SHAKUNTALA vs NEW INDIA ASSURANCE CO. LTD.

THIS appeal arises out of the order of the State Consumer Disputes Redressal Commission, Chandigarh, whereby the State Commission upheld the order of the District Forum. The facts in brief which led the complainant to approach the District Forum are as under :

THE complainant''s husband had obtained a personal accident policy for Rs. 1,50,000/- for one year covering the period from 1st July, 1992 and met with an accident on 3.9.1992 due to fall from the staircase. He was admitted in the hospital and died on 31.10.1992. THE complainant lodged a claim with Insurance Company which was rejected on 8.2.1994. This had lead the complainant to approach the District Forum claiming the amount of Rs. 1,50,000/- with interest and costs of Rs. 10,280.75. On notice being issued the opposite party, Insurance Company, filed its reply wherein it had taken the stand that the claim did not fall within the ambit of the policy as the complainant had died of cardiac arrest; that the complainant had suppressed the fact of his suffering from cardiac problem; that complicated questions are involved and hence, the matter be dealt by a Civil Court and not by the Consumer Forum.

The District Forum while deciding the issue as to whether the death of the complainant was covered under the policy, referred to the certificate issued by Dr. Diwan, which reads as under : "Certified that Kapil Dev Garg aged 60 years appx. expired on 30.10.1992 at 12.20 a.m. due to cardiac arrest and due to slip. I was present at that time."

THIS issue was decided by the District Forum against the complainant as it was of the opinion that the accident took place on 3.9.1992, the patient was discharged on 7.9.1992 and he died on 30.10.1992 due to cardiac arrest, i.e. after a period of around two months and that there was no material placed before the District Forum to connect the occurrence of the cardiac arrest and the injuries received almost two months before the death. As far as the expenses incurred by the complainant on account of injuries suffered, the District Forum allowed Rs. 6,875/- and observed that non-payment of this amount amounts to deficiency in service by the Insurance Company. For the reasons stated above, the District Forum partially allowed the complaint by awarding the amount of Rs. 6,875/- with interest at the rate of 12% from 1.2.1993 till the date of payment.

FEELING dissatisfied with the order of the District Forum, the complainant approached the State Commission by way of an appeal for enhancement of the compensation. The State Commission dismissed the appeal with the following observations : "A perusal of the oral and documentary evidence referred to above makes it clear that the deceased did not possess a Life Insurance Policy, he only possessed a policy of Hospitalisation and Domiciliary Hospitalisation Benefit Policy. We are of the view that the death in this case was not on account of the fall which Kapil Dev suffered about 8 weeks earlier. The statement of Dr. Dewan that he destroyed the record of the present case believing that it may no longer be required is not helpful to the appellant. Dr. Dewan who issued Annexure C-2 indicates that he had been Resident Doctor in General Hospital, Chandigarh. The omission on his part in not preserving and producing the record of this patient and the short certificate that patient expired on 30.10.1992 due to cardiac arrest which the patient had on account of slip is not convincing and does not fulfil the requirement to meet and rebut a repudiated claim. The conclusion is that there is no good ground for interference with the impugned order and the appeal is hereby dismissed."

Against the order of the State Commission, the complainant has come in revision before us. Heard the learned Counsel for the parties. We have also gone through the orders of the State Commission and that of the District Forum. During the course of hearing the contention advanced before us was that the policy covers not only mediclaim (hospitalisation and domiciliary hospitalization) but also death or disablement caused due to personal accident and hence that the death of the insured had resulted due to personal accident. We are not impressed by this argument, as, nowhere on record it is shown that the death had directly resulted due to the accident. Moreover, the District Forum and the State Commission have elaborately dealt with on this point and came to the concurrent finding. In view of the above discussion we find no merit in this Revision Petition and dismiss the same without any order as to costs. Revision Petition dismissed.