JUSTICE AJIT BHARIHOKE, PRESIDING MEMBER This revision petition is directed against the order of the State Commission, Hyderabad dated 18.09.2012 in First Appeal No.743/2011 whereby the State Commission allowed the appeal preferred by the respondent/complainant, set aside the order of the District Forum and directed the petitioner to pay a sum of Rs.5 lacs to the respondent/complainant with interest of 9% p.a. from the date of the complaint till the realization of amount besides cost of litigation of Rs.5,000/-. 2. Briefly put the facts relevant for the disposal of the revision petition are that Late Buddeda Venkata Ramana, husband of the respondent/complainant had obtained a Group Personal Accident Policy through M/s. Golden Multi Service Club Ltd. The policy was valid for the period w.e.f. 16.01.2006 to 15.01.2007 and it covered accident risk of Rs.1 lac. It is claimed by the complainant that on 22.02.2006, the insured accidently fall from a coconut tree and sustained head injury. He was taken to Government Hospital Anakapalle where he was given treatment as out-patient. Thereafter, he was shifted to his residence where he died on 22.02.2006. The death was immediately notified to the Village Gram Panchayat and insurance claim was filed with the petitioner insurance company but the claim was not allowed. Being aggrieved, the respondent/complainant filed a consumer complaint before the District Forum. 3. The petitioner insurance company in their WS took the plea that the insurance claim filed by the respondent/complainant was rightly repudiated because the reason for death of the insured was not the accident but he died due to jaundice. 4. Learned District Forum on consideration of evidence and the pleadings of the parties, did not find merit in the complaint. Accordingly, the complaint was dismissed with cost of Rs.5,000/-. 5. Being aggrieved by the order of the District Forum, the respondent/complainant preferred an appeal. The State Commission, Hyderabad on consideration of evidence came to the conclusion that the death of the deceased was caused because of injuries suffered due to fall from the coconut tree. As such, the State Commission thus held that the claim was covered under the insurance policy and the repudiation was not justified. Accordingly, the appeal was allowed, order of the District Forum was set aside and the petitioner insurance company was directed to pay the insurance amount with 9% interest p.a. from the date of filing of complaint along with cost of Rs.5,000/-. It is against this order the petitioner filed the revision petition. 6. It is not disputed that the deceased was insured under personal accident group policy. It is also not disputed that during the validity of the said policy the insured died on 22.06.2006. Only dispute between the parties is with regard to the cause of death. According to the respondent/complainant, the insured died because of the head injury suffered on 20.06.2006 due to fall from the coconut tree whereas according to the petitioner the cause of death of the insured was jaundice as such under the terms and conditions of personal accident cover group policy, the petitioner insurance company was not obligated to pay the insurance claim. 7. On perusal of record, we find that the foundation of the order of the State Commission is the medical certificate purported to have been issued by Dr.G.Sarat Chandra Babu of Vaidyalayam Area Hospital, Anakapalle, which reads thus: EDICAL CERTIFICATE Signature of the Patient: This is to certify that Sri/Smt./Kum Boddeda Venkata Ramana, Male 38, Chinna Vathapalem (V) is suffering from injury head due to fall from tree and is advised rest and treatment for a period of one day w.e.f. 20/2/06. Hence this certificate. Place: Sd/- Date: MEDICAL OFFICER 8. The above medical certificate which is the bedrock of the impugned order is highly suspect and even if it is taken as correct, then also it does not establish that the insured B.V.Ramana died because of head injury suffered in an accidental fall from coconut tree. Perusal of the translated copy of the insurance claim filed by the respondent complainant would show that in the aforesaid claim, against the column escription of accident / cause of accident the answer given is aundice No information regarding the extent of injury, date or time of death is given. Further against the column ame / ADD of Hospital where insured was treatedand ame / ADD of Doctor who attended injured neither the name of the hospital is mentioned nor name of the doctor is mentioned. Had the insured been taken to Vaidyalayam Area Hospital, Anakapalle under the natural course of circumstances, the complainant respondent would have mentioned the name of the hospital and had the patient been examined / treated by Dr.G.Sarat Chandra Babu, the complainant obviously would have mentioned his name. This circumstance clearly show that the medical certificate issued by the above noted doctor has been procured to substantiate the claim. Otherwise also, on reading of the medical certificate we find this certificate does not throw any light upon the cause of death of the deceased. It may also be noted that Dr. K.V.V.Anand of Area Hospital Anakapalle in his testimony has stated that the OPD ticket of the hospital bearing no. 14205 dated 20.02.2006 in the name of N.V.Rao aged 35 years is not in the handwriting of any of the medical officers working in the hospital. He further stated that medical certificate issued by Dr. Babu is not based upon OPD ticket. Therefore, OPD ticket itself is a suspect. Perusal of Investigation Report dated 29.09.2006 of R.Ramakrishna Rao, Surveyor and Loss Assessor, we find that during the inquiry, the Surveyor spoke to the respondent complainant as also Mrs.B. Poornimavathi, daughter of the insured and Sh. B.Sriramulu, father of the insured. All of them stated that insured Sh. B.Venkata Ramana had died on 22.02.2006 at home due to jaundice and fever. In view of the above, we find it difficult to rely upon the medical certificate issued by Dr.G.Sarat Chandra Babu and OPD ticket. 9. The State Commission in our considered view while setting aside the order of the District Forum has failed to appreciate aforesaid aspect of the case. Therefore, the order of the State Commission which has been passed ignoring the material evidence, cannot be sustained. Revision petition is, therefore, allowed. Order of the State Commission is set aside and the complaint is dismissed. |