Kochi Ombudsman Centre
Case No. IO/KCH/GI/11-005-059/2004-05
Sri P. Sivadasan
Vs.
Oriental Insurance Co. Ltd.
The Complaint under Rule No 12(1)(b) read with Rule 13 the RPG Rules, 1998 is a consequence of repudiation of a claim under Group Personal Accident Insurance floated by the Insurer for the employees of M / s Apollo Tyres Ltd. The Complainant had sustained contusion injury while working in the factory and the Insurer had rejected the claim stating that “Contusion” as such was not covered under the policy. However, the Insurer had not taken into account the nature of work required to be done by the complainant in the factory.
The nature of work of the insured was such that he had to pull a shaft for tightening the grinder side and besides applying a lot of force in the process of his work, he also had to stand at the same place for hours together. In the nature and circumstances of the case, it was clear that the complainant had a real problem in as much as that he could no do his work with a contusion on his leg. Therefore, in all fairness, it was necessary to treat the period of his absence from duty and spent on rest as advised by the Doctor to be eligible for the benefits and the Insurer having been found to be in error of judgement, the complaint was allowed.
