HDFC EGRO GENERAL INSURANCE CO. LTD. Vs. LATABEN

JUDGEMENT

(1.) This appeal has been filed under Sec. 19 of the Consumer Protection Act, 1986 (hereinafter referred to as the 'Act') in challenge to the Order dtd. 22/2/2012 of the State Commission in complaint no. 04 of 2008, whereby the complaint of the complainant was allowed and appellant ' insurance company was directed to pay a sum of Rs.20,00,000.00 to the complainant with interest at the rate of 6 per cent from the date of admitting complaint till payment of the amount.

(2.) I have heard the learned counsel for the appellant ' insurance company and the learned counsel for the respondent ' complainant and perused the record including the State Commission's impugned Order dtd. 22/2/2012 and the memorandum of appeal.

(3.) The facts of the case are that the husband of the complainant took a personal accident insurance policy (Bank Accident Protection Plan ' HV) from the appellant ' insurance company for a sum insured of Rs.20,00,000.00 in case of accidental death / permanent disability and for sum insured of Rs.2,00,000.00 in case of Broken Bones. The policy was valid for the period from 28/6/2006 to 27/6/2007. It is alleged that during the subsistence of the said insurance policy, on 12/12/2006, while the insured ' Prakashbhai Mehta was trying to sit in rickshaw, his head hit with the upper hood of the auto-rickshaw and received some head injuries. He was taken to Mahavir General Hospital, admitted there and took the treatment from there but unfortunately on 23/12/2006, he died. The complainant submitted a claim with the insurance company. It is alleged that the insurance company did not pay any heed to the claim. Thereafter the complainant went to the branch office of the insurance company with a written application dtd. 19/12/2006 but the insurance company did not reply to the application. When the legal notice was sent to the insurance company, reply thereto was sent through her advocate stating that the complainant's claim was repudiated vide letter dtd. 2/4/2007 on the ground that the investigation report concludes that the death has occurred as a result of internal brain defect and not due to any accident caused by external violent and visible means.