Sri Shyamal Gupta, Member

Challenging the Order dated 31-01-2018, passed by the Ld. District Forum, Paschim Medinipur in CC/19/2017, by which the complaint case has been dismissed, this Appeal is preferred by Smt. Mallika Singh.

The dispute relates to an insurance claim being lodged by the Appellant over the death of her husband.

We heard both sides in the matter and perused the documents on record.

It is the case of the Respondents that Appellant’s husband was suffering from Hematemesis and Melena since 2009.  However, while opting for the subject policy in the year 2014, the said DLI did not disclose such fact in the proposal form.  For this very reason, the instant claim was repudiated.

We do appreciate the contention of the Respondents. However, the real test, to our mind is, whether the aforesaid medical condition precipitated the death of the life insured in any manner whatsoever.

It appears from the medical journals that Hematemesis is the vomiting of blood; whereas, Melena is the passage of black, tarry stools; further that, Hematemesis and Melena, are symptoms of acute gastrointestinal bleeding.

In the death certificate dated 24-04-2016, the cause of death was attributed to “CVA-hemoorrliagiac stroke and HTN (irregular treatment)”.

It appears that a hemorrhagic stroke is when blood from an artery begins bleeding into the brain. This happens when a weakened blood vessel bursts and bleeds into the surrounding brain and that the risk factors for intracerebral hemorrhage include HTN, Cerebral cavernous malfunctions, Arteriovenous malformations.

Significantly, no such documentary proof or expert opinion or medical journal is produced from the side of the Respondents to satisfy us that there remains direct nexus between the two medical conditions (Hematemesis/Melena vis-à-vis CVA/hemoorrliagiac stroke and HTN). In view of this, we are unable to endorse the repudiation of instant claim by the Respondents.    

In our considered opinion, therefore, the Appellant deserves due settlement of her claim.

Accordingly, we allow this Appeal in part with a direction to the Respondents to pay the sum assured to the Respondent No. 1 within 40 days hence, i.d., they shall be liable to pay simple interest @ 9% p.a. over the decreetal sum for the entire period of default.  The impugned order is hereby set aside.