RAKESH SINHA Vs. NEW INDIA ASSURANCE COMPANY LTD

JUDGEMENT

(1.) AGGRIEVED by the order of Chhattisgarh State Consumer Disputes Redressal Commission, Raipur (for short as 'State Commission' dismissing its complaint No. 12/2003 appellant has filed this appeal here under Section 19 of Consumer Protection Act. Facts in brief - -the complainant's father late Sh. Badri Prasad Sinha had obtained "Janata Personal Accident Policy" from the New India Assurance Company Ltd, bearing No. 4745090308723, for a period of 5 years and the complainant was nominee under the said policy. The policy holder was insured for a sum of Rs. 10,00,000 for the period from 16.5.1998 to 15.5.2003, covering the risk of the Life Assured in the event of his sustaining injury or death resulting from an accident (e.g. road, rail, drowning, fall in bathroom, snake bite, dog bite, etc.) during the aforesaid period of the policy.

(2.) ON 11.10.1998 at around 12 -00 noon the life assured fell in the bathroom and was immediately admitted to the Holy Cross Hospital, Ambikapur, where he expired on 14.10.1998. The cause of death, as reported by the attending doctor, was Hepatic Failure and Hypovolemic Shock due to blunt injury in abdomen. On 16.10.1998 complainant had informed the opposite party and accordingly submitted claim forms on 20.12.1998.

(3.) THEREAFTER , on 17.6.1999 the opposite party repudiated the complainant's claim on the ground that the cause of the death was due to a disease "Cirrhosis with Portal Hypertension Hepatorenal Syndrome with Hepatic Encephalopathy" and it was held that the claim was not payable in terms of the insurance policy, which was a Personal Accidental Policy.