IN THE HIGH COURT OF KERALA AT ERNAKULAM PRESENT : THE HONOURABLE MR. JUSTICE V.K.MOHANAN TUESDAY, THE 18TH AUGUST 2009 / 27TH SRAVANA 1931 WP(C).No. 26038 of 2004(Y) --------------------------------------- PETITIONER(S): ----------------------- V.G.JOHN, AGED 52 YEARS, S/O. GEORGE, VADASSERRY HOUSE, MACHAMTHURUTH, PARAVUR TALUK, ERNAKULAM DIST. BY ADVS.MR.G.BALAMURALEEDHARAN (PARAVUR) MR.MATHEWS V.JACOB (PARAVUR) MR.N.T.NANDAKUMAR (PARAVUR) RESPONDENT(S): -------------------- 1. THE ORIENTAL INSURANCE COMPANY LTD., DIVISIONAL OFFICE NO.1, BLDG. NO.XL-216/12, P.B.NO.1010, LAYAM ROAD, COCHIN-682 011. *2. APOLLO TYRES LTD., PERAMBRA P.O., THRISSUR DIST.(DELETED) 2ND RESPONDENT DELETED FROM THE PARTY ARRAY AS PER ORDER DT. 23.11.05 ON WPC. R1 BY ADVS.MR.K.J.SAJI ISAAC, DR.ELIZABETH VARKEY . THIS WRIT PETITION (CIVIL) HAVING BEEN FINALLY HEARD ON 18/08/2009, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING: W.P.(C) NO.26038/2004 APPENDIX PETITIONER'S EXHIBITS P1:- COPY OF THE GROUP PERSONAL ACCIDENT POLICY TAKEN FROM THE RESPONDENT. P2:- COPY OF THE DON BOSCO HOSPITAL CASE SHEET /MEDICAL CHART. P3:- COPY OF THE SCAN REPORT DT. 23.8.02. P4:- COPY OF THE DON BOSCO HOSPITAL OUT PATIENT RECORD. P5:- COPY OF THE MEDICAL CERTIFICATE DT. 7.10.02. P6:- COPY OF THE LETTER DTD. 17.2.03 ISSUED BY THE IST RESPONDENT. P7:- COPY OF THE AWARD PASSED BY INSURANCE OMBUDSMAN IN COMPLAINANT NO.10/KCH/G1/11/OIC/O11/2003-04 DTD. 21.6.04. TRUE COPY P.S. TO JUDGE tss V.K.MOHANAN, J. --------------------------------------------- W.P(C).No. 26038 of 2004 - Y --------------------------------------------- Dated this the 18th day of August, 2009 J U D G M E N T The petitioner preferred this writ petition challenging Ext.P7 order passed by the Insurance Ombudsman, Kochi, by which the petitioner's claim for compensation for his entire leave period from the company, M/s.Apollo Tyres, for the alleged disablement was rejected and it was held that the insurer has rightly repudiated the claim of the petitioner. Thus, in this writ petition, it is prayed to issue a direction to the first respondent to release 93 days compensation to the petitioner, as he is entitled for the same as per the Group Personal Accident policy issued by the first respondent. 2. According to the petitioner, he preferred a complaint on 12.5.2003, wherein the claim is that on 4.8.2002, he had met with an accident which resulted in his temporary total disablement and that the insurer had granted him compensation only for 42 days, though he had undergone treatment for 92 WP(C) NO.26038 of 2004 :-2-: days. According to the insurer, the claim of the petitioner for temporary total disablement by an accident fall on 4.8.2002 is duly compensated and the claim for disablement for 93 days was unsustainable, since actually the disablement period was only for 42 days as per medical opinion. It is the specific case of the insurer that the treatment after 18.9.2002 was for anti diabetic complaint and hence, the petitioner is not entitled to get the compensation for such period. 3. The Ombudsman, after considering the entire issue under the particular factual background of the case, specifically found that the medical certificates issued from Don Bosco Hospital, N.Paravur are clear on the aspect that he was advised rest for anti diabetic treatment for the period beyond 18.9.2002 and according to the Ombudsman, the case sheet from Don Bosco Hospital, N.Paravur also supports the plea of the insurer. According to the Ombudsman, since the complainant had already received compensation for the disablement period of 42 days, in the absence of medical WP(C) NO.26038 of 2004 :-3-: evidence to the effect that he was under total disablement, after 18.9.2002, coupled with the reason that after the period, the complainant was kept under anti diabetics treatment, the insurer had rightly repudiated that part of the claim. 4. Counsel for the petitioner advanced his argument on the basis of Ext.P5 certificate issued by the Doctor of the petitioner. Ext.P5 cannot be relied and is not sufficient to take a different view and to come into a conclusion that the petitioner was continuously treated for the temporary disablement even after the 42 days period. The evidence, on record, fully supports the case of the insurer. In the absence of any cogent and admissible evidence on material, the petitioner's contention and prayer in this writ petition fail. In the result, there is no merit in the writ petition and accordingly, the same is dismissed. V.K.Mohanan, Judge MBS/ WP(C) NO.26038 of 2004 :-4-: V.K.MOHANAN, J. -------------------------------------------- O.P.NO. OF 200 -------------------------------------------- WP(C) NO.26038 of 2004 :-5-: J U D G M E N T DATED: -6-2009 WP(C) NO.26038 of 2004 :-6-: