State Consumer Disputes Redressal Commission
National Insurance Co. Ltd. vs Mahendra Singh on 4 August, 2009
BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION, RAJASTHAN, JAIPUR APPEAL NO: 202/2009 1. National Insurance Co. Ltd., regd. office 3 Middleton Street, Kolkatta through Managing Director 2. Br.Manager, National Insurance Co.Ltd. Khetan Bhawan, M.I.Road, Jaipur. Opposite parties-appellants Vs. Sh. Mahendra Singh r/o A 576 Malviya Nagar, Jaipur. Complainant- respondent Date of Judgment 4.8.09 Before: Mr.Justice Sunil Kumar Garg-President Mrs.Vimla Sethia-Member 2 Mr.Sanjeev Arora counsel for the appellants Mr.Mahendra Singh complainant respondent in-person JUDGMENT
BY THE STATE COMMISSION ( PER HON. MR.JUSTICE SUNIL KUMAR GARG, PRESIDENT) This appeal u/s 15 of the Consumer Protection Act,1986 has been filed by the appellants Insurance Co. which were opposite party no. 1 & 2 before the District Forum against order dated 18.12.08 passed by the District Forum, Jaipur camp, Jaipur in complaint no. 396/08 by which the complaint of the complainant respondent was allowed in the manner that the appellants were directed to pay a sum of Rs. 5,299/- + Rs. 50,476/- total Rs. 55,775/-, the amount incurred by the complainant respondent in the treatment of his son within 45 days failing with the appellants would further pay interest @ 9% p.a. on the above amount from the date of passing of the order and further they were directed to pay a sum of Rs. 3000/- as costs of litigation and Rs. 5000/- as compensation for mental agony.
2. It arises in the following circumstances-
That the complainant respondent had filed a complaint against the appellants before the District Forum, Jaipur on 16.6.08 inter alia stating that the complainant respondent had taken a Medi Claim Policy 3 for himself on 18.10.02 for one year and thereafter he had got that policy renewed w.e.f. 17.10.03 and under the renewed policy apart from the complainant respondent, his wife Smt. Jyoti, Divaspati ( son) Shivani ( daughter) and Vagmita ( daughter ) were also got insured and in other words they were also members of the medi claim policy which was in force w.e.f. 17.10.03. It was further stated in the complaint that thereafter the said policy was again renewed by the complainant respondent on 12.10.04 for one year and in the renewed policy the members were the same. It was further stated in the complaint that his son Divaspati who is also one of the insured persons in the policy, had developed ear problem with pus discharge and pain in the month of July 2004 and for that he had consulted several doctors and on the basis of the diagnosis it was found that the pus discharge and pain were related to posterior right ear retraction pocket as a result of which patient had also developed hearing loss and apart from some problem in the ear his son was having problem of deviation in the nasal septum known as DNS ( Deviated Nasal Septum ). It was further stated in the complaint that thereafter his son Divaspati was got admitted in the SMS Hospital, Jaipur in the Unit of Dr. S.P.Srivastava, ENT surgeon on 19.10.04 and was discharged on 20.10.04 and the diagnosis which was made by the doctor was DNS and in the pre operative note it was also mentioned that he was a patient of cold, cough and hearing loss since childhood and that is 4 marked as Anx. R-1. and operation of Septoplasty was done . It was further stated in the complaint that a claim for a sum of Rs. 5,299/- was submitted by the complainant respondent for re-imbursement being the expenses incurred in connection with the said hospitalization and operation but that claim was repudiated by Paramount Health Services Pvt. Ltd. on behalf of the appellants through letter dated 14.12.04 ( Anx. R-4 ) in the following manner-
"We have received your documents for claim processing based on our review, we find that the claim does not fall under the perview of the policy for the following reasons-
Patient was admitted with rec cold, cough with hearing loss since childhood. Therefore, case can be repudiated under pre-existing clause 4.1 of the policy.
If we will not et any response within 15 days, the same shall be conveyed to the insured.
Hence we regret to convey that the claim is not payable."
It was further stated in the complaint that the said repudiation was wrong one as was evident from the certificate given by Dr. S.P.Srivastava ( Anx. R-3 ) which is quoted here for reference-
5" This is to certify that Mr. Divaspati Singh who was under my care suffered from recurrent cold and cough since childhood. Seven months ago he had a sproblem of pus discharge from his right ear which caused partial hearing loss. He underwent septoplasty on 20.10.04 to correct a deviation in his nasal septum."
