Kochi Ombudsman Centre
Case No. IO/KCH/GI/11/OIC/127/2003-04
Mr. Rajendran
Vs.
Oriental Insurance Co. Ltd.
Sri Rajendran has filed this complaint against the respondent on their repudiation of his claim under Group Personal Accident Policy. According to the complaint he had an injury due to an accident at his workplace while lifting the tyres. He was under treatment at Dhanya Hospital. The respondent rejected his claim for compensation for the reason that the treatment was not for any accidental injury, but for some diseases which are explicitly excluded from the scope of the policy. 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. 6000/- . The Insured contented that the complainant had not met with an accident while on duty. No injury was visible extremely or through x-rays, And since the GPA policy issued to M / s Apollo Tyres Ltd. excludes claims for Sprain, Lumbago and similar diseases, which are not visible by the medical tests, the claim was repudiated. The order of repudiation 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 had not suffered an injury by any accidental, external, violent or visible means. He may be under treatment for muscle pain or sprain while he was lifting the tyre in course of his duties. 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.
