Smt. C.S. Sulekha Beevi, President,<br /> <br /> 1. Brief facts of the case:-<br /> <br /> Complainant who is an agriculturist availed a personal accident policy with opposite party. During the currency of the policy complainant met with an accident while he was pouring petrol into pumpset. His left leg suffered severe burn injuries and he was treated as inpatient in Al-Shifa Hospital, Perintalmanna from 22-03-03 to 03-4-03. He was again admitted on 12-4-03 for skingrafting and discharged on 15-4-03. Doctor advised him to take three months bed rest. He incurred expenses of Rs.30,000/- towards medicines. On submitting the claim under the policy opposite party informed that the amount payable is only Rs.6,000/-. This complaint is preferred claiming Rs.18,000/- under the policy.<br /> <br /> 2. Opposite party has filed version admitting the issuance of Personal Accident Policy and Mediclaim policy to complainant. It is submitted that an amount of Rs.5,000/- has already been paid under Mediclaim. As per the terms and conditions of Personal Accident Policy complainant is entitled to get compensation for temporary total disablement and he is not entitled to get compensation for any temporary partial disablement. It is contended that the injury resulted in total disablement for one month only and Rs.6,000/- was offered taking into consideration disablement for 4 weeks. Complainant refused to accept the same. Complaint is liable to be dismissed.<br /> <br /> 3. Evidence consists of affidavits filed by both sides. Exts.A1 to A5 marked on the side of complainant. Exts.B1 to B6 marked on behalf of opposite party. Either side has not adduced any oral evidence.<br /> <br /> 4. According to complainant he was totally disabled for three months and claims compensation of Rs.18,000/- ie., Rs.1500/- x 12 weeks. Opposite party resists this claim contending that complainant was totally disabled only for one month and the amount payable is Rs.6,000/- ie., Rs.1500/- x 4 weeks. Ext.B1 is the policy. Condition 1(f) states that Rs.1500/- per week is payable so long as the insured is totally disabled from engaging in any employment or occupation of any description whatsoever. Ext.A3 series is the discharge summary. The accident occurred on 22-03-03 and complainant was admitted as inpatient on the same day. The injuries sustained are 2º to 3º burns on the left leg. He was treated as inpatient for 13 days and discharged on 03-4-03. He was again admitted on 12-4-03 for skingrafting surgery and was discharged on 15-4-03 with advice to review on 18-4-03. Thus opposite party has calculated compensation for 4 weeks from date of accident to 18-4-03. Complainant relies on Ext.A1 dated, 06-5-03 which is the Medical report of Dr.Cheriyan Joseph who treated complainant. In column 7 of Ext.A1 doctor has stated that insured will be able to resume normal duties fully after three months. Opposite party controverts Ext.A1 relying upon Ext.B4 Certificate issued by the same doctor dated, 22-08-03. Ext.B4 reads as under:-<br /> “He had full thickness burns of the thigh and leg and required skingrafting for the same. He is totally disabled for a period of one month. After discharge he requires physiotherapy and pressure banding frequently. He will be partially disabled for another 2 months after which he should be able to resume his normal duties.”<br /> Much thrust was laid by counsel for opposite party on Ext.B4 and contended that total disablement was only for one month. In Ext.B4 the doctor has categorically stated that only after another two months the insured would be able to resume his normal duties. As per Condition 1(f) the period during which the insured is disabled in engaging his occupation has to be taken into consideration. Ext.B4 does not state that insured will be able to resume his occupation after one month. Further Ext.B4 was issued four month after discharge when opposite party issued Ext.B6 letter to doctor asking him to clarify the total disablement and partial disablement periods of the insured. It is also stated in Ext.B4 that insured was continuing treatment even after one month of accident. No evidence is adduced by opposite party that complainant was able to engage in his occupation after one month. Ext.A5 is the microbiology report which shows wound had infection on 29-4-03. From the evidence adduced and materials on record it can reasonably be inferred that complainant could not engage in his occupation for three months due to disablement. While settling claims Insurance Company should take a human approach rather than be highly technical. We hold that complainant is entitled to compensation of Rs.18,000/-. The act of opposite party adhering to flimsy grounds to deny compensation amounts to deficiency in service.<br /> <br /> 5. In the result, we allow the complaint. Opposite party is ordered to pay a sum of Rs.18,000/- to the complainant along with interest @ 12% per annum from the date of complaint till realisation within three weeks from the date of receipt of copy of this order. Opposite party shall also pay to complaint Rs.2000/- being cost of this litigation.<br /> Dated this 18th day of April 2008.<br /> <br /> <br /> C.S. SULEKHA BEEVI, PRESIDENT<br /> <br /> <br /> <br /> <br /> E. AYISHAKUTTY, MEMBER<br /> <br /> <br /> APPENDIX<br /> <br /> <br /> Witness examined on the side of the complainant : Nil <br /> Documents marked on the side of the complainant : Ext.A1 to A5<br /> Ext.A1 : Photo copy of the Personal Accident Insurance – Medical Report<br /> issued by Dr.Cheriyan Joseph M.S. Consultant Surgeon, Al-Shifa Hospital<br /> and C.T. Scan Centre, Perintalmanna dated, 06-5-03.<br /> Ext.A2 : Photo copy of the Medical Report issued by Dr.Cheriyan Joseph M.S. <br /> Consultant Surgeon, Al-Shifa Hospital and C.T. Scan Centre, Perintalmanna.<br /> Ext.A3 series : Photo copy of the Discharge Summary (2 Nos.) relating to complainant for the <br /> period from 22-3-03 to 03-4-03 and from 12-4-03 to 15-4-03 from Al-Shifa Hospital & C.T.Scan Centre, Perintalmanna.<br /> <br /> Ext.A4 : Prescription dated, 09-6-03 by Dr. Cherian Joseph M.S.<br /> Ext.A5 : Culture Examination Report<br /> Witness examined on the side of the opposite parties : Nil<br /> Documents marked on the side of the opposite parties : Ext.B1 to B6<br /> Ext.B1 : Photo copy of the Policy Schedule with terms and conditions issued by<br /> opposite party in favour of complainant.<br /> Ext.B2 : Settlement Intimation Voucher executed by complainant to opposite party.<br /> Ext.B3 : Request by complainant to opposite party.<br /> Ext.B4 : Photo copy of the Medical Certificate issued by Dr.Cheruian Joseph M.S.<br /> to opposite party.<br /> Ext.B5 : Proposal Form for Individual Personal Accident Insurance submitted by<br /> complainant to opposite party.<br /> Ext.B6 : Letter dated, 18-7-2003 sent by opposite party to Dr.Cheriyan Joseph M.S.<br /> <br /> <br /> <br /> <br /> <br /> C.S. SULEKHA BEEVI, PRESIDENT<br /> <br /> <br /> <br /> <br /> <br /> E. AYISHAKUTTY,MEMBER<br />