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2020 Supreme(Del) 1357

PRATEEK JALAN
Sudhakar Tiwari – Appellant
Versus
New India Assurance Co. Ltd. – Respondent


Advocates Appeared:
Rajiv Dutta, Advocate, Piyush Sharma, Advocate, Aditya N Prasad, Advocate, J.P.N. Shahi, Advocate

JUDGMENT

Prateek Jalan, J. - The dispute between the parties arises out of a medical insurance policy known as the "New India Mediclaim Policy" (hereinafter, "the policy"), purchased by the petitioner from the respondent. The petitioner is aggrieved by a communication dated 05.04.2020 by which the respondent has declined to cover the petitioner''s claims under the policy.

    FACTS

    2. The petitioner first purchased the policy (bearing no. 311600- 341625-00000498) in the year 2002. It came into effect on 11.09.2002. The sum assured under the policy was then Rs. 5,00,000/-. The policy was renewed annually. In the year 2017, the respondent offered the petitioner an enhancement of the sum assured, which the petitioner accepted. The sum assured under the policy was thus enhanced to Rs. 8,00,000/- with effect from 11.09.2017, and the policy document to this effect was issued on 04.09.2017.

    3. The genesis of the present dispute is that the petitioner was diagnosed with metastatic squamous cell carcinoma in cervical lymph nodes in January 2020, and is undergoing treatment at Medanta Hospital, Gurugram, and Apollo Hospital, Delhi. In accordance with the procedure under the policy, the petitioner

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