KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION

                     VAZHUTHACAUDTHIRUVANANTHAPURAM      

                                                  APPEAL NO.462/09

                             JUDGMENT DATED 27.10.2010

PRESENT

JUSTICE SHRI.K.R.UDAYABHANU            --  PRESIDENT

SRI.S.CHANDRAMOHAN NAIR                     --  MEMBER

Kunjuraman Pillai,

Kizhakkekara Panavila Veedu,                           --  APPELLANT

Nellimukku.P.O,

Kareepra, Kottarakkara.

   (By Adv.Dinesh Sajan & Ors)

                    Vs.

The Branch Manager,

Oriental Insurance Company Ltd.,

Kottarakkara Branch,

Kottarakkara P.O,                                                --  RESPONDENT

Kollam District.

    (By Adv.V.Manikantan Nair)

                                                JUDGMENT

JUSTICE SHRI.K.R.UDAYABHANU,PRESIDENT

                    The appellant is the opposite party/Oriental Insurance Company Ltd. in CC.384/05 in the file of CDRF, Kollam.   The complaint stands dismissed.

            2. The case of the complainant is that he had availed personal accident coverage policy from the appellant for a sum of Rs.1 lakh along with the liability only cover for his vehicle.  On 15.2.03, he met with a traffic accident and sustained severe injuries including fractures to the clavicle ribs and head.  He was an in-patient at Benziger Hospital, Kollam and Amritha Hospital, Ernakulam.  According to him, he sustained serious disabilities and is permanently  disabled.  According to him, Rs.4 lakh was spent for his treatment.  The claim was repudiated.  He was examined by the Medical Board at the instance of the opposite parties and Medical Board has certified permanent disability. 

          3. The main contention of the opposite parties  is that the policy coverage as per Section 3 of the Conditions of Policy extended only to the instances mentioned therein ie; 1) death  2) loss of two limbs or   sight of two eyes or one limb and sight of one eye     3) loss of one limb or sight of   one eye 4) permanent total disablement from injuries other than named above.   The scale of compensation mentioned is 100% for category No.1, 100% for category No.2,  50% for category No.3 and 100% for category No.4. 

          4. The evidence adduced consisted of the testimony of PW1, DW1, P1 to P18 and D1.

          5. The Forum has accepted the contention of the opposite parties and dismissed the complaint.

          6. We find that the documents produced by the complainant would indicate that he sustained facture of the right clavicle, fracture of 2 ribs  of the right side,  right brachial plexes injury as well as head injury.  CT scan report would show fracture of the antero- medial wall of right orbit and fracture of right frontal bone subdural haematoma on the left temporal region and hemorrhagic contusion left temporal lobe.  He has also produced a certificate issued by the Medical Board which mentions that he is having 45% of permanent moderate disability due to right hemeparasis.

          7. The contention of the respondent/Insurance Company is that Section 3 of the conditions of policy provides only for compensation for the injuries mentioned therein at the scale mentioned therein.  We find that Section  3 only mentions that the Company undertakes to pay compensation as per the “ following scale for bodily injury/death sustained by the owner/driver of the vehicle”.  It is not specified that only for the injuries/death mentioned therein the policy coverage is extended.  The contingencies four number mentioned are under the head “nature of injury” and the extent of compensation is mentioned under the head “scale of compensation”.  We find that Section 3 of the policy conditions does not rule out other injuries or confine the coverage only to permanent total disablement, which evidently is eligible for 100% scale of compensation equivalent to death. It is settled law that when the conditions are vague, the terms are to be interpreted in favour of the   assured.  Hence,  we are not inclined to accept the contention of the respondent/company that the complainant is not entitled for any amount of compensation.  The Medical Board has assessed 45% permanent moderate disability due to right hemiparasis.   The Medical Board consisted of doctors at specialization.  In the circumstances, we find that the complainant is entitled for 45% of the amount covered by the policy ie; Rs.45,000/-  Hence, the order of the Forum is set aside.  The appeal is allowed.  The opposite parties/respondents are directed to pay Rs.45,000/- of the assured sum with interest at 9% per annum from the date of the complaint ie; 17/10/2005.  The complainant would also  entitled for cost of Rs.5000/-.

          8. The amounts are to be paid within 3 months from the date of receipt of this order, failing which the complainant could be entitled for interest at 12% from today the date of the order of this Commission.

          The office will forward the LCR  along with the copy of this order to the Forum urgently.

JUSTICE  K.R.UDAYABHANU --  PRESIDENT

 S.CHANDRAMOHAN NAIR --  MEMBER

s/L