Insurance claims for accidents must be evaluated considering all aspects of disability, emphasizing strict adherence to policy terms when determining entitlements.

JUDGMENT

The above writ petition is filed seeking to quash Ext.P5 and for a declaration that the petitioner is entitled for 100% disability personal accident claim, in the facts and circumstance of the case.

2. The brief facts necessary for the disposal of the above writ petition are as follows:

Petitioner is a Doctor by profession, aged 29 years. The vehicle driven by the petitioner slipped back and fallen into a cliff of 5000 ft. down. The unfortunate accident resulted in serious injuries and the petitioner is paralyzed below the hip. The petitioner had undergone treatment at various hospitals at Trivandrum and CMC Velloor and he is confined to wheelchair with a paralysis of below hip termed as 'Traumatic Paraplegia'. The police registered a case making the petitioner as accused for rash and negligent driving as evident from Ext.P1 FIR, in crime No.86/2021 of Vagamon police station. The petitioner has approached this Court to get the FIR quashed, by filing Crl. M.C.No.2719/2021 and the same is pending consideration. The petitioner had to spend several lakhs for his treatment and it is confirmed that he cannot stand on his legs or walk any more in his life. Ext.P2 is the discharge summary issued by the Christian Medical College, Vellore. The petitioner is also issued with a disability certificate by the Medical Authority, Thiruvananthapuram proving that he has 65% permanent locomotor disability for both lower limbs. The vehicle from which the petitioner sustained injuries was insured with 2^nd respondent and there was a compulsory Personal Accident cover for owner- driver for a sum of Rs.15,00,000/- as evident from Ext.P4 Policy Certificate. Thereafter the petitioner approached the 2^nd respondent with a claim under the Personal Accident disability claim, covered under Ext.P4. To the surprise of the petitioner, the file was closed as per Ext.P5 stating that the petitioner has only 65% permanent disability in relation to insured's both lower limb and the claim cannot be entertained as 100% permanent loss is only covered as per the conditions stated in the policy. It is aggrieved by the same that the present writ petition has been filed.

3. A detailed counter affidavit has been filed by the respondent Insurance Company, wherein a contention regarding the maintainability of the writ petition was raised, stating that the petitioner is claiming the benefit under a policy of insurance and the claim for Personal Accident is a special contract, which is to be decided on the basis of the terms of contract and the petitioner cannot approach this Court under Article 226 of the Constitution of India claiming the benefit under a contract of insurance. Various contentions were also raised on the merits of the matter stating that the petitioner has only 65% permanent disability as certified by the Medical Board and only the persons having 100% disability is entitled for the benefit under the policy and the terms and conditions attached to the policy has been produced as Ext.R2(a) along the with the counter affidavit. On the basis of the above said contentions, the learned Senior Counsel appearing for the 2^nd respondent sought for dismissal of the writ petition.

4. I have heard the rival contentions on both sides.

5. The only issue to be decided is as to whether the petitioner is entitled for the personal accident claim as per Ext.P4 policy. The first question to be decided is regarding the maintainability of the present writ petition as contended by the learned Senior Counsel appearing for the 2^nd respondent.