CONSUMER DISPUTES REDRESSAL FORUM, KOTTAYAM. Present Sri. Santhosh Kesavanath P. President Smt. Bindhu M. Thomas, Member Sri. K.N. Radhakrishnan, Member CC No.60/09 Wednesday, the 28th day of October, 2010 Petitioner : M.C.Zacharia, Mulakanchira House, Madukkani Lane, Muttambalam PO, Kottayam. (Adv. Anitha V.R) Vs. Opposite party : National Insurance Co. Ltd., Divisional Office, Kottayam. (Adv. C.J. Jomi) ORDER Sri. Santhosh Kesavanath P. President The case of the petitioner, filed on 3-11-09, is as follows:- Petitioner taken a personal accident insurance policy from the opposite party. The policy was valid from7/2/08 to 6/2/09. Sum insured is Rs. 5,00,000/-. As per the policy opposite party undertakes to the insured that if at any time during the currency of the policy the insured shall sustained any bodily injury, resulting solely and directly from accident caused by external violence and visible means, then the opposite party shall pay to the insured or his legal representatives the sum specified in the policy. The petitioner met with an accident on 26/10/08 and was admitted in a hospital at Kottayam. There was a crack fracture to the right lateral malleous and he discharged on 27/10/08. After treatment petitioner preferred a claim to the opposite party. On 28/11/08 petitioner received a letter from the opposite party asking the petitioner to return the enclosed voucher for Rs. 1429/- in full and final settlement of the claim. According to the petitioner the assessment made by the opposite party is not legal. Petitioner preferred complaint to Regional Manager of the opposite party. But no reply were still received to the petitioner. According to the petitioner act of the opposite party in not processing claim of the petitioner, as submitted, is a clear deficiency in service. So the petitioner prays for a direction to the opposite party to settle the claim of the petitioner for Rs. 20,000/- with 18% interest from the date of accident till realisation. Petitioner claims Rs.10,000/- as compensation and cost of the proceedings. Opposite party filed version contenting that the petition is not maintainable. According to the opposite party complainant sustained injury and he was not under complete bed rest from 27/10/07 to 26/11/08 as claimed. According to the opposite party the complainant has not sustained a total disablement during the injured period. Opposite party contented that the eligible amount of compensation allowable to the petitioner, as per the policy, is Rs.1429/- the total temporary disablement for two days. According to the opposite party there is no deficiency in service on their part and they pray for dismissal of the petition if their costs. Evidence in this case consists of affidavit filed by both parties. Ext.A1 to A7 document on the side of petitioner and ext B1 series document on the side of opposite party. Points for consideration: i) Whether there is any deficiency in service on the part of the opposite party? ii) Reliefs and costs? Point No.1 According to the Petitioner he sustained temporary total disablement. So he is entitled for a sum at the rate of 1% or the capital sum assured. In any case not exceeding Rs. 5,000/- per week in all. Opposite party contented that the petitioner had no total temporary disablement as alleged. Conditions with the policy is produced by the petitioner. Said documents is marked as Ext.A1. In Ext.A1 conditions(F) is stated as follows. “If such injury shall be the sole and direct cause of temporary total disablement then so long as the insured person shall be totally disabled from engaging in any employment or occupation of any description whatsoever, a sum at the rate of 1% of the capital sum insured stated in the schedule hereto per week but in any case not exceeding Rs.5,000/- per week. So, as per the policy conditions an insured is entitled to get the amount Rs. 5000/- per week only, if the injured was under temporary total disability”. Admittedly the injury of the petitioner was only a crack fracture petitioner has not produced anything on record to prove that there is temporary disablement. Opposite party produce the claim form submitted by the petitioner to the opposite party. Said document is marked Ext.B1(a). In Ext.B1(a) petitioner himself stated that there is partial disability. The discharge card produced by the opposite party is marked Ext.B1. In Ext.B1 the date of admission of the petitioner is shown as 26/10/08, dated of discharge is shown as 27/10/08. So from the documents produced we are of the view that petitioner sustained partial disability and not total disability, so the claim of the petitioner is not allowable. In our view there is no deficiency in service on the part of the opposite party. So point no.1 is found accordingly. Point No.2 In view of the finding in point no.1 the petition is dismissed. Considering the facts and circumstances of the case no costs and compensation is ordered. Dictated by me transcribed by the Confidential Assistant corrected by me and pronounced in the Open Forum on this the 28th day of October, 2010 Sri. Santhosh Kesavanath P. President Sd/- Smt. Bindhu M. Thomas, Member Sd/- Sri. K.N. Radhakrishnan, Member Sd/- Appendix Documents from the petitioner: 1. Ext.A1-Copy of the personal accident insurance policy 2. Ext.A2-Certificate issued from GIMS Hospital, Vadavathoor. 3. Ext.A3-letter dtd 28-11-08 4. Ext.A4 Copy of letter dtd 6/12/08 from the petitioner to the opposite party 5. Ext.A5-Copy of letter dtd 16/12/08 6. Ext.A6-Copy of letter dtd 27/12/08 from Divisional Manager to the petitioner 7. Ext.A7-Envelop Documents from the opposite party 1 .Ext.B1-Copy of discharge summary 2 .B1(a)Personal accident claim form 3. Ext.B1(b)Medical Certificate By Order, Senior Superintendent. S/3cs
| | [HONORABLE Bindhu M Thomas] Member[HONORABLE Santhosh Kesava Nath P] PRESIDENT[HONORABLE K.N Radhakrishnan] Member | | 
