ATULYA SOOD Vs. NATIONAL INSURANCE COMPANY LTD.

JUDGEMENT

(1.) Appellant is aggrieved by the order dated 21.10.2013, of learned District Consumer Disputes Redressal Forum, Solan, whereby his complaint, under Section 12 of the Consumer Protection Act, 1986, which he filed against the respondent, seeking a direction to the respondent to pay Rs.1,14,532/ -, with interest at the rate of 18.5% on account of insurance money and compensation, has been dismissed.

(2.) Appellant had taken a policy from the respondent, covering risk of his death and injuries sustained in personal accident. Policy was effective from 11.09.2009 to 10.09.2010. Appellant allegedly suffered an injury of left Achilles tendon, which caused temporary total disablement from 21.10.2009 to 03.03.2010. Besides being unable to pursue and follow his occupation during the aforesaid period, he spent a sum of Rs.8,532/ - on treatment. He lodged a claim with the respondent seeking reimbursement of medical expenses and also compensation for the period he remained unable to pursue his job/occupation. The claim was repudiated on the ground that the injury had not been sustained by him in an accident but while doing physical exercise, as stated by him in the claim form itself. Appellant felt aggrieved and filed a complaint seeking direction to the respondent to pay compensation and also to reimburse the medical expenses.

(3.) Respondent contested the complaint and pleaded that this was not a case of injury caused by accident and that, in fact, injury had been sustained by the appellant while exercising. It was stated that as per definition of accidental injury, appearing in the insurance policy itself, there have to be some external violent and physical means to be the cause of the injury and it is only in such a situation that the liability of the insurance company arises.