ANJALI PRASAD W/O LATE RAMESH PRASAD Vs. NEW INDIA ASSURANCE COMPANY LTD REPT BY DIVISIONAL OFFICER-III

JUDGEMENT

(1.) This first appeal has been filed under Section 19 of the Consumer Protection Act, 1986 against the order dated 30.05.2012 passed in consumer complaint No. 27 of 2010 by A. P. State Consumer Disputes Redressal Commission, Hyderabad ( in short, 'the State Commission') whereby the State Commission dismissed the complaint.

(2.) The brief facts are that complainant's husband, Mr. Ramesh Prasad, since deceased, (hereinafter referred as 'the patient') was employee of Visakhapatnam Steel Plant. He was insured under Group Personal Accident Death Insurance Policy through his employer, who was tied up with New India Assurance Co. Ltd./OP. During the subsistence of the insurance policy, on 15.9.2008, the patient suddenly fell down while parking his vehicle at about 11 p.m. at his residence and sustained head injury. He was immediately taken to Visakha Steel Plant General Hospital (in short, 'VSPGH') and thereafter shifted to Apex Hospital, where he died on 17.9.2008. The complainant registered a FIR at Steel Plant Police Station. The post mortem report revealed that death was due to head injury. The complainant approached the insurance company/OP for the claim of insured amount but the OP repudiated the claim without any reasons. The legal notice was also issued by the complainant claiming compensation but no response come from the OP. Hence, the complainant filed a complaint before A.P. State Consumer Disputes Redressal Commission, Hyderabad.

(3.) The OP filed a written version opposing the claim of the complainant and denied allegations. OP submitted that the deceased was covered under personal accident policy and liability of OP would arise only as per the terms and conditions of the policy. In case of accidents only and deaths caused by other ways or other means, are not covered under the policy. The OP submitted that as per investigator's report, the deceased was suffering from hypertension. The same was evident from the documents of Apex Hospital where the deceased was treated on 16.9.2008. the condition was diagnosed as Intra-cerebral hemorrhage, Hypertensive bleed, Aneurysm bleed. Hence, the death of insured was on account of massive intra cranial hemorrhage due to a possible rupture of an artery.