It was further stated in the complaint that thereafter Divaspati was got admitted in the Cumballa Hill Hospital and Heart Institute, Mumbai on 21.12.04 with the problem in his right ear and operation was done by Dr. Milind V. Kirtane on 22.12.04 to cure the problem of right ear posterior quadrant retraction pocket and he was discharged from that hospital on 23.12.04. It was further stated in the complaint that a sum of Rs. 50,400/- were spent by the complainant respondent for the hospitalization, operation and treatment at Mumbai and the claim was preferred by the complainant respondent before the office of the appellants on 13.1.05 but that claim was repudiated by Paramount Health Services Pvt. Ltd. on behalf of the appellants through letter dated 2.4.05 ( Anx. R-8) in the following manner-
" Patient is admitted from 21.12.04 to 23.12.04 for surgical treatment of retraction pocket ear and choleas. The present problem is a chronic disese which develops gradually in years as a complication of ear infection sinusitis and DNS. As DNS is a pre-6
existing ailment ( as per file no. 347/264 ) the present claim also stands pre-existing and can be repudiated under clause 4.1 of policy.
If we will not get any response within 15 days, the same shall be conveyed to the insured. Hence we regret to convey that the claim is not payable."
It was further stated in the complaint that on 22.4.05 a letter was sent by Paramount Health Services Pvt. Ltd. justifying the decision already taken by the appellants to repudiate the claim. It was further stated in the complaint that repudiation in respect of both claims by Paramount Health Services Pvt. Ltd. on behalf of the appellants through letters dated 14.12.04 and 2.4.05 was not justified at all as the DNS problem is not a problem that could be treated as pre-existing disease and thus there was no suppression of material facts on the part of the complainant respondent at the time of taking the medi claim policy for his son and thus there was deficiency in service on the part of the appellants in repudiating the claim of the complainant respondent and for that deficiency the present complaint was filed by the complainant.
A reply was filed by the appellants before the District Forum, Jaipur on 21.10.05 and in the reply they have taken the same pleas which were taken by them in the repudiation letters dated 14.12.04 and 2.4.05 . It was further stated in the reply that all the conditions 7 of the policy were made known to the complainant respondent and the claim shall be payable only subject to terms and conditions and exceptions of the policy. It was further stated in the reply that as per clause 4.1 of the policy claim was not payable and for convenience clause 4.1 is quoted here-
"4.1 Such diseases which have been in existence at the time of proposing the insurance. Pre-existing condition means any injury which existed prior to the effective date of this insurance. Pre-existing condition also means any sickness or its symptoms which existed prior to the insured person had knowledge that the symptoms were relating to the sickness. Complications arising from pre-existing disease will be considered part of that pre-existing condition."
It was further stated in the reply that from the record produced by the complainant respondent it was very much clear that the disease of DNS and other diseases which were found diagnosed were pre-existing diseases and since they were suppressed by the complainant respondent at the time of taking the policy, therefore, it was a case of suppression of material facts regarding health on the part of the respondent. It was further stated in the reply that the past history was not got mentioned intentionally in the discharge ticket of the Cumballa Hill Hospital and Heart Institute, 8 Mumbai. It was further stated in the reply that the son of the complainant respondent was suffering from the diseases which were found from the hospital records by birth and the son of the complainant respondent was having a partial hearing loss by childhood which had increased thereafter from time to time and it was prayed that complaint be dismissed as the claim of the complainant was rightly repudiated by the appellant through above mentioned two letters.
After hearing the parties, the District Forum,Jaipur camp Jaipur through impugned order dated 18.12.08 had allowed the complaint of the complainant respondent inter alia holding-
(i) That the policy for the period of 17.10.03 to 16.10.04 was a renewed medi claim policy
(ii) That in the month of July 2004 the son of the complainant respondent had developed some problem in the right ear for the first time and thereafter Septoplasty was done by Dr. S.P.Srivastava on 20.4.04 in the SMS Hospital, Jaipur.
(iii) That since from the certificate which was given by Dr. S.P.Srivastava, the fact that the son of the complainant was a patient of ear peoblem since childhood is not found established, therefore, it 9 could not be said that he was having ear problem since childhood and if the son of the complainant respondent was having some problem of cough and cold in childhood, it does not mean that it would cause partial hearing.
