JUDGMENT JUSTICE SHRI. K.R. UDAYABHANU: PRESIDENT The appellant is the opposite party/New India Assurance Company in OP 773/01 in the file of CDRF, Thrissur. The appellant is under orders to pay a sum of Rs. 1,00,000/- with interest at 12% per annum from 02-02-2000 and costs of Rs. 6,00/-. 2. The case of complainant is that he is the holder of Karshaka Raksha policy of the opposite party. During the period of policy coverage he sustained an accident. As a result of it he is having total and permanent disablement. The claim submitted accompanied by the relevant documents were repudiated. 3. It is the contention of the appellant/opposite party that the complainant is entitled only for Rs. 5,000/- towards hospitalization expenses for grievous injury subject to the production of original bills of treatment. It is contended that the above bills and prescriptions were demanded as per letter dated 14-05-2001 but the same were not produced. It is contended that the complainant has not sustained permanent and total disability as envisaged under the policy. 4. The evidence adduced consisted of Ext.P1 to P4 and R1 to R9. 5. The Forum has relied on Clause 4 in Et.R1 policy wherein it is mentioned that if the injury has resulted immediately in permanent, total and absolute disablement, disabling the insured from engaging in, being occupied with or giving attention to any paid employment or occupation of any description the assured should be entitled for the capital sum assured. Ext.P4 disability certificate mentions that the petitioner has sustained permanent disability of 30% and loss of earning capacity of 90%. Hence it is contended that the disablement attracts Clause 4 of the schedule to Ext.R1. We find that the benefits of the policy mentioned on the reverse of Ext.P1 policy would show that the assured sum of Rs. 1,00,000/- would be provided in case of accidental death, permanent and total disability and in case of loss of two legs or two hands or one hand and one leg or two eyes. For the loss of one hand or one leg or one eye the amount provided is Rs. 50,000/-. The Counsel for the appellant has relied on the decision reported in Vanajakshan Vs Joseph 2003(2) KLT 462 (FB) of the full bench of the High Court of Kerala that considered the similar provision in the Workmen’s Compensation Act and held that the disablement should be such that incapacitated the workman “for all work" and not for the work for which he is actually employed. The High Court has also observed that cumulative consideration of the provisions contained in Sections 2,3 and 4 therein clearly showed that the intention of the Legislature was to compensate the workman for loss of earning capacity and not for the failure to perform the duties of the particular post on which he was actually working. The decisions relied on by the respondent/complainant ie, LIC of India Vs Devi Das Sirsode, IV (2005) CPJ 212 (NC) is a case in which legs were amputated. It was also noted therein that the policy terms if vague should be interpreted for the benefit of the assured. Evidently, the above was a case of amputation which is specifically covered by the policy herein also. In Oriental Insurance Company Ltd Vs Rajak Bhat Gafurbhai Manshri, IV (2007) CPJ 289 (NC) was a case in which the complainant therein got his both legs fractured and were left of no use and the permanent disability suffered is mentioned as 70%. It is the case where the complainant was ordered to be given 50% of the insurance amount. In the above case it is mentioned that both his legs were left of no use. 6. In Ext.P4 medical certificate, it is mentioned that the complainant sustained Type I open fracture to right femur, intertrochateric fracture of right femur. He was subjected to surgery. It is mentioned that there are limitation for movements for the legs. The permanent disability mentioned as 30%. The loss of earning capacity is mentioned as 90% as an auto rickshaw driver. In the instant case it is Karshaka Raksha policy that issued to the complainant. We find that it is not established that the complainant is unable to engage in any occupation. It has also to be noted that as per Ext.P1 policy even for loss of one eye or one leg or one hand, the amount provided is only 50,000/- and for loss of both limbs ie, both legs or both hands or one leg or one hand or two eyes, the compensation is Rs. 1,00,000/-. We find that the above envisage physical deformity as well. Hence we find that for disability with respect to one leg alone it cannot be held that the complainant is entitled for the actual sum assured. Hence we find that the order of the Forum in this regard cannot be sustained and the same is set aside herewith. 7. The complainant would be entitled for Rs. 5,000/- in case he sustained grievous injury and was hospitalized for more than one day. It is mentioned in the medical certificate that the complainant was hospitalized for about one month in two instances and undergone surgery. In the circumstances, the complainant is entitled for Rs. 5,000/- as mentioned in Ext.P1 policy. It was not proper for the appellant in such circumstance to insist for any detailed bills etc. In the result, the order of the Forum directing to pay a sum of Rs. 1,00,000/- etc. is set aside. The appellant is directed to pay a sum of Rs. 5,000/- to the complainant with interest at 12% per annum from 02-02-2000 till realization and also to pay costs of Rs. 600/-. The amount is to be paid within 3 months from the date of receipt of this order failing which the complainant would be entitled for interest at 15% from the date of this order. The appeal is allowed in part as above. JUSTICE K.R. UDAYABHANU: PRESIDENT Sr. | 
