Mr. Justice M.S. Parikh, President—This appeal arises from order dated 15th July, 1997 passed by the learned Ahmedabad City Consumer Disputes Redressal Forum in Complaint No. 798/1995 dismissing the complaint.

2. It was the complainant’s case that he had taken mediclaim policy from the opponent Insurance Company while disclosing all the facts concerning the medical history of the complainant. In doing so the complainant disclosed the details of accidental injuries sustained by the complainant and his subsequent operation and treatment in respect thereof. The agent assured the complainant that all the benefits would be granted without there being any exclusion in respect of the facts of medical history/injury disclosed by the complainant. Accordingly the complainant made proposal dated 13.9.1993 before the opponent Insurance Company. Prior to that the complainant had taken mediclaim policy from Oriental Insurance Company Limited. The opponent Insurance Company accepted the proposal in full and issued mediclaim policy for the period 1.10.1993 to 30.9.1994. It was the complainant’s case that there was no exclusion of any kind in that policy. On 16.8.1994 the complainant was required to undergo some surgical operation of implant removal and he informed the opponent Insurance Company with regard to his operation and details of the treatment. The complainant thereafter preferred claim of Rs. 26,318.45 ps. on 12.10.1994 enclosing therewith copy of the policy and detailed papers of the hospital which were also submitted along with letter dated 20.6.1995. Opponent Insurance Company repudiated the claim on the ground that material fact of accidental injury was, although disclosed, pre-existing. Reference was made to the printed clause in the policy in question. Learned Forum relying upon such clause dismissed the complaint. That is how the complainant is before this Commission by way of this appeal.

Sl. No.

Name of Insured Person

Plan Option

Pre-existing Illness if any Excluded

Remarks

1.

6150

Dinesh P. Shah

6

2.

6151

Renuka D. Shah

6

3.

6152

Vibhuti D. Shah

5

4.

6153

Jaimin D. Shah

5

5.

6.

3. We have heard the learned Advocates for the parties. The first question that arises in this appeal is with regard to construction of policy of insurance in question. It is the admitted position that the specific column of ‘pre-existing illness if any excluded’ is left blank. The whole Clause No. 4 reads as under :

“4. Details of Insured Person(s)

4. As against the aforesaid submission it has been submitted on behalf of the opponent Insurance Company that in the Exclusion Clause No. 6 Item No. (c) recites that “All diseases/injuries which are pre-existing when this cover incepts for the first time”. It has, therefore, been submitted that the operation in question and the consequent expenditure incurred by the complainant cannot be considered as it would fall in the exclusion clause. The complainant had taken mediclaim policy also for the subsequent period and Clause-4 reads as under :

“4. Details of Insured Person(s)

Sl. No.

Name of Insured Person

Plan Option

Pre-existingIllness if Any

Premium Rs.

Service Tax Rs.

23991

Dinesh P. Shah

6

Cervical Fracture of Femur

675

34

23992

Jaimin D. Shah

5

-

425

22

23993

Renuka D. Shah

6

-

675

34

23994

Vibhuti D. Shah

5

-

425

22

From the aforesaid tenor of both the policies it has been submitted that if the intention of the opponent Insurance Company was to exclude cervical fracture of femur which was already medically managed prior to taking of the aforesaid first policy that would have been excluded in the aforesaid first insurance of the opponent Insurance Company. It has been submitted that exclusion clause had been in both the policies but when there is a specific exclusion require to be provided in the policy upon an honest disclosure of the ailment/accidental injury, the same is being provided by the Insurance Company specifically in column No. 4 meant for that purpose. In that event printed clause as above would not operate.

5. Having hear