1

BEFORE THE STATE CONSUMER DISPUTES

REDRESSAL COMMISSION, RAJASTHAN,CIRCUIT

BENCH, UDAIPUR.

APPEAL NO.169/2012

1.Life

Insurance

Corporation

of

India

through

General

Manager,

Office

:

Sub

City

Center,

Udaipur (Raj.).

……….Appellant/Non-Complainant

Vs.

1. Bhimsen

Khanna

son

of

Shri

Lekhraj

Khanna

resident

of

1-J-26,

RHB

Colony,

Banswara

(Raj.).

…Respondent/Complainant.

Date of Order -

17.01.2017

Before:

Hon’ble Mr.Vinay Kumar Chawla -

Presiding Member

Hon’ble M. Kailash Soyal – Member

Present:

Shri

Suresh

Dwivdi,

Counsel

for

the

Appellant/Complainant.

ORDER

PER MR.VINAY KUMAR CHAWLA (PRESIDING MEMBER)

1.

This

appeal

has

been

filed

against

the

judgment dated 18.05.2012 passed by the ld.

DCF,

Banswara

by

which

the

complaint

was

allowed.

2

2.

The

brief

facts

giving

rise

to

this

dispute are that the complainant had taken

fixed

medical

policy

from

the

opposite

party. The complainant on 26.12.2011 fell-

down from the stairs and his left knee had

broken.

He

was

operated

upon

in

Mewar

Orthopedic

Private

Limited

Hospital

at

Uaipur.

He

has

submitted

the

bill

of

Rs.1,40,200/- for replacement of his knee.

The

claim

was

repudiated

by

the

LIC

of

India

on

the

ground

that

complainant

had

not

undergone

replacement

of

knee

and

under policy conditions the claim was not

payable.

Before

the

ld.

DCF

a

medical

opinion

on

Discharge

Report

was

obtained

with

the

consent

of

both

parties.

As

per

the

Dr.

B.L.

Shekahawat

the

treatment

taken by the complainant was certified to

be a knee replacement case. The ld. DCF on

the

basis

of

the

opinion

allowed

the

complaint.

3.

The

ld.

counsel

for

the

appellant

has

drawn

our

attention

to

the

policy

condition

and

has

submitted

that

it

was

not a knee replacement.

3

4.

The

Respondents/Non-Complainants

have

not

appeared before us despite the notices.

5.

We

have

heard

the

ld.

counsel

for

the

appellant/complainant and have perused the

discharge

ticket

of

Mewar

Orthopedic

Private

Limited

Hospital,

Udaipur.

The

discharge ticket clearly states that trial

prosthesis was tried. The prosthesis is an

artificial limb. In the report it is also

mentioned

that

PFC

Sigma

knee

system

was

chosen.

The

Sigma

knee

system

is

a

comprehensive integrated knee system. This

system is a total knee replacement system.

Thus

the

objection

of

the

appellant

is

that

complainant

did

not

undergo

a

knee

replacement surgery cannot be accepted. No

interference is called for in the judgment

of the ld. DCF. The appeal is dismissed.

(KAILASH SOYAL)

MEMBER

(VINAY KUMAR CHAWLA)

PRESIDING MEMBER

R.C. KHATRI, PA

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