PER JUSTICE K.S. CHAUDHARI, PRESIDING MEMBER

          This revision petition has been filed by the petitioner against the order dated 2.12.2010 passed by the Karnataka State Consumer Disputes Redressal Commission, Bangalore (in short, ‘the State Commission’) in Appeal No. 4228/2009 – The Regional Manager, The Bajaj Allianz General Ins. Co. Ltd. Vs. R. Venkatesh by which, while dismissing appeal, order of District Forum allowing complaint was upheld.

2.       Brief facts of the case are that complainant/respondent took comprehensive health coverage policy from OP/petitioner with coverage of Rs.12,50,000/- for himself, his wife and son on 24.9.2008.  His son Jeevan aged one year started severe vomiting on 2.10.2008 and was admitted to hospital, but expired on 4.10.2008.  Complainant lodged complaint with OP, but OP repudiated claim. Alleging deficiency on the part of OP, complainant filed complaint before District Forum. OP resisted complaint and submitted that son of the complainant fell sick and later on expired within 30 days from the commencement of policy and as per exclusion clause, OP rightly repudiated claim and prayed for dismissal of complaint.  Learned District forum after hearing both the parties, allowed complaint and directed OP to pay Rs.2,50,000/- with interest and further allowed Rs.1000/- as litigation cost.  Appeal filed by OP was dismissed by learned State Commission vide impugned order against which, this revision petition along with application for condonation of delay has been filed.

3.       Heard learned Counsel for the petitioner and respondent in person and perused record.

4.       Learned Counsel for the petitioner submitted that strictly speaking there is no delay but even if there is delay of 31 days in filing appeal, it may be condoned.  Petitioner submitted in the application for condonation of delay that certified copy of impugned order dated 2.12.2010 was received on 19.1.2011 and revision petition has been filed on 15.4.2011. In such circumstances, revision petition has been filed within period of 90 days from receipt of certified copy.  In such circumstances, apparently, there is no delay in filing revision petition and even if there is delay of 31 days, delay stands condoned.

5.       Learned Counsel for the petitioner submitted that in the policy no claim was payable for death; even then, learned District Forum committed error in allowing claim for death of complainant’s son and learned State Commission further committed error in dismissing appeal; hence, revision petition be allowed and impugned order be set aside.  On the other hand, respondent submitted that order passed by learned State Commission is in accordance with law; hence, revision petition be dismissed.

6.       Perusal of policy reveals that policy is “Comprehensive Health Coverage”.  On the second page of policy it has again been mentioned that premium has been paid for health insurance for the period from 23.9.2008 to 22.9.2009. Perusal of policy clearly reveals that coverage has been granted for expenses incurred towards hospitalization, but at the same time in case of death of the complainant or his wife in accident coverage was for Rs.10,00,000/-.  As per coverage of child is concerned, no coverage has been given for death in ordinary course in this comprehensive health coverage policy and in such circumstances, complainant was not entitled to get any claim on account of death of his son within 10 days from obtaining policy. As per exclusion clause No. 4 medical expenses incurred within 30 days of commencement of policy except those incurred as a result of accidental bodily injury were also not payable.  Admittedly, complainant’s son was admitted in the hospital on 2.10.2008 on account of vomiting expired on 4.10.2008 meaning thereby, expenses for treatment were incurred within 30 days of the policy without any accidental bodily injury.  In such circumstances, complainant was not even entitled to get reimbursement of expenses incurred during hospitalization and he has also not claimed.  Learned District Forum committed mistake in allowing complaint and learned State Commission further committed error in dismissing appeal without any coverage for life of the child in ordinary course and in such circumstances, impugned order is liable to set aside.  Respondent could not show any clause in the policy which covers life of his son in ordinary course.

7.       Consequently, revision petition filed by the petitioner is allowed and impugned order dated 2.12.2010 passed by learned State Commission in Appeal No. 4228/2009 – The Regional Manager, The Bajaj Allianz General Ins. Co. Ltd. Vs. R. Venkatesh and order of District forum dated 12.8.2009 passed in Complaint No. 465 of 2009 – R. Venkatesh Vs. The Regional Manager, The Bajaj Allianz General Ins. Co. Ltd. is set aside and complaint stands dismissed with no order as to costs.