Kochi Ombudsman Centre
Case No. IO/KCH/GI/11.005.069/2004-05
Sri. K. P. Cherian
Vs.
Oriental Insurance Co. Ltd.
The complaint under Rule 12(1}(b) read with Rule 13 of the RPG Rules, 1998 arose out of repudiation of a GPA claim of the complainant by the insurer. It was a group personal accident cover for the benefit of the employees of M / s. Apollo Tyres. The complainant had sustained an accidental injury at his work place on 29.5.2004 and the doctor had classed it as “Group II sprain (L) Ankle”. The medical report also mentioned it as “Ankle sprain (L)”.
The insurer contended that sprain etc. which are not visible even though medical tests are not covered under the policy. On a closer scrutiny of the case file, it was clear that the socalled injury was only a minor sprain and the claim was made only because there was a GPA facility available. There being no merits in the case, the repudiation of the claim by the insurer was upheld and the complaint was dismissed.