(iv) That since the complainant respondent had taken the policy for the first time for his family members for the period 17.10.03 to 16.10.04 and since the same was renewed on 20.10.04 to 19.10.05, therefore, there is no evidence on record to prove the fact that prior to 17.10.03 the son of the complainant respondent had taken the treatment any where.
(v) That the appellants were not justified in repudiating the claim of the complainant respondent and it had amounted to deficiency in service on the part of the appellants and thus the expenses incurred in respect of the treatment of the son of the complainant respondent at Jaipur as well as at Mumbai were ordered to be re- imburssed by the appellants to the complainant respondent.
Aggrieved from the said order dated 18.12.08 passed by the District Forum, Jaipur Camp, Jaipur , this appeal has been filed by the appellants Insurance Company.
103. In this appeal the following contentions have been raised on behalf of the appellants -
(i) That the findings recorded by the District Forum that the hearing loss was not since childhood is absolutely erroneous one as this fact could be proved from the discharge ticket of the SMS Hospital, Jaipur as in the discharge ticket ( Anx. R-1 ) it was mentioned that there was pre-operative complaint of pus discharge , RCC, cold, cough, hearing loss since childhood , therefore, these findings of the District Forum be quashed and set aside.
(ii) That the certificate issued by Dr. S.P.Srivastava should have not been relied upon by the District Forum as this certificate does not bear any date and further the contents of the certificate are contrary to discharge ticket of the SMS Hospital, Jaipur and thus the findings recorded in respect of that certificate be quashed and set aside.
(iii) That in the repudiation letter dated 14.12.04 issued by Paramount Health Services Pvt. Ltd. it was clearly mentioned that hearing loss was since childhood , therefore, claim could be repudiated on the ground of pre-existing disease and thus the findings recorded by the District Forum could not be sustained and further in another letter dated 9.3.05 the same was again re- iterated by Paramount Health Services Pvt. Ltd.
11(iv) That the case of the complainant respondent was rightly repudiated by the appellants under pre-existing clause 4.1 of the policy as the problem of DNS was such a problem that was since childhood and the learned District Forum has committed serious error and illegality in decreeing the claim of the complainant respondent and the findings of the District Forum are wholly erroneous, illegal and perverse one and the same could not be sustained and liable to be quashed and set aside and this appeal deserves to be allowed.
4. On the other hand, the learned counsel appearing for the respondent has supported the impugned order of the District Forum.
5. We have heard the learned counsel appearing for the appellants as well as for the respondent and gone through the entire materials available on record.
6. There is no dispute on the point that the complainant respondent had taken a Medi Claim Policy for himself on 18.10.02 for one year and thereafter he had got that policy renewed w.e.f. 17.10.03 and under the renewed policy apart from the complainant respondent, his wife Smt. Jyoti, Divaspati ( son) Shivani ( daughter) and Vagmita ( daughter ) were also got insured and in other words they were also members of the medi claim policy which was in force w.e.f. 17.10.03.
127. There is no dispute on the point that thereafter the said policy was again renewed by the complainant respondent on 12.10.04 for one year and in the renewed policy the members were the same.
8. There is also no dispute on the point that the son of the complainant respondent Divaspati the son of the complainant respondent was got admitted for the first time in the SMS Hospital, Jaipur in the Unit of Dr. S.P.Srivastava, ENT surgeon on 19.10.04 and was discharged on 20.10.04 and operation of Septoplasty was done by Dr.S.P.Srivastava.
9. There is no dispute on the point that the son of the complainant respondent was got admitted in the Cumballa Hill Hospital and Heart Institute, Mumbai on 21.12.04 with the problem in his right ear and operation was done by Dr. Milind V. Kirtane on 22.12.04.
10. There is no dispute on the point that the claim of the complainant respondent was repudiated by the appellants through letters dated 14.12.04 and 2.4.05 as stated above on the grounds mentioned therein.
11. Thus, in the facts and circumstances just narrated above, the question for consideration is whether repudiation of claim of complainant respondent by the appellants on ground of suppression of facts was justified or not or whether the findings of the District Forum decreeing the claim would be sustained or not.
1312. Before proceeding further something should be said about the disease DNS ( Deviated Nasal Septum ) which could be defined in the following manner-
" The nasal septum is the wall that separates the left and right nostrils. A centered septum allows air to flow equally through each nostril. In a deviated nasal septum the wall is not centered.
