Insurance claims can be rejected if material information about pre-existing medical conditions is suppressed by the insured party.

Mr. Justice V.S. Kokje, President— This appeal is directed against the decision of District Forum, Bhopal rejecting a complaint against the United India Insurance Company Ltd. on the ground of suppression of material facts. The complainant/appellant took an insurance cover on 1712-90 for a year under which hospitalisation and domiciliary hospitalisation expenses were to be paid by the insurance company. In the proposal form against the column about knowledge of any positive existence or presence of any ailment, the complainant stated “Nil. Against the column of previous medical treatment also he had remarked “NA”. The complainant was examined in Escorts Heart Institute and Research Centre Okhla Road, New Delhi and Angiograpy Test was carried on him during 17.1.91 to 19.1.91. Expenses of Rs.10,700/- were incurred on this. When these expenses were claimed the Insurance Company refused to pay on the ground that material information was concealed from it by the complainant. It was alleged that complainant was suffering from hypertension for the last 20 years and he has been on regular medications for last 10 years. He was having angina in exertion for 2 years and was being treated for that also.

2. The District Forum has found that there was actual suppression of material fact on the part of the complainant which was sufficient to reject the claim. We see no reason to take a different view specially when the policy was taken on 17-12-90 and within a month Angiograply was carried out at a well known an costly hospital like Escorts Heart Institute and Research Centre, New Delhi. There is reason to believe that the insurance cover was taken in anticipation of these expenses by suppressing the ailment from the Insurance Company. If the Insurance Company has taken that view, it cannot be said to be a deficiency in service. The appeal is therefore dismissed. There shall be no order as to costs.

Appeal dismissed.

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