Page 111 - Suri’s - NCDRC ON LIFE INSURANCE 2017 V1.3

Suri’s - NCDRC ON LIFE INSURANCE 2017 111

A close look at the two discharge summary reports is in order. Patiala Heart Insti-
tute records admission of the complainant as a 44 year old male without significant
past history for chest pain radiating to left arm. It then records that the patient was
diagnosed and managed as a case of CAD (coronary artery disease), ACS (acute
coronary syndrome), USA ( unstable artery), and responded well to the treatment. It
further records that there were no complications during hospital stay and the patient
was discharged in satisfactory condition and advised follow up with the Doctor.It is
clear from this discharge summary that there was no advice given to the petitioner for
angiography, contrary to what has been claimed in the complaint. Only a follow up
with the Doctor was suggested. Clearly, nothing under ―critical illness‖ so far.
A look at the discharge summary of Dayanand Medical College &Hospital reveals
that the petitioner was admitted for evaluation of coronary artery status. It records a
history of chest pain 1½ months back. It further records no history of palpitations,
cough, fever or syncope. Its final diagnosis is CAD-single vessel disease and its rec-
ommendation PTCA with stenting to LAD which was carried out. It is clear from this
that the petitioner complainant had not been shifted to DMCH as claimed in his com-
plaint; rather, he had gone there for an evaluation of his coronary artery status. There
is a significant difference in ‗being shifted‘ and ‗going for an evaluation‘. As it turned
out, the evaluation led to PTCE with stenting.
Thus, when the contents of the discharge summaries are seen against the require-
ments of what constitutes a CRITICAL ILLNESS under the policy, it becomes quite
clear that the petitioner complainant‘scase cannot be called a case of critical illness.
This does not mean that his illness or treatment was not real or not important. It only
means that his claim under critical illness category cannot be sustained.
In view of the foregoing discussion, I see no infirmity in the well-reasoned orderof
the State Commission. Accordingly, the revision petition is dismissed. No order as to
costs.

......................
ANUP K THAKUR
PRESIDING MEMBER

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