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7.         Petitioner have challenged the said Order dated 26.09.2019 of the State Commission mainly on following grounds:

(i)        The impugned order passed by the State Commission is bad both in law as well as on facts and ought to be set aside.  The impugned order is passed without due application of mind and the same is erroneous and is based on conjunctures and surmises. The State Commission failed to appreciate that the Policy only covered the illnesses/ailments which were specifically mentioned in the list of Major Medical Illnesses in the Policy Schedule itself i.e. 1) Cancer 2) End Stage of Renal Failure 3) Multiple Sclerosis 4) Major Organ Transplant 5) Heart Valve Replacement 6) Coronary Artery Bypass Graft 7) Stroke 8) Paralysis 9) Myocardial Infarction.  It was also mentioned in the said Policy Schedule that "the coverage provided to the insured under the Policy was restricted only to the above mentioned 9 Major Illnesses and Procedures.  The insured had been diagnosed and treated on "Acute Respiratory Distress Syndrome" (ARDS), "Accute Respiratory Failure" (ARF) and "Sickle Cell Crisis".  Bare perusal of the list of the "Major Medical Illness" mentioned in the Policy Schedule confirms that the said illnesses/ailments were not covered under the Policy. Therefore, the claim of the Respondent-1 had been rightly repudiated.

"(1)Cancer (2) End Stage Renal Failure (3) Multiple Sclerosis  (4) Major Organ Transplant (5)  Heart Valve Replacement (6) Coronary Artery Bypass Graft  (7) Stroke (8)  Paralysis (9) Myocardial Infarction."

This portion of the schedule further states that "the list of Major Medical Illnesses and procedures enlisted under Section III has 18 illnesses/procedures.  However,  "please note that the coverage provided to you under this policy is restricted only to the above mentioned 9 Major Medical illnesses and Procedures."

1. Major Organ Transplant;

2. Heart Valve Replacement;

3. Coronary Artery Bypass Graft;

4. Surgery of Aorta;

c. Occurrence for the first time of the following medical events more specifically described below:

1. Stroke;

2. Paralysis;

3. Myocardial Infarction;

4. Major Burns;

                 5. Loss of Speech;

6. Deafness

7. Coma   The Insured Event under this Section 3 and the conditions applicable to the same are more particularly defined below:

 The following are excluded   Transient ischemic attacks (TIA) Traumatic injury of the brain Vascular diseases affecting only the eye or optic nerve or vestibular functions  Permanent Paralysis of Limbs:

Total and irreversible loss of use of two or more limbs as a result of injury or disease of the brain or spinal cord. A specialist Medical Practitioner must be of the opinion that paralysis will be permanent with no hope of recovery and must be present for more than 3 months.