RAJAKBHAI GAFURBHAI MANSURI Vs. ORIENTAL INSURANCE COMPANY LIMITED

JUDGEMENT

(1.) THIS appeal arises from order dated 30.6.2001 rendered by Consumer Disputes Redressal Forum, Banaskantha District in Consumer Complaint Case No. 14(b) of 2000.

(2.) IT was the complainant s case that he availed of Janta Personal Accident Insurance Policy from the opponent Insurance Company covering the period 3.2.1998 to 2.2.1999 as per the particulars set out in the complaint. The policy covered the risk to the extent of Rs. 5,00,000/ - against accidental death or disability. On 9.12.1998, the complainant met with accident while he was driving his tanker No. GRO 4345 and passing by Chitrod village. The truck which was proceeding from the opposite direction had dashed with the tanker driven by the complainant resulting into fractures in the right and left legs of the complainant. FIR was lodged at No. 97/98 in Bhimasar Police Station. The complainant was first admitted into Bhuj Hospital and then shifted to Palanpur Civil Hospital. He had taken treatment till 23.2.1999. Both his legs were operated. Steel plates and rods were required to be implanted in the legs yet, the complainant sustained disability on both his legs and they were left of no use. The complainant, therefore, lodged his claim with the opponent Insurance Company on 31.5.1999 in the prescribed form. As he did not receive any reply or settlement of his claim he was required to send notice through his Advocate on 18.1.2000.

(3.) THE opponent Insurance Company contended in reply to the notice that the matter was investigated through Shri Kuntal Rao and opinion with regard to permanent disability was also obtained from Dr. S.K. Mewada. The complainant produced medical report inter alia stating therein that there was permanent disability to the extent of 70%. As the opponent Insurance Company called for clarification with regard to such permanent disability the complainant obtained medical certificate where the doctor assessed permanent disability at 55%. Ultimately, the opponent Insurance Company disowned the claim inter alia on the ground that the loss and disability were not such as would stand covered under the policy of insurance in question.