JUGAL KISHORE CHOUKESE vs Oriental Insurance Co. Ltd.

THIS Revision Petition is directed against the order passed by the Madhya Pradesh State Consumer Disputes Redressal Commission, Indore in Appeal No. 1647 of 2004 dated 20.1.2006.

HEARD the learned Counsel for the petitioner. The complainant had obtained a medi-claim policy. The wife of the complainant Smt. Sangeeta Choukse was a pregnant. All of a sudden on 4.6.2003 her condition deteriorated. On contacting doctor, the doctor advised her to get admitted in the hospital and accordingly she was admitted in the hospital. Sonography test was done. After the Sonography test, it transpired that the child had already died. She was accordingly treated. On 10.6.2003, she was discharged from the hospital. The complainant preferred a medi-claim before the Insurance Company/respondent. The Insurance Company/respondent repudiated the claim. It was claimed by the respondent that the case of treatment of the wife of the petitioner was not covered under the medi-claim policy in terms of Clause 4.12 of the Exclusion Cause which reads as under: "Treatment arising from or traceable to pregnancy (including voluntary termination of pregnancy) and childbirth (including ceasarian section)".

The District Forum interpreted this clause and held that the complainant/petitioner was entitled to medi-claim on the ground that the hospitalisation was not on account of pregnancy but on account of stomach ache and high blood pressure and in such circumstances her pregnancy had to be terminated. It could not be taken to be a wilful termination of pregnancy and awarded a sum of Rs. 21,554.

THE State Commission took the view that the ailment itself was directly traceable to her pregnancy. It may be noted that on Sonography the child in the womb was found to have expired. In absence of any evidence it is not possible to accept that she did not suffer on account of pregnancy and her suffering was not directly traceable to her pregnancy. Consequently, we feel that the view taken by the State Commission was appropriate and much more preferable then the view taken by the District Forum. For the aforesaid reasons, we do not find any force in this revision petition and the revision petition is dismissed accordingly. Revision Petition dismissed.