Mr. D.D. Bahuguna, Sr. Member—This appeal has been filed against the judgment and order dated 20.9.2001 passed by District Consumer Forum, Kanpur Nagar, in Complaint Case No. 496/1998. Briefly stated the facts of the case are as follows.

The complainant No. 1 is Raj Kumar Singh and complainant No. 2 is his wife Smt. Baby Singh. The complainants obtained a Mediclaim insurance policy for themselves as well as for their two children from opposite party against a premium of Rs. 4,026/-. The policy was valid from 25.9.1996 to 24.9.1997 and the policy number was 4842030103046. All of a sudden the wife of the complainant No. 1 suffered chest pain and she was admitted to Regency Hospital, Kanpur. The Valve implantation surgery was carried out in the hospital on 30.5.1997 by Dr. Prateek Bhatnagar. The total expenditure incurred on the treatment including the replacement of valve amounted to Rs. 2 lacs. As per the terms of the policy the complainant informed the opposite party on 6.6.1997. After completing the formalities a Claim No. 48/97/254 was submitted to the Insurance Company. Inspite of repeated approaches to the opposite party the claim was not settled and ultimately it was repudiated on 3.3.1998. The opposite party did not abide by the terms and conditions of the policy and it is liable to pay the amount claimed. Accordingly registered notice was sent to Insurance Company which remained unreplied. The complainants then filed a claim before the District Consumer Forum for recovery of Rs. 2,80,000/- being, expenses against the treatment of Rs. 2 lacs, compensation for mental and physical torture Rs. 50,000/-, food and journey expenses Rs. 25,000/- and fee for Advocate and notice etc. Rs. 5,000/-. Interest @ 15% p.a. was also claimed from the date of filing of the claim till the date of payment.

3. The opposite party in its written statement admitted the mediclaim insurance policy of the complainants but the rest of the allegations were denied. It was contended that wife of complainant No. 1 was suffering from heart disease at the time of obtaining the medi-claim policy and this fact was not disclosed at the time of obtaining the policy due to which claim of complainant No. 2, wife of the complainant No. 1 was repudiated. The claim is denied when there is violation of the terms and condition of the policy and is paid only when there is no such violation. The claim was repudiated after considering the entire facts and circumstances of the case. Thus the complainant No. 1 and his wife were at fault by not disclosing the fact in regard to the heart disease of complainant No. 2 at the time of obtaining the policy. On receiving the information from the complainants on 6.6.1997 an investigator was appointed to obtain the previous medical history of Smt. Baby Singh complainant No. 2. The investigator reported that she was suffering from cronic heart disease at the time of obtaining mediclaim policy. Dr. Piyush Misra had confirmed in writing that Baby Singh was suffering from severe A.R. and thereafter she was referred to L.P.S. Institute of Cardiology at Kanpur. Again the opposite party appointed Dr. R.K. Kakkar for collecting various medical documents from Regency Hospital in order to arrive at a correct decision in regard to processing of the claim lodged by the husband of the complainant No. 2. Dr. Kakkar obtained the opinion of Dr. Piyush Misra who reported that Baby Singh has a heart disease for quite a long time. Dr. Piyush Misra diagnosed the case of the complainant No. 2 as Rheumatic Heart Disease with Aortic Reguragitation with Aortic Stenosis and such type of illness are chronic in nature and take up several years to develop. Therefore, Dr. R.K. Kakkar in his opinion dated 2.3.1998 concluded that it is difficult to believe that the insured not aware of her heart ailment as different symptoms start appearing from time to time.

The opposite party, therefore, repudiated the claim which is not an arbitrary action. Therefore, ther