the present appeal is to be allowed. Hence we do so. In the result the appeal is allowed. The impugned order dated:23..3..2006 passed by CDRF, Thrissur in OP:663/02 is set aside. The parties are directed to suffer their respective costs. M.V.VISWANATHAN: JUDICIAL MEMBER VL. M.K. ABDULLA SONA : MEMBER | 
