ORIENTAL INSURANCE COMPANY LIMITED Vs. MADAN LAL JAIN

JUDGEMENT

(1.) the Oriental Insurance Company appeals against the judgment and order dated 3.12.1997 passed by the District Forum, Hazaribagh whereby the appellant has been directed to pay a sum of Rs.1,50,000/- (Rupees one lakh and fifty thousand only) to the complainant along with interest at the rate of 12% p. a. payable from 1.4.1995 till the date of realisation of the amount within the time mentioned in the order itself.

(2.) This relates to the Mediclaim in terms of the policy purchased by the insured for a sum of Rs.1,50,000/-. The policy covers hospitalisation and domicilliary hospitalisation including personal accident claim. During the subsistence of the policy, the insured died on 7.9.2003 due to fall in the bathroom while she was hospitalised. Accordingly, a claim was preferred for Rs.1,50,000/- which was repudiated by the Insurance Company on 30.3.1995 resulting filing of the instant complaint claiming compensation under the said Mediclaim Policy.

(3.) On being noticed, the opposite party Insurance Company appeared and filed the show-cause stating, inter alia, that though the Mediclaim Policy was issued and during the subsistence of the policy, the insured died of operation but not due to accidental fall as claimed by the complainant. According to the opposite party the operation is not covered under the policy and hence the claim has been rightly repudiated. However, relying upon the materials on record including the medical certificate issued by the hospital the District Forum has allowed the claim as aforesaid.