IMPORTANT POINT
Variations in BP recordings are usually due to physiological changes.

Dr. S.M. Kantikar, Presiding Member—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.

4. The State Commission dismissed the complaint. Being aggrieved, by the order of State Commission, the complainant preferred first appeal before this Commission.

5. Heard learned counsel for both the parties. Learned counsel for the appellant/complainant submitted that the insured deceased fell down in the night around 11.00 p.m. and suffered head injury. Due to severe headache in the early hours, he was taken to VSGPH at 8.45 a.m.. The duty doctor examined the patient and said that it was severe injury and the condition of patient was critical, therefore, he was shifted to Apex Hospital for further management, thus, the patient underwent cranial surgery. During the treatment, he died.

6. Learned counsel for the OP vehemently argued that on receipt of claim form from the complainant, the surveyor investigated the matter and obtained past medical record of the insured, for the period from September 2002 to August, 2008. On the basis of said record, it was confirmed that the deceased was suffering from hypertension. Also, as per the discharge certificate issued by Dr. Sridhar of Apex Hospital the deceased was suffering from hypertension, which had caused Intra-cerebral hemorrhage. The patient had aneurysm bleed, which means “localized abnormal dilation of a blood vessel, usually an artery, due to a Congenital defect or weaknesses in the wall of the vessel. Counsel for OP submitted that as per medical record (Ex. B-6) and the opinion of Dr. Durgesh, it was not possible for any person to die of massive intra cranial (intra cerebral hemorrhage) following a fall, as suffered by the deceased. The post mortem report was vague, it is merely an opinion, which observed it as head injury to the brain. There was