NEW INDIA ASSURANCE COMPANY LTD Vs. PABBATI SRIDEVI

JUDGEMENT

(1.) One Shri Pabbati Satya Nookaraju (hereinafter referred to as P.S.N.) had taken a Personal Accident Insurance policy from the New India Assurance Company (hereinafter referred to as RP/OP) for a sum of Rs.5 lakhs. During the operation of the policy, he suffered a sun stroke on 5.5.2008 and was admitted to Apollo Hospital Kakinada. P.S.N. died on 12.5.2008 and therefore, a claim under the policy was made by his wife on 16.5.2008. The Insurance Co. repudiated the claim within three days, on 19.5.2008 on the following ground:-

(2.) The District Consumer Forum, East Godavari, Andhra Pradesh allowed the complaint and directed the RP/OP to pay a sum of Rs.5 lakhs together with interest and cost. While doing so, the District Forum has noted that the specific conditions of the policy were not communicated to the insured and observed:-

(3.) Appeal of the New India Assurance Company Limited against the above order of the District Forum was dismissed by the AP State Consumer Disputes Redressal Commission in FA No.1377/2010 on 26.6.2012. The RP/OP has now challenged the order of the State Commission through the present proceeding. The main ground of challenge is that the death was not caused by 'any bodily injury resulting solely and directly from accident caused by external violent and visible means.' It is alleged by the RP/OP that according to the discharge summary of the hospital death of the insured was caused due to several ailments and not due to sun stroke, as alleged. However, the revision petition lists ten points of diagnosis in which the very first one is listed as 'heat exhaustion.'