Exclusion clauses in insurance policies must be strictly construed and cannot be applied to deny coverage where the insured could not have known about the existence of the disease or any symptoms thereof at the time of making the proposal for insurance.

Mr. Justice S.A. Kader, President—These two appeals arise out of the order of the District Consumer Disputes Redressal Forum, Coimbatore dated 23.4.92 in O.P. 301/91. The complainant who has succeeded in part is the appellant in A.P. 258/92 while the opposite party is the appellant in A,P. 291/92.

2. The complainant who is an agriculturist took a Hospitalisation and Domicilary Hospitalisation Benefit Policy with the opposite party under Category IV of Scheme B. The period of insurance was from 30.11.89 to 29.11.90. He was admitted in the Kuppuswamy Naidu Memorial Hospital on 21.10.90 and discharged on 14.11.90 and there underwent and Open Heart Surgery for Aortic Valve Replacement, Aortic Stenosis Pericardial Effusion. He made a claim with the opposite party for a sum of Rs. 30,000/- with all necessary particulars. The claim was rejected by the opposite party on the ground that the insured would have had the symptoms of the disease even prior to the taking of the policy and he was not, therefore, eligible It was treated as ‘no claim’. Hence this complaint.

3. The opposite party questioned the jurisdiction of the District Forum to entertain this complaint as it was not a contract of service. On merits it claimed that as per the discharge summary produced by the complainant he was suffering from breathlessness for the past one year i.e., prior to the taking of the policy that he must have, therefore known about the existence of the disease prior to the taking of the policy on 30.11.89 and his claim was, therefore, rightly treated as no claim.

4. The District Forum found that it had jurisdiction to entertain this claim and held that the complainant could not have known that he was suffering from any heart ailment prior to the taking of the policy and awarded compensation in the sum of Rs. 5,465/- only with interest thereon at 18%. Aggrieved by the quantum awarded the com- plainant has preferred A.P. 258/92, while the opposite party has preferred A.P. 291/92 disputing the award made by the District Forum.

5. The first question which arise for consideration is whether the claim is maintainable under the Consumer Protection Act Section 2(1)(o) of the Consumer Protection Act defines service as service of any kind any specifically includes insurance. Insurance companies are performing a very valuable service to mankind and the insurer has hired the services for consideration, the consideration being the premium paid. It has been repeatedly held by this Commission as well as by the National Commission that the services rendered by the insurer comes well within the ambit of this Act. The contention raised in the counter that the claim does not fall within the provision of the Act has no substance and has to be mentioned only to be rejected.

6. Exhibit AI is the Policy of Insurance and it covers period from 30.11.89 to 29.11.90. The complainant has suffered from heart ailment and has been examined by the Department of Cardiology, Coimbatore Medical College Hospital on 22.8.90 under Exhibit A-2. They have come to the conclusion that he was suffering from Calcific Aortic Stenosis Pericardial Effusion (small). Thereafter he has got himself admitted in the Kuppuswamy Naidu Memorial Hospital, Coimbatore on 21.10.90 and has been discharged therefrom on 14.11.90. He underwent in the said hospital Open Heart Surgery for Aortic Valve Replacement, Aortic Stenosis Pericardial Effusion on 24.10.90. Exhibit A-3 is the Discharge Certificate and Exhibit A-4 is Operation Record. In Exhibit A-3 it is mentioned that the “patient complains of breathlessness or one year”. On the basis of this entry in Exhibit A-3 Discharge Certificate, the opposite party insurer has taken the opinion of a panel doctor who has stated as follows in Exhibit B-2, Report. -

‘Though it is mentioned in the discharge summary that the insured was suffering from breathlessness on exertion for the past one year which denotes prior to taking the policy on 30.11.89,1 am sure the insured