NATIONAL INSURANCE CO LTD Vs. ARUN KUMAR GOYAL

JUDGEMENT

(1.) National Insurance Co. Ltd. (Petitioner herein) which was Opposite Party before the District Consumer Disputes Redressal Forum (for short, the District Forum) has filed this Revision Petition against the order dated 3.11.2006 passed by the State Consumer Disputes Redressal Commission (for short, State Commission) Delhi, in First Appeal No. 704/2006 confirming the Order passed by the District Forum in directing the Petitioner to pay Rs. 50,000 towards insurance policy to the Respondent- Complainant along with Rs. 7,000 towards compensation and Rs. 3,000 as costs.

(2.) Respondent took a Mediclaim Policy (Hospitalization and Domiciliary Hospitalization Benefit Policy) for himself and his family members including his wife, son, daughter and father namely, Sangeeta Goyal, Aman Goyal, Ashna Goyal and Satya Prakash Goyal respectively, bearing No. 351700/48/ 02/8501315 dated 18th July, 2002 for the period 18.7.2002 to 17.7.2003. As per policy, five members of the family were insured for a sum of Rs. 50,000 each. The insurance was granted subject to terms, conditions and stipulations as stated in the policy.

(3.) Wife of Respondent Smt. Sangeeta Goyal complained of breathlessness on exertion and for this she underwent comprehensive checkup at G.B. Pant Hospital on 7.8.2002. As per registration card dated 9.8.2002 it was mentioned that the wife of Respondent was having complaint of dysponea on exertion breathlessness Grade II-III since last l ?1/2 months, her B.P. was 120/80 mm of Hg, Pulse was 80 per minute. After examination she was provisionally diagnosed as having a septal defect, pulmonary stenosis and anemia. She was advised to undergo ECG, ECHO, x-ray chest and other investigations. ECHO findings confirmed the diagnosis of ostium secondum atrial septal defect, a congenital heart disease. Later on she was advised to get herself admitted in the Hospital on 7.10.2002 for cath and pressure . studies. The Respondent took his wife to Dharamvira Heart Centre, Sir Ganga Ram Hospital, Rajender Nagar, New Delhi to take a second opinion where she was advised to undergo open heart surgery, which was performed on her on 4.6.2003 on which Respondent incurred an expenditure of Rs. 1,45,000.