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Judgment
None is present on behalf of the petitioner even on the second round. The petitioner has written to this Commission that he is an old person of 74 years and he cannot attend the proceedings in this Commission nor can he afford the services of an advocate, therefore, his case may be decided by this Commission on merit. Accordingly, I have carefully gone through the case file.
The brief facts of the case are that the petitioner took an Individual Personal Accident Policy from the respondent - insurance company for an amount of Rs.60,000/-. The policy was valid from 07.02.2016 to 06.02.2017. On 03.09.2016, the petitioner had an accidental fall into the accumulated water caused due to sudden heavy rainfall, due to which the petitioner suffered serious back injury. The petitioner lodged a claim of Rs.2,605/- which he had incurred for his medical expenses. The said claim was repudiated by the insurance company on 24.11.2016. The petitioner filed a Consumer complaint no. 6 of 2017 before the District Consumer Disputes Redressal Forum, Kolkata Unit II ('the District Forum'). The District Forum vide its order dated 10.04.2017 dismissed the complaint.
Dissatisfied by the order of the District Forum, the petitioner filed an appeal no. A/531 of 2017 before the West Bengal State Consumer Disputes Redressal Commission, Kolkata ('the State Commission'). The State Commission vide its order dated 27.12.2018 dismissed the appeal.
Hence, the present revision petition.
The State Commission in its order dated 27.12.2018 has recorded the following:
"So in the instant case, the patient was covered neither under inpatient care, nor was it covered under day care treatment. He was not even an out patient as he was not included under the scope of definition of day care treatment.
We have searched the record thoroughly. There was no indication that the patient would have otherwise required hospitalisation for more than 24 hours. Moreover, the injury was not certified by the medical practitioner to the effect that the same was caused by external, violent, visible and evidence means as provided under paragraph 10 of the policy.
We have no reason to differ from the observations made by the District Forum towards not considering the appellant/ complainant a consumer in view of the facts and circumstances narrated above. Hence, the appeal be and the same stands dismissed. The impugned judgment and order stand affirmed."
From the above, it is clear that the case of the petitioner/ complainant cannot be covered under the policy, moreover, there is concurrent finding of facts given by the fora below and scope under the revision petition is quite limited as the facts cannot be re-assessed by this Commission in the revision petition as held by the Hon'ble Supreme Court in Lourdes Society Snehanjali Girls Hostel and Ors. Vs. H&R Johnson (India) Ltd. and others, (2016) 8 Supreme Court Cases 286, wherein, the following has been held:-
"23. The National Commission has to exercise the jurisdiction vested in it only if the State Commission or the District Forum has either failed to exercise their jurisdiction or exercised when the same was not vested in them or exceeded their jurisdiction by acting illegally or with material irregularity. In the instant case, the National Commission has certainly exceeded its jurisdiction by setting aside the concurrent finding of fact recorded in the order passed by the State Commission which is based upon valid and cogent reasons."
Based on the above discussion, I do not find any illegality, material irregularity or jurisdictional error in the order of the State Commission which calls for any interference from this Commission. Consequently, the revision petition no.513 of 2019 is dismissed at the admission stage.