New India Assurance Co Ltd vs JAGRUT NAGRIK

-THIS appeal is preferred by the Insurance Company-original opponent against the order dated 12. 7. 2006 rendered in Complaint No. 295/2001 by the learned Vadodara District Consumer Disputes Redressal Forum.

WE have heard the learned Advocates of both the parties, perused the impugned judgment and evaluated the documents submitted before us and also perused the written submissions. There is no dispute regarding existence of valid policy or that the complainant had undergone emergency surgery in relation to Ruptured Ectopic Pregnancy. The repudiation was based on Condition Nos. 4 and 4. 12 which read as under: "4 Exclusions: 4. 12 - Treatment arising from or traceable to pregnancy, childbirth including cesarean section. "

Prima facie there cannot be any dispute - looking to the records and presentations of parties that surgery was not voluntary, planned or not life-saving meaning thereby that complainant had no option but to undergo life-saving Emergency Surgery for "ruptured Ectopic Pregnancy" and hence Condition No. 4. 12 will not be applicable in the present case.

AS far as Condition No. 4. 12 is concerned it is to be noted that complainant had to undergo emergency life saving surgery for ruptured fallopian tube, causing haemorrhage and threatening life. This surgery was not of pregnancy or for pregnancy. As a part of procedure unviable pregnancy had to be removed as a step of surgery. What was done in surgery was to check the bleeding and remove offending part of fallopian tube which incidentally was harbouring pregnancy. Even if there was or not pregnancy and life threatening bleeding was present from the said fallopian tube - for whatever reason - the same surgical procedure was warranted and patient will be required to undergo the procedure to save the life. The above referred clause is in relation to the treatment of or for pregnancy and as suggested in supra. In our view this surgery not being for or of pregnancy. The said condition does not apply here and therefore repudiation of claim on said ground does not hold. Learned Advocate for appellant has shown us the judgment in Appeal No. 1445/2004 dated 16. 6. 2005 of this Commission regarding the observation therein that Ectopic pregnancy is pregnancy and that any treatment for that pregnancy is treatment for pregnancy is well received. With our proviso that in present case, surgery undergone by the complainant in our view, neither of pregnancy nor for pregnancy, but for the bleeding, shock and damaged fallopian tube which incidentally and pregnancy, we do not consider that above referred judgment does apply here and hence the repudiation of claim by the appellant Insurance Company is not justified here.

WE have noted the observations made by the learned District Forum and also the final order. Needless to say that in view of the above mentioned observations we do not consider it necessary to interfere in the final order passed by the learned Vadodara District Forum, hence the following order: order appeal is dismissed. No order as to cost. Appeal dismissed.