(1.) IN this Revision Petition, under Section 21(b) of the Consumer Protection Act, 1986 (for short the "Act"), the Complainant questions the correctness and legality of the order passed by the State Consumer Disputes Redressal Commission, Rajasthan (for short the 'State Commission") in Appeal No. 1900 of 2008. By the impugned order, the State Commission allowed the Appeal and set aside the order of the District Consumer Protection Forum, Sirohi (for short "the District Forum") in CC No. 25 of 2007. By its order, the District Forum, allowed the complaint and directed the Insurance Company to pay the insured amount of ?2,00,000/ - together with compensation of ?5,000/ - and costs of ?1,500/ -.
(2.) THE brief facts of the case, according to the Petitioner who was the original Complainant before the District Forum, are that the Complainant's husband had taken a Personal Accident Policy, covering the period 27.10.1997 to 26.10.2007, for an insured sum of ?2,00,000/ - from the Respondent -Insurance Company. While so, on 2.12.2005, the insured had a fall in the bathroom and subsequently died due to the injuries sustained. The Complainant had informed the Insurance Company on 19.12.2005 and submitted all the particulars. The Respondent vide their letter dated 26.9.2006 rejected the claim on the ground that the Complainant had not submitted the relevant documents and closed the claim as 'No Claim'. The Complainant had issued a legal notice on 21.6.2007 requesting the Respondent to send the prescribed proforma, but received no response. Hence the Complaint, seeking direction to the Insurance Company to pay the insured amount together with compensation of ?10,000/ - and costs of ?5,000/ -.
(3.) THE Respondent filed its written version before the District Forum and pleaded that the death of the insured was a natural one and not an accidental death. They averred that the Investigator had sent a letter to Dr. C. Ramji, working in Government Hospital, Pindwada, who observed that the insured was diabetic, hypertensive and a cardiac patient and that there was no visible 'injury' on the patient. The Respondent pleaded that these are the symptoms of cardiac arrest and not the symptoms of haemorrhage and therefore, the death cannot be on account of fall in the bathroom. The injury report and the bed head ticket were not prepared as he was kept in the ICU only for observation. The Respondent further submitted that the Claimant had given information through letter dated 19.12.2005 and that the insured had died on 2.12.2005 i.e. 17 days after the death of the deceased and did not send the desired documents with the claim letter. On 17.5.2006 and once again on 12.6.2006, reminders were sent seeking certified copy of police report, panchnama, post -mortem report and the original policy within 15 days. The Applicant did not send these documents and therefore, the claim was closed as 'No Claim'.