DURGA DEVI Vs. NATIONAL INSURANCE CO LTD

JUDGEMENT

(1.) Complainant/ Petitioner Smt Durga Devi has filed the present revision petition against the order of the Madhya Pradesh State Consumer Disputes Redressal Commission, Bhopal (in short 'the State Commission').

(2.) Briefly the facts of the case according to the Petitioner are that, the Petitioner took a Janata Personal Accident Policy from the National Insurance Company Ltd., (Respondent in this case) for Rs.5.00 lakh for a period of 12 years from March 1997 to March 2009. The policy indemnified her in case of any event of injury or death resulting from an accident. On 01.04.2004, the Petitioner had an accidental fall in the bathroom because of which she became completely paralyzed in the right side resulting in 100% disability. She was immediately admitted at the Apex Hospital, Bhopal and was shifted on 03.04.2004 to the Bhopal Memorial Hospital and Research Centre for specialized treatment where she was diagnosed as having suffered Cardio Vascular Accident (in short 'CVA') with Hemiplegia as a result of the fall. This fact was clearly stated in the medical certificate issued from that hospital by Dr R Gulati, who certified as follows:

(3.) The Petitioner lodged a claim with the Respondent Insurance Company. The Respondent repudiated the claim on the grounds that the Petitioner's accidental fall was due to a pre-existing disease and was therefore, not covered by the insurance policy since, it was not an accident. The Petitioner, therefore, filed a complaint before the District Forum on the grounds of deficiency of service on the part of the Respondent and sought the following reliefs :