JUSTICE J. M. MALIK, PRESIDING MEMBER (ORAL) 1. Arguments heard. 2. Shri Rajpal, since deceased, husband of complainant No. 1, Smt. Kanta Devi and father of Naresh Kumar, Dinesh Kumar and Monika Kumari, complainants No. 2, 3 and 4, respectively, obtained Life Insurance Policy from the Oriental Insurance Co. Limited. The policy mentions that in the event of Raj Pal dying an accidental death, a sum of Rs. 4 lakh was to be paid and in addition to that a sum of Rs.2 lakh was to be paid by way of reimbursement of medical expenses. Unfortunately, Shri Raj Pal died on 4.11.2003 due to fall, which resulted in head injury. 3. The complainants filed a complaint before the District Forum in the year 2006. The District Forum allowed the complaint. Aggrieved by that order, the opposite party filed the first appeal before the State Commission. The State Commission dismissed the appeal meaning thereby that both the fora below have decided the case against the petitioner. 4. We have heard the learned counsel for the parties. She submits that there is no concrete evidence that Raj Pal had died and was having accidental death. She submits that there is no evidence, worth the name, which may go to show that he had fallen down and he had received the head injury. Moreover, as per the policy, the information should have been given to the petitioner within one week as required by the policy. However, needful was not done. According to her, complaint was filed before the District Forum after about 3 years and the direction of the District Forum had been considered by the insurance company and the claim of the complainants was repudiated vide order dated 26.8.2008. She stressed that there is delay in informing the petitioners and the said accident does not stand proved. 5. All these arguments are devoid of merits. The policy clearly reveals that if due to unavoidable circumstances, the information cannot be given, the reasons for delay would be considered. The delay should not be more than one week. In this case, it has been well explained that wife of the deceased was bedridden and the remaining complainants were minor. 6. We are of the considered view that the explanation given by the complainants is satisfactory. Second, there is sufficient evidence that the predecessor of the complainants suffered the accident. There is certificate which has been placed on record. It is the report/certificate given by Life Insurance Corporation where the deceased had also obtained another policy. The opposite party has placed on record the certificate issued by Life Insurance Corporation of India. Relevant portion of which reads: “SHIMLA DIVISION Branch Certificate of Hospital Treatment C. R. No. In connection with claim under Policy No……………………on the life of Raj Pal………………………………………….(deed) S/o Late Sh. Krishnoo Ram …………………………. “2.What was the date of his admission Emergency consultation on humanitarian into the hospital ground 3.Under whose treatment was the patient Pt. was having head injury before he was admitted into the Hospital? Was unconscious, advised to go If the patient had brought a letter or a IGMC for further management note from any doctor at the time of admission. Kindly furnish us with a copy thereof. | 5. (a) What was the exact history H/o fall on head reported by the patient at the time of admission? 4.11.2003 (Dates, Duration of the ailments, the symptoms narrated etc. to be given) |
At the foot of the document it is also mentioned as “certified that the above information is correct as per records of the Hospital”. Learned counsel for the petitioner further submits that the claim of the complainants was repudiated by the Life Insurance Corporation of India. We are not concerned with that claim. The claim stands proved. The revision petition is lame of strength, therefore, the same is dismissed. | 
