IMPORTANT POINT
Accidental death claim cannot be allowed on made-up story.

B.C. Gupta, Member—This revision petition has been filed under Section 21(b) of the Consumer Protection Act, 1986 against the order dated 16.04.2007 passed by the Gujarat State Consumer Disputes Redressal Commission, Ahmedabad (hereinafter referred to as “State Commission”) in First Appeal No. 1053 of 2006, Shashi Kumar Mohata & Anr. versus Iffco Tokio General Insurance Company Ltd., vide which the appeal filed by the present petitioner against the order dated 17.08.2006 passed by the District Consumer Disputes Redressal Forum, Ahmedabad in consumer complaint No. 644 of 2003, was ordered to be dismissed.

2. Briefly stated, the facts of the case are that Purushottam dasji Mohata, father of petitioner No.1 had taken a mediclaim policy from the respondent/opposite party, bearing No. 51000337, according to which there was a coverage of risk for Rs. 6,00,000/- for himself and Rs. 2,00,000/- for his wife, who is petitioner No.2, Taramani Devi Purushottamdasji Mohata. The aforesaid policy was for the duration from 01.01.2002 to 31.12.2002. The petitioner No.1-Shashi Kumar Mohata is the son and power of attorney holder of Taramani Devi P. Mohata. The case of the complainant is that on 13.06.2002 morning, the policy holder Purushottamdasji Mohata, now deceased, was cleansing his right ear with ear cotton buds at his residence when their maidservant Geeta came forward carrying a tea-tray towards Shri Mohata. By chance, the leg of maid servant got entangled with the carpet with the result that the tea-tray fell on the head of Purushottamdasji Mohata and thereby, the cotton ear buds penetrated with force in his ear and blood started coming out. Shri Mohata was admitted to Breach Candy Hospital at Mumbai where he was subjected to intensive treatment during the next few months, but he could not survive and ultimately died on 19.11.2002. As per the case of the complainant, the opposite party was informed about the accident from time to time and also claims were filed before it, during the on-going treatment of the policy holder. Additional claim was filed after his death, but the opposite party refused to entertain the same on the main ground that the policy holder died due to many other diseases, as made out from the medical report. The consumer complaint was filed before the District Forum, but it was dismissed vide order of the District Forum dated 17.08.2006. An appeal against the said order was dismissed by the State Commission on 16.04.2007 at admission stage. The learned State Commission held that the time gap between the incident of 13.06.2002 and the death on 19.11.2002 suggested that the incident of 13.6.2002 cannot be said to be the proximate cause for death on 19.11.2002, especially considering a number of complications of serious nature. It is against this order that the present revision petition has been filed.

3. The learned counsel for the petitioner has filed written arguments in the case dated 04.3.2013, in which he has taken the plea that as per the terms and conditions of the policy, 50% of the insured sum was promised in the event of permanent partial hearing disablement in both ears i.e. Rs. 3,00,000/-. 1% of the assured sum was promised per week in case of temporary total disablement which works out to be Rs. 6,000/- per week for a maximum of 104 weeks. The learned counsel has further stated in the written arguments that after the incident on 13.06.2002, the policy holder had to be admitted in the hospital six times in Mumbai and Ahmedabad, but he could not survive and died on 19.11.2002. The maid servant Geeta responsible for the accident also died on 09.07.2002 and hence her affidavit in support of the version of the accident could not be filed. According to the learned counsel, it is a case of an accident and hence the claim should have been allowed by the opposite party. It is further stated that in the report given by the hospital after his death, one of the junior Doctors wrongly mentioned about the problem