IMPORTANT POINT
Insurance company is not liable to pay any claim arising out of any alcoholism, drunkenness or abuse of drugs.

This revision is directed against the order of the Andhra Pradesh State Consumer Disputes Redressal Commission, Hyderabad (in short, “the State Commission) dated 10.11.2010 whereby the State Commission allowed the appeal preferred by the respondent/opposite party against the order of the District Forum, set aside the order of the District Forum and dismissed the complaint.

2. Briefly put facts relevant for the disposal of the revision petition are that the petitioner filed a consumer complaint in the District Forum alleging that he had purchased an overseas medi-claim policy valid w.e.f. 17.8.2006 to 6.9.2006. The policy promised reimbursement for expenses on treatment and illness etc. It is alleged that the petitioner reached U.S.A. on 18.8.2006. On the same day the petitioner while having a shower bath fell down and sustained injury. He was immediately taken to the hospital where he was given treatment as an inpatient for a day and was discharged on 19.8.2006. The medical expenses incurred by the petitioner were to the tune of US dollars 14,965/- equivalent to Rs.5,99,979.20P. The petitioner submitted insurance claim with agent of opposite party No.1 insurance company. The insurance claim was, however, repudiated on the ground that as the injury had occurred as a direct result of past history of ailment of the petitioner, in view of the exclusion clause the claim for expenses incurred on treatment was not payable. Being aggrieved of the repudiation of the claim the petitioner raised a consumer dispute before the District Forum-II, Hyderabad which was contested by the opposite party.

3. The District Forum on consideration of the pleadings and the evidence held the respondent/insurance company to be deficient in service and directed as under: -

“In view of our clear finding on point No.1 the complainant successfully proved deficiency of service on part of the opposite parties 1 to 3. Hence, we are opined that the opposite parties 1 to 3 are jointly and severally liable to pay Medi Claim amount USD 14,965/- @ 1=40.08. Rs.5,99,979.20P (rupees five lakhs ninety nine thousand nine hundred and seventy nine rupees twenty paise only) and compensation of Rs.5,000/- (rupees five thousand only) and cost of the complaint Rs.1,000/- (rupees one thousand only) to the complainant.

In the result we direct that opposite parties 1 to 3 are jointly and severally liable to pay Medi Claim amount USD 14,956/- @ 1=40.08. Rs.5,99,979.20P (five lakhs ninety nine thousand nine hundred and seventy nine rupees twenty paise only) and compensation of Rs.5,000/- (rupees five thousand only) and cost of the complaint Rs.1,000/- (rupees one thousand only).

Dictated to Steno, transcribed and typed by her, pronounced by us on this the 23rd day of January, 2009.”

4. Being aggrieved of the order of the District Forum, the opposite party/insurance company preferred an appeal and the State Commission vide impugned order allowed the appeal, set aside the order of the District Forum and dismissed the complaint. This has led to filing of the revision petition.

5. Learned Shri K. Maruthi Rao, Advocate for the petitioner has taken us through the proposal form as also the consultation prescription of Saint Barnabas Medical Center under the signatures of consulting physician Mr.Louis Rizio, MD and submitted that as per the aforesaid document the past medical history was non-contributory to the ailment of the petitioner and as such the repudiation of insurance claim is not justified. It is further contended that the State Commission has failed to consider the above-said document as such the impugned order is not sustainable.

6. Learned Shri A.K. De, Advocate for the respondents has argued in support of the impugned order.

7. We have considered the rival contentions and perused the record. On perusal of record we find that the petitioner has placed on record copy of his discharge summary prepared by the attending Physician Shri Maninder Abraham, MD. The relevant portion o