<br /> By Smt. Padmini Sudheesh, President:<br /> <br /> The petitioner’s case in brief is as follows: The petitioner is an employee of the Apollo Tyres Ltd., Chalakudy. The said company insured the complainant with the respondents under the Group Personal Accident Policy. On 8.8.02 the petitioner has sustained Collateral Ligament injury on left hand MCP Joint 4th finger and had undergone treatment for 26 days at Dhanya Mission Hospital, Chalakudy from 8.8.02 to 3.9.02. He was totally unable to do the work for that period. After the accident on 9.9.02 the petitioner submitted the medical claim along with the details of treatment. But the claim was repudiated stating that the claim for temporary total disablement is due to sprain and sprain will not come under the policy. The treatment was for the injury suffered due to accident. Hence this complaint.<br /> <br /> 2. The respondents have filed their version to the following effect. The respondents have issued a Group Personal accident Policy in the name of M/s. Apollo Tyres Ltd. for the period from 1.4.02 to 31.3.03 covering their 1201 employees including the petitioner. As per special condition No.2 injuries like sprain are excluded from the scope of the policy. As per the medical reports obtained from M/s. Dhanya Mission Hospital the petitioner has suffered MCP Ligament Sprain to the little finger of the left hand. Since sprain is a specific exclusion as per special condition of the policy respondents are not liable to pay the claim of the petitioner. These respondents admit that they had sent letters to the petitioner repudiating the claim of the petitioner. The claim was repudiated since the petitioner had sustained only a Sprain, which was specifically excluded as per Special Condition No.2 of the policy. The petitioner is not entitled to get an amount of Rs.15,600/-. Hence dismiss the complaint. <br /> <br /> 3. The points for consideration are:<br /> <br /> (1) Is the petitioner entitled to get the medical claim?<br /> (2) Is there any deficiency in service?<br /> (3) Other reliefs and costs.<br /> <br /> 4. The evidence consists of Exts. R1 to R5, R6 series, R7 series and R8 and R9.<br /> <br /> 5. Points-1 to 3: The case of the complainant is that on 8.8.02 he has sustained collateral ligament injury on left hand MCP joint 4th finger. He is an employee of the Apollo Tyres Ltd., Chalakudy and the Company insured the complainant with the respondents under the Group Personal Accident Policy. As per the policy the respondents are liable to compensate the complainant in case of accident occurred during the course of employment. According to him due to the accident occurred on 8.8.02, he had undergone treatment for 26 days at Dhanya Mission Hospital, Chalakudy from 8.8.02 to 3.9.02. He was totally unable to do the work for the said period. After all these he had applied for the insurance benefit along with all the relevant documents on 9.9.02, but the complainant had received a letter dt. 28.3.03 stating the repudiation of claim. The reason stated for repudiation of the claim is that the disablement is due to sprain and sprain does not come under the policy. In the counter the respondent Company admitted the policy and stated that the limits of liability of the Company is as per the terms and conditions in the policy. As per special condition No.2 of the policy injuries like sprain are specifically excluded from the purview of policy. The evidence in this case consists of Exts. R1 to R7 series in which Ext. R1 the schedule of the policy is crucial to this case. The claim was repudiated as per the special conditions envisaged in Ext. R1 in which it is specifically stated that any injury, which is not visible even through medical tests like sprain and similar injuries are excluded. Ext. R7 series are the medical certificates issued to the complainant on various dates regarding the injury sustained in the accident. The certificate dt. 8.8.02 shows that he was suffered from collateral ligament injury left hand MCP Joint 4th finger and all the other certificates in Ext. R7 series contain the nature of injury. As per Stedman’s Medical Dictionary the word ligament means a band or sheet of fibrous tissue connecting two or more bones, cartilages, or other structures or serving as support for fasciae or muscles. The word injury means the damage or wound of trauma. Trauma is an injury, physical or mental. Sprain is an injury to a ligament as a result of abnormal or excessive forces applied to a joint, but without dislocation or fracture. In the present case the injury is ligament and the meaning is already explained. So it is clear that the complainant was suffered from sprain only. Hence this is a specific exclusion as per the policy, the complainant is not eligible for the policy benefits. There is no deficiency in service on the part of respondent company.<br /> <br /> 6. In the result, complaint is dismissed without costs.<br /> <br /> <br /> Dictated to the Confdl. Asst., transcribed by her, corrected by me and pronounced in the open Forum this the 21st day of November 2008.<br />