SUKUMAR BAG Vs. ORIENTAL INSURANCE COMPANY LIMITED

JUDGEMENT

(1.) WITH respect to the judgment and order, recorded by my Brother, Mr. B. K. Taimni, Member and endorsed by the President, National Consumer Disputes Redressal Commission, I would like to observe as under:

(2.) THE relevant facts leading to this revision petition, as evident from the documents produced before the District Forum (and copies thereof enclosed with this petition) and some of the findings of the lower Fora, need to be first revisited in some detail.

(3.) IN view of the aforesaid discussion of the evidence on record, two questions arise: (a) is it probable that the complainant, a 26 year old male, claiming to be otherwise hale and hearty, would develop such serious ailment of the aortic as well as mitral valves of his heart as to call for a major surgery for their complete replacement during a period as short as one month (from 05. 06. 1997 to 03. 07. 1997, leaving aside the 30-day period from 05. 05. 1997 within which no claim for reimbursement of expenditure on medical treatment was admissible in terms of the exclusion clause no. 4. 2 of the medi-claim policy) and (b) is it also equally probable that such an ailment would cause no symptoms serious enough for the complainant to become aware of some problem with his heart till as late as 08. 07. 1997, i. e. , till he was referred to Dr. S. Dutta? I am afraid it would be very brave of even an expert cardiologist or cardiac surgeon to answer both these questions firmly and state that both these events are more than probable. However, a firm finding could be returned only on the basis of a complete review of the records, aided by relevant medical literature and their interpretation by qualified experts. Such an opportunity does not exist in this case.