A deviated septum may cause no symptoms at all. In severe cases, airflow through one or both nostrils may be blocked. A blocked nostril may cause chronic stuffiness and a tendency to get sinus infections.
A deviated septum is a common physical disorder of the nose, involving a displacement of the nasal septum."
And its causes are as follows-
(i) Present at birth- arose during fetal development ( 5% of cases )
(ii) Birth injury to the nose
(iii) A blow to the nose, often during an accident or while playing sports
(iv) It is most frequently caused by impact trauma, such as by a blow to the face. It can also be a congenital disorder caused by compression of the nose during childbirth.
14On Medi claim policy
13. The United India Insurance Co. Ltd. Vs. Mohan lal Agarwal (2004 ACJ 1657 ), the Division bench of the Gujarat High Court has laid down the following six principles in respect of medi claim policy-
(i) The insured has an option under the existing medi claim insurance policy to continue the cover by payment of renewal premium in time in respect of the sum insured.
(ii) In case of renewal without break in the period, the medi claim insurance policy will be renewed without excluding any disese already covered under the existing policy which may have been contracted during the period of the expiring policy. Renewal of medi claim insurance policy cannot be refused on the ground that the insured had contracted disease during the period of the expiring policy so far as the basic sum insured under the existing policy is concerned.
(iii) In cases where the insured seeks an enhancement of the amount of sum insured at the time of renewal, the option to renew will not extent to the amount of such enhancement and renewal in respect thereof will depend upon the mutual consent of the contracting parties.
15(iv) Renewal of a medi claim insurance policy cannot be refused, despite timely payment of the renewal premium, on the ground that continuance of the cover would become more onerous or burden some for the insurer due to the insured contracting a covered disease during the period of the existing policy.
(v) The insurer may refuse renewal, even in cases where the insured has an option to renew the policy on payment of the renewal premium in time, on the grounds, such as, misrepresentation, fraud or non-disclosure of material facts that existed at the inception of the contract and would have vitiated the contract of insurance at its inception or non- fulfilment of obligations on the part of the insured or any other ground on which the performance of the promise under the contract is dispensed with or excused under the provisions of the Contract Act or any other law or when the insurer has stopped doing business.
(vi) The Government insurance companies continue to be 'State' within the meaning of article 12 of the Constitution notwithstanding the entry of private companies in the field of general insurance, ending their monopoly by virtue of insertion of section 24 A in the Act of 1972 and they cannot 16 arbitrarily cancel or refuse to renew an existing medi claim policy."
On suppression of material facts
14. It may be stated here that it is the fundamental principle of insurance law that utmost good faith must be observed by the contracting parties and good faith forbids either party from non-disclosure of the facts which the parties known. The insured has a duty to disclose and similarly it is the duty of the insurance company and its agents to disclose all material facts in their knowledge since obligation of good faith applies to both equally and in this respect, the decision of the Hon'ble Supreme Court in M/s.Modern Insulators Ltd. Vs. Oriental Insurance Co. (AIR 2000 SC 1014) may be referred to.
15. The onus probandi, in cases of fraudulent suppression of material facts rests heavily on party alleging fraud namely the insurer. In this respect, the decision of the Hon'ble Supreme Court in LIC Vs. Smt. G.M.Channabasemma (1996 (III) CPJ 8 (SC) may be referred to where it was held that the burden of proving that the insured had made false representation and suppressed material facts is undoubtedly on the LIC of India. Furthermore, mere concealment of some facts will not amount to concealment of material facts and if there is fraudulent suppression of material facts in the proposal, the policy could be vitiated otherwise not.
1716. Suppression of fact must be a conscious operation of the giver of the answer which he knowingly did not disclose.
17. The Hon'ble National Commission in National Insurance Co. Ltd. Vs. Bipul Kunda (2005 CTJ 377 (CP) (NCDRC) ) has held that for repudiating a claim of an insured, it is for the insurer to show that a sttement on a fact, which was material for the policy, had been suppressed by the insured and that statement was fraudulently made by him/her with the knowledge of the falsity of that statement.
18. The word "misrepresentation" means suggestio falsi, in matter of substance essentially material to the subject, whether by acts or by words, by manoeuvres, or by positive assertions or material concealment (suppressio veri) whereby a person is misled and damnified.
