Decided on March 20,2009

Life Insurance Corporation Of India Divisional Office No.1 Appellant
Sangeeta Karwa Respondents


J.D.KAPOOR,PRESIDENT - (1.)THIS appeal is directed against Order dated 14 -08 -2006 passed by the District Forum whereby the appellant insurance company has been directed to settle and pay the claim of two policies for Rs. 5.00 lacs and Rs. 2.8 Lacs in respect of Mr. Tarun Karwa, the deceased husband of the respondent, forthwith after processing the same and in accordance with law and after obtaining the requisite documents if not already furnished along with details of premium paid by her after the death of her husband. Appellant has also been directed to allow waiver of premium for remaining three policies of three children and pay Rs.10,000/ - as compensation and Rs. 5,000/ - cost of litigation.
(2.)ADMITTEDLY , the aforesaid two policies were taken on 28 -01 -2002 and 28 -03 -2002 respectively. The deceased insured was discharged from Pentamed Hospital on 23 -02 -2003 after having been admitted for Bronchial Asthma. The claim was rejected on the ground of concealment of pre -existing disease of Bronchial Asthma and having committed breach of good faith; Other documents that formed the basis for rejection of claim is medical record of treatment at Apollo Hospital in the year 1999.
(3.)SO far as Apollo Hospital treatment is concerned the observations are:
Course in the Hospital: -

Patient was brought to the hospital in a sale of severe respiratory distress. He was managed conservatively in the medical ICU by O2, Nebulizers, antibiotics, bronchodilators and steroids. He responded to them well but developed epigastric tenderness and vomiting. Dr. S. Jain, Gastroenterologist, was consulted for the same who started with Rantac. Sparcid for him. Dr. Samant, ENT Consultant was consulted for ENT complaints. In the last week of his stay in the hospital he had severe episode of watery diarrhoea, abdominal pain and vomiting. Dr. S. Jain was consulted again for that who managed him conservatively on Metrogyl and Cifran. Colonoscopy was done which was normal. Patient is being discharged in a satisfactory condition.

As regard the treatment at Pentamed Hospital the discharge summary is to the following effect: -

K/C of Bronchial Asthma and NIDD for 6 -8 months with sudden cardio -respiratory arrest resuscitation done. Pt. on ventilator. SIMV mode with 70% Fio2. HOPE - K/C of Bronchial Asthma for 6 -8 months. Admitted with complaint of unconsciousness for last 15 min. H/O fall in bathroom which was noticed by the wife. H/c diabetes mellitus for 6 -8 months.

O/E -Pt. unconscious. BP un -recordable. Heart - No heart sound. Resp No spontaneous activity.  case of age -27 B.

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