KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD THIRUVANANTHAPURAM APPEAL NO:352/2004 JUDGMENT DATED 12.01.2010 PRESENT SRI.M.V.VISWANATHAN : JUDICIAL MEMBER SRI.M.K. ABDULLA SONA : MEMBER 1.Branch Manager, National Insurance Co. Ltd, Thrissur, Branch Ambika Archade, M.G.Road, Thrissur-1. : APPELLANTS 2.Divisional Manager, National Insurance Co. Ltd., Thrissur. (By Adv: Sri. Saji Isaac K.J.) Vs. Mejo Benny, W/o Benny, Kariyattil Vellani House, P.O. Kottamuri, Kottavathil, : RESPONDENT Thambazhakkad-680 732. JUDGMENT SRI.M.V.VISWANATHAN: JUDICIAL MEMBER The appellants are the opposite parties 1 and 2 in OP:770/01. The complaint therein was filed by the respondent herein claiming mediclaim under Janatha Accident Insurance Scheme by the name Asha Jyothi Suraksha III. The claim preferred by the complainant was repudiated by the opposite parties (appellants) on the ground that the claim is excluded by clause 4.12 and 4.12.1 of the terms and conditions of the policy. It was contended that the treatment expenses were incurred in connection with voluntary medical termination of pregnancy during the first 12 weeks from the date of conception. Ext.R6 discharge summary issued from Mariam Thressia Hospital, Kuzhikkattussery would show that the complainant was admitted at that hospital on 18..8..2001 for incomplete abortion and D and C was done. It is the case of the complainant that the termination of the pregnancy was done to save her life. Ext.R6 discharge summary would make it abundantly clear that it was not a voluntary medical termination of pregnancy but the pregnancy was terminated on account of incomplete abortion and thereby D and C was done by the doctor attached to the aforesaid Mariam Thressia Hospital, Kuzhikkattussery. So, the case of the opposite parties (appellants) that the medical termination of pregnancy was done voluntary cannot be accepted. No contra evidence is forthcoming from the side of the opposite parties to discard R6 discharge summary which was produced by the complainant in support of her mediclaim. The Forum below has rightly appreciated the documentary evidence available on record in its correct perspective and come to a just, fair and reasonable conclusion that medical termination of pregnancy was done for the purpose of saving the life of the patient namely the complainant/insured. The Forum below has also rightly held that the pregnancy is not a disease and there is nothing to show that the treatment was related to any disease traceable to pregnancy. So, the claim of the complainant ought to have been allowed by the opposite party/insurance company. The repudiation of the said claim would amount to deficiency of service. 2. The Forum below has directed the opposite parties to pay the claim amount of Rs.1,888/- with compensation of Rs.10,000/- and cost of Rs.250/-. There can be no doubt that there was deficiency of service on the part of the opposite party/National Insurance Company Ltd. in dishonouring the insurance claim put forward by the complainant. Considering the claim put forward by the complainant, the compensation of Rs.10,000/-ordered by the Forum below can be treated as exorbitant. This Commission is of the view that compensation of Rs.5000/- is sufficient to meet the ends of justice. So, compensation of Rs.10,000/- ordered by the Forum below is reduced to Rs.5000/-. In all other respects the impugned order passed by the Forum below is confirmed. In the result the appeal is allowed partly. The impugned order dated:4..2..2004 passed by the CDRF, Thrissur in OP:770/01 is modified. Thereby the appellants/opposite parties are directed to pay the insurance claim of Rs.1,888/- with 12% interest from 7..9..2001 till realization with compensation of Rs.5000/- and cost of Rs.250/-. As far as the present appeal is concerned, the parties are directed to suffer their respective costs. M.V.VISWANATHAN : JUDICIAL MEMBER M.K. ABDULLA SONA : MEMBER VL. | 
