UNITED INDIA INSURANCE CO. LTD. Vs. ALKA MAHESHWARI

JUDGEMENT

(1.) This revision petition has been filed under section 21(b) of the Consumer Protection Act, 1986, against the impugned order dated 12.01.2016, passed by the Rajasthan State Consumer Disputes Redressal Commission, Jaipur (hereinafter referred to as "the State Commission") in First Appeal No. 177/2015, United India Insurance Co. Ltd. vs. Smt. Alka Maheshwari, vide which, while dismissing the appeal, the order passed by the District Consumer Disputes Redressal Forum, Jaipur, dated 13.01.2015, in Consumer Complaint No. 1060/2012, filed by the present respondent, allowing the said complaint, was upheld.

(2.) The facts of the case are that the deceased Bhagwan Sahai Maheshwari, his wife and complainant Smt. Alka Maheshwari and their two daughters ­ Kavita and Komal were insured under the Individual Personal Accident Policy, issued by the opposite party (OP) United India Insurance Co. Ltd. for the period from 01.02.2007 to 21.01.2008. The said policy was continuously being renewed and the cumulative bonus and other benefits were regularly being added to the same. The accidental death risk was covered for a sum insured of Rs. 5,35,000/-, in which the basic sum insured was Rs. 4,00,000/- and cumulative bonus was Rs. 1,35,000/-. It is stated in the memo of Revision Petition, filed by the Insurance Company, that on 05.07.2007, when the deceased, after waking up from the bed, went to the bathroom, he suddenly fell on the floor. The blood started oozing out from his ears and nose and thereafter, he vomited. He was rushed to a nearby hospital, where Dr. Atul Saxena of Government Hospital, provided him First-aid and referred him to the SMS Hospital, Jaipur. The deceased could not be admitted at that hospital due to non-availability of beds in the ICU at that time. He was then taken to S. K. Soni hospital, but he succumbed to his injuries, before he reached that hospital.

(3.) The version given in the consumer complaint filed by the wife of the deceased, Alka Maheshwari says that on 05.07.2007, when he went to the bathroom, he suddenly slipped, dashed against the wall and fell on the floor, due to which he sustained grievous internal injuries. The case of the complainant, therefore, is that it is a case of accident, as the deceased slipped in the bathroom and hence, he was entitled to get the benefits under the policy. The complainant stated that the insured was not suffering from any disease since the last ten years. However, the case of the petitioner Insurance Company is that Bhagwan Sahai Maheshwari was suffering from high blood pressure, which resulted in brainstem hematoma, as confirmed in the report of the investigator and hence, he had not died due to any accident. The claim under the policy was, therefore, not payable.