Kochi Ombudsman Centre
Case No. IO/KCH/GI/11/OIC/128/2003-04
Sri T. O. Thomas
Vs.
Oriental Insurance Co. Ltd.
Shri T O Thomas has filed this complaint against the respondent on their repudiation of his claim under Group Personal Accident Policy. According to the complainant he had an accidental fall in his house premises and had gone to Dhanya Hospital for treatment. The respondent rejected his claim for compensation for the reason that the treatment was for a disease and not for any accidental injury. His appeal to the grievance cell was of no use. Aggrieved with this he had approached this Authority and prayed for an award of Rs. 45000/-.
The Insurer contented that the complainant was under treatment at Dhanya Hospital for some ailments existing for the past 4 years and not for any illness arising out of an accidental injury. The policy covers accidental Injuries only. As such the repudiation of the claim is in order.
Taking into consideration all the records available in the file and also the contentions of the parties concerned, the Ombudsman ruled that the complainant was under treatment for degenerative disc problems. The term “Degenerative” itself denotes that the disease was not due to any accidental injury, but a problem arose gradually by degeneration of the disc. The order of repudiation is judiciously made and this Authority does not find any justifiable grounds to intervene. Being devoid of merits, this complaint is dismissed.
