IMPORTANT POINT
Insurance contract has to be construed like any other contract on the basis of its terms and conditions and outside aid for construction of an insurance policy is impermissible.

Suresh Chandra, Member—This revision petition has been filed by petitioner Insurance Co. which was OP No.1 before the District Forum. Respondent No.1 is the original complainant and respondent No.2 was OP No.2 before the District Forum.

2. Brief facts of this case which have led to the filing of this revision petition are that the complainant/respondent No.1 who is a renowned physical fitness trainer took a credit card from the OP Bank/respondent No.2. Being a credit card holder of the OP Bank, the complainant was insured with the petitioner Insurance Co./OP No.2 for accident benefit policy. The complainant met with a fire accident in her own house and got severely injured. She took treatment for her burn injuries and incurred an expenditure of Rs.5,25,000/-. In view of the accident benefit policy cover available to her as a credit card holder of the OP Bank, she sent an application to the OPs for reimbursement of the amount incurred by her over the treatment of the burn injuries under the policy but she was informed by OP No.2/petitioner Co. to submit her claim in the prescribed form along with FIR, entire medical record pertaining to treatment, disability certificate from a Government hospital and confirmation from the OP No.1/respondent No.2 Bank as to validity of the credit card as on the date of accident along with a copy of the credit card. As per the allegation, the complainant appeared before the Medical Board, Osmania General Hospital which issued a medical certificate certifying disability of 20% to 25%. Thereafter, she submitted her claim to the petitioner Insurance Co. but the OP Bank informed her that the accident insurance policy covers compensation for partial/total disability arising out of accident and that hospitalization claim for credit card holders is not covered under the policy. In view of the repudiation of her claim, the complainant approached the District Forum by filing the consumer complaint in question praying for refund of an amount of Rs.5 lakhs under the accident insurance policy together with compensation of Rs.2 lakhs for mental agony with interest @ 24% p.a. and costs of Rs.5000/-. On being noticed by the District Forum, OP Nos.1 & 2 contested the complaint and filed their replies. They denied the allegations and contended that the complainant suffered only 20% to 25% disability and according to the terms and conditions of the policy unless there is permanent/partial loss or damage at the time of accident, she was not entitled to get the insured amount and as such her claim had been repudiated. Denying any deficiency in service on their part, they prayed for dismissal of the complaint.

3. Based on the evidence adduced and the pleadings put forward by the respective parties, the District Forum vide its order dated 9.7.2007 partly allowed the complaint directing OP Nos.1 & 2 jointly and severally to pay the amount of Rs.1 lakh to the complainant towards insurance claim and Rs.10,000/- towards compensation along with cost of litigation of Rs.1,000/-. Aggrieved of this order of the District Forum, OP No.2 /petitioner Insurance Co. challenged the same before the A.P. State Consumer Disputes Redressal Commission, Hyderabad by filing appeal bearing No.1494 of 2007. The State Commission vide its impugned order dated 7.12.2007 confirmed the order of the District Forum and dismissed the appeal of the OP Insurance Co. Aggrieved of the said order of the State Commission, the petitioner has now filed the present petition challenging the same before this Commission.

4. Learned Shri V.S. Chopra, Advocate has argued the case on behalf of the petitioner Insurance Co. and learned Shri N.P. Gaur, Advocate has appeared for respondent No.2 Bank. None has appeared for respondent No.1/complainant and hence she has been proceeded ex parte.

5. The main ground on which learned counsel would assail the impugned order is that the burn injury being only upto 20% to 25%, the complainant was not entitled to get her claim