ORDER (ORAL)         

The present Appeal, under Section ­19 of the Consumer Protection Act, 1986 (for short “the Act”) has been filed by the Appellant (hereinafter be referred as “the Insurance Company”) against the order dated ­­­­­09.02.2021 of the State Consumer Disputes Redressal Commission, Uttar Pradesh (for short “the State Commission”) in Complaint No.27 of 2020.  Vide the impugned order, while allowing the Complaint of the Complainant, the State Commission has directed as under:

ORDER

“The complaint is allowed with cost partially. The opposite parties no 2 and 3 are directed to settle the claim of the complainant and pay her Rs.33,27,346/- at a rate of 10% simple interest per annum from the date of filing of this complaint within 30 days and if they fail to do so a higher rate of interest at the rate of 15% will be charged after 30 days till the date of payment. The opposite parties are also directed to pay Rs.2 lakh compensation for mental agony and, Rs.50,000 cost of the suit. If it is not paid within 30 days the complainant will be free to recover it through the court on the cost of opposite parties no. 2 & 3. Till then no recovery letter/notice/demand shall be issued and no interest shall be payable on loan amount by the complainant from the date of filing of the complaint till the payment of decreetal amount.”

2.      The Insurance Company has challenged the impugned order solely on the ground that the disease which caused the death of the insured was not covered under the insurance policy and therefore, the impugned order suffers with illegality and infirmity and is liable to be set aside.  It is argued that End Stage Liver Disease means, as per Clause of the Policy, end stage liver disease resulting in cirrhosis and evidenced by all of the following criteria; a) permanent jaundice, b) ascites, c) encephalopathy, d) portal hypertension. In present case, the cause of the death of the insured was not due to these reasons. The argument of learned Counsel for the Appellant is that the Death Summary itself shows that the immediate cause of death was sepsis with septic shock with multiorgan dysfunction syndrome which shows that the death of the insured was not due to End Stage Liver Disease.

3.      Learned Counsel for the Complainant has argued that the Death Certificate which contains the illness history clearly shows that the insured had died of End Stage Liver Disease and it also elaborately mentions the reasons, illness and the symptoms with which the patient was suffering and for which he was treated in the Hospital but despite medical attention given to the patient, the Doctors could not save him and this fact clearly shows that he was suffering with End Stage Liver Disease.  It is argued that had he not been suffering with the End Stage Liver Disease, the Doctors would have been able to save his life by providing the medical treatment.

4.      We have heard the arguments at length and have given thoughtful consideration to the arguments as well as perused the documents on record.

5.      The admitted facts of the case are that the diseases were covered by the insurance policy issued by the