19. The word "fraud" means a conduct either by letter or words, which induces the other person, or authority to take a definite determinative stand as a response to the conduct of former either by word or letter. In this respect, the decision of the Hon'ble Supreme Court in Ram Preeti Yadav Vs. UP Board of High School & Intermediate Education and ors. (JT 2003 (Supp.I) SC 25 ) may be referred to.
20. It is well settled that misrepresentation itself amounts to fraud in some cases.
21. The word "misconduct" means an act or conduct in the 18 nature of a breach of trust or an act resulting in loss to other party.
22. The word "suppression of fact" envisages a deliberate or conscious omission to state of fact with the intention of deriving wrongful gain. In this respect, the decision of the Hon'ble Supreme Court in Collector of Customs Calcutta Vs. Tin Plate Co. of India Ltd. ( (1997) 10 SCC 538 ) may be referred to.
On material facts
23. On material facts it could be said that everything is material which will guide a prudent insurer in determining whether he will take the risk and if so, at what premium and on what conditions.... In detrmining the question whether a particular fact is one which ought to be disclosed, the test to be applied is not what the assured thinks but whether a prudent and experienced insurer would be influenced in his judgment if he knew of it. The test is not whether the insurer in question, even if he is a prudent one, would have himself been influenced, but whether applying the standard of the judgment of a prudent insurer, the insurer in question would have been influenced in his judgment.
Burden to prove concealment on insurer
24. It may be stated here that if the claim is repudiated by the insurance company on the ground that the insured had 19 suppressed the material facts, the burden shall lie heavily on the insurance company and for that the law laid down by the Hon'ble Supreme Court in the case of Life Insurance Corporation of India Vs. G.M.Channabasamma ( 1991) 1 SCC 357; AIR 1991 SC 392 ) may be referred to.
Meaning of Pre-existing disease
25. Pre-existing disease is one for which the insured should have undergone hospitalisation or undergone long treatment or operation. Otherwise, for laymen these day to day normal problems are not to be disclosed as even otherwise medical terminology of such problems is difficult to understand and know.
26. Merely because some positive science in respect of so called disease are noticed later on, but for that; that disease could not be treated as pre-existing disease.
27. It may be stated here that a person might be suffering from a disease but he may not take care to that and go to a doctor. Quite often a person, who might be having some problem with the heart may not be knowing about it and may not go to a doctor. The question always, which has to be determined, is, was the pre-existing disease to the knowledge of the insured. That knowledge could be attributed if the person takes some or the other treatment from a doctor/hospital and on point of pre-existing disease the law 20 laid down by this Commission in the case of New India Assurance Co. Ltd. Vs. Vishwanath Manglunia ( ( 2006 ) 3 CPJ 68 ) may be referred to.
28. Keeping the above legal position and definitions in mind, the facts of the present case are being examined.
29. In this case as per discharge ticket of the SMS Hospital, Jaipur where the son of the complainant respondent was admitted on 19.10.04 and was discharged on 20.10.04 and operation of Septoplasty was done and no doubt in that discharge ticket it was mentioned that there was Pus discharge, RCC, cold , cough, hearing loss and since childhood but there is nothing on record to show that before taking the first medi claim policy on 17.10.03, the son of the complainant respondent had taken the treatment of DNS or had consulted any medical man for taking the treatment of that disease.
30. It may be stated here that there are certain diseases such as kidney, heart and brain and they are connected with the life span of a person and if any misstatement is made in respect of such type of diseases by the person seeking insurance, in such case, it can be believed that knowingly the person taking out the insurance has made misstatement. But if any one suffers from temporary illness such as fever, cough, cold etc., and the same was not mentioned at the time of taking insurance, it cannot be stated in true sense that a misstatement in respect of 21 the state of health has been made by the person seeking insurance.
31. No doubt from the discharge ticket of the SMS Hospital, Jaipur and even from the discharge card of Cumballa Hill Hospital and Heart Institute, Mumbai where the son of the complainant respondent was admitted on 21.12.04 and was discharged on 23.12.04 and operation was done by Dr. Milind V. Kirtane on 22.12.04, it does not appear that the problem which was being faced by the sone of the complainant respondent might be by birth.
32. Furthermore, after some tests the disease of DNS was diagnosed by Dr. S.P.Srivastava on 19.10.04 when the son of the complainant respondent was admitted in the SMS Hospital, Jaipur and thus it could not be said that the disease for which the son of the complainant respondent had gone for operation could not be diagnosed until and unless some tests were done.
