The central legal point established in the judgment is the importance of establishing the proximate cause and nexus between accidental injuries and the insured's death in insurance claims.

ORDER

Mrs. M. Shreesha, Presiding Member—Challenge in this Revision Petition under Section 21 (b) of the Consumer Protection Act, 1986 (for short "the Act") is to the order, dated 14.02.2014, passed by the Gujarati State Consumer Disputes Redressal Commission at Ahmedabad (for short "The State Commission") in Dispute No. 926/2010. By the impugned order, the State Commission allowed the Appeal preferred by the Insurance Company and set aside the order of the District Forum.

2. The brief facts as set out in the Complaint are that the complainant's husband Dr. B. P.Shah was holding the following policies with the Opposite Party Insurance Company:-

(i) Fifteen Year Money Back Policy with Profits (With Accident Benefit) of Rs. 50,000/- bearing Policy No.811128809 for the period from 28/03/1991 to 28/03/2006.

(ii) Fifteen Year Money Back Policy with Profits (With Accident Benefit) of Rs. 50,000/- bearing Policy No.811137832 for the period from 28/03/1992 to 28/03/2007.

(iii) Endowment Assurance Policy with Profits (With Accident Benefit) of Rs. 1,00,000/- bearing Policy No.811149058 for the period from 28/05/1993 to 28/05/2008.

(iv) Endowment Assurance Policy with Profits (With Accident Benefit) of Rs. 50,000/- bearing Policy No.811151192 for the period from 28/10/1993 to 28/10/2008.

(v) Twelve Year Jeevan Sanchay Plan without Profits/with Accident Benefit of Rs. 1,00,000/- bearing Policy No.811190454 for the period from 09/10/1997 to 09/10/2008.

(vi) Jeevan Anand (with Profits) with Accident Benefit of Rs. 2,00,000/- bearing policy No.812410567 for the period from 23/04/2002 to 23/04/2016.

3. The Insured was a practising Doctor and had fallen down in the lobby from the stairs on 24.12.2003 and received injuries. He was shifted to Madhuram Hospital where he was treated for his accidental injuries. The Complainant submitted that her husband's X-rays showed fractures for which he was treated and discharged on 06.01.2004 and was advised bed-rest. His condition deteriorated and subsequently, he was shifted to Prarthana Hospital where he was treated by Dr. Vidyut Shah who diagnosed the injured as suffering from Multi Trauma with Septicaemia and Acute Renal Failure. Thereafter, on the advice of the Nephrologists, the injured was shifted to Nephrological Care in Harilal Jechand Doshi Sarvajanik Hospital where Dr. Kamal R. Doshi treated the patient and diagnosed him to be suffering from Upper GI Bleeding with Anaemia and Hypoprotienaemia; with Septicaemia; Left Renal Calculus; Hydronephrosis; and Hydroureter; Uareamia with Acidosis. The Complainant averred that her husband was admitted there on 12.01.2004 and had expired on 15.01.2004. The Post Mortem examination was not advised by the Doctor as it was clinically established that the death was caused on account of accidental injuries which resulted in Multiple Trauma, Septicaemia and Acute Renal Failure.

4. The Complainant pleaded that the Insurance Company paid her the single benefit of Rs. 7,90,950/- but did not settle the double accident benefit on the ground that the death was not due to accidental injuries. The Complainant pleaded that despite correspondence and several requests, the Opposite Party did not settle the double accident benefit as per the terms of the contract. The deceased had also given a statement on 01.01.2004 to the police which established the accident and the injuries. Hence, the Complaint seeking direction to the Opposite Party to pay the double accident benefit of all the policies totalling to Rs. 5,50,000/- with interest @ 18% p.a., compensation of Rs. 50,000/- and costs of Rs. 10,000/-.

5. The Opposite Party filed their reply admitting the issuance of the policies and averred that only the double accident benefit was not paid as the accidental death was not established by way of any documentary evidence. It is pleaded that the deceased had given a statement to the police on 01.01.2004 in which he had submitted that he was injured in both hands, left leg and jaw and he had