33. In this case, there is nothing on record to suggest that prior to taking the medi claim policy on 17.10.03 the son of the complainant respondent had undergone any of the tests that were done in the SMS Hospital, Jaipur and after that operation was done, therefore, it could not be said that the complainant respondent was aware of the fact that his son was suffering from the disease of Deviated Nasal Septum (DNS) prior to taking the policy. Thus, if the complainant respondent had not disclosed at the time of taking the medi claim policy 22 on 17.10.03 that the son of the complainant respondent was suffering from DNS, it could not be said that he was guilty of suppression of material facts or the disease could not be said a pre-existing disease.
34. As already stated above for proving the pre-existing disease, it is necessary that the insured should have undergone hospitalisation or undergone long treatment or operation and in this case this aspect is totally missing and from that point of view also it could easily be said that the disease which was diagnosed by Dr. S.P.Srivastava in the month of July 2004 was not a pre-existing disease.
35. Furthermore, in coming to the above conclusion the law laid down by the Hon'ble National Commission in the case of New India Assurance Co. Ltd. Vs. Mary Jane Govias and ors. ( IV 2006 CPJ 228 (NC) ) may be referred to.
36. So far as the disease DNS is concerned, it is a common physical disorder of the nose, involving a displacement of the nasal septum and it is most frequently caused by impact trauma such as by a blow to the face. It can also be a congenital disorder caused by compression of the nose during childbirth and since in the present case this disease was diagnosed for the first time by Dr. S.P.Srivastava on 19.10.04 when the son of the complainant respondent was admitted in the SMS Hospital, Jaipur and since this disease could be caused by trauma, meaning thereby apart from congenital disorder, it could be caused by some other factors, therefore, 23 in the present case the disease of DNS developed by the son of the complainant respondent could not be said to be a congenital disease and it can be said that the son of the complainant respondent had developed this disease later on and the same was diagnosed for the first time by Dr. S.P.Srivastava and from that point of view also that disease could not be said to be a pre-existing disease.
37. Had there would have been any evidence that the son of the complainant respondent had taken treatment of DNS prior to taking the medi claim policy i.e. on 17.10.03 from any hospital or medical man, the position would have been different one.
38. It may further be stated here that the insured is bound to disclose those facts which had bearing on the risk and since in the present case the son of the complainant respondent suffers from cough, cold and fever and that had lead some problem in the ear, therefore, if they were not disclosed by the complainant respondent , it would not amount to misstatement on the part of the complainant respondent because a persistent cold especially in the child affects the hearing sight of the ear and it appears that this happens in this case.
39. Apart from that even for the sake of arguments, it could be said that the son of the complainant respondent was having some problem of cold, cough and fever prior to taking the medi claim policy on 17.10.03, it may be stated here that since such are minor ailments and nobody could imagine or 24 visualize that they would affect the hearing later on and therefore, non-mentioning of such type of diseases i.e. cough, cold and fever, it does not amount to suppression or concealment of material fact or mis-statement in real sense and,therefore, the appellants were not justified in repudiating the claim of the complainant respondent on the ground of suppression of material facts and thus the appellants could not claim the benefit of clause 4.1 of the policy and repudiation of claim on the ground of that clause was not justified and in view of this the findings of the District Forum by which the claim of the complainant respondent was allowed are based on correct appreciation of entire materials on record and no infirmity or illegality is found in them and thus considering all facts and circumstances of the case, the complainant respondent is entitled to claim re-imbursement from the appellants Insurance Co. for the expenditure incurred by him for the operation and treatment of his son and thus all contentions raised on behalf of the appellants stand rejected.
40. For the reasons stated above, the appellants were not justified in repudiating the claim of the respondent complainant on the ground of suppression of material facts and the appellants had repudiated the claim of the complainant respondent without any basis and on wrong assumption and in an arbitrary manner and in view of this the findings of the District Forum decreeing the claim of the complainant respondent are liable to be confirmed as they are based on correct appreciation of entire materials and evidence on record 25 and they do not suffer from any basic infirmity,illegality or perversity and this appeal deserves to be dismissed.
Accordingly, the appeal filed by the appellants Insurance Company is dismissed.
(Vimla Sethia) (Justice Sunil Kumar Garg) Member President