IMPORTANT POINT
Where insurance company failed to produce proposal form filled in for mediclaim policy, it could not be held that insured had suppressed information regarding pre-existing disease and insurance company would not be justified in repudiating the claim.

S.N. Aggarwal, President—Tarsem Lal Gupta father of the appellants had taken medi-claim insurance policy from the respondents in the sum of Rs.1,00,000. It was valid for the period from 12.6.2001 to 11.6.2002. The said insurance policy was renewed by Tarsem Lal Gupta for the period from 12.6.2002 to 11.6.2003. The insured fell ill due to stomach problem and got himself checked up in Patel Hospital, Jalandhar. He was admitted on 8.10.2002 and was discharged on 11.10.2002. It was diagnosed that Shri Tarsem Lal Gupta was suffering from pancreatitis for which he had undergone treatment in Patel Hospital Jalandhar. It was further pleaded that Tarsem Lal Gupta had incurred an expenditure to the tune of Rs.7,934.55P on account of hospitalization and domiciliary hospitalization expenses for which the claim was lodged with the respondents on 20.11.2002. However it was not settled by the respondents.

2. It was further pleaded that Tarsem Lal Gupta again felt severe pain in his stomach and he got himself checked up from Patel Hospital, Jalandhar. He was admitted for medical treatment on 13.12.2002 but he expired on 20.12.2002 in the hospital. The information was given to the respondents. An expenditure to the tune of Rs.56,748.64 P was incurred on his medical treatment. The claim was lodged with the respondents but it was repudiated by the respondents. Hence the appellants lodged the claim to the tune of Rs.7,934.55 P + Rs.56,748.64 P = Rs.64,683.19 P as compensation. Interest and costs were also prayed.

3. The respondents filed the written reply. It was not denied that Tarsem Lal Gupta had taken medi-claim insurance policy from the respondents in the sum of Rs.1,00,000 which was valid for the period from 12.6.2001 to 11.6.2002. It was also admitted that the medi-claim insurance policy was got renewed by Tarsem Lal Gupta from the respondents for the period from 12.6.2002 to 11.6.2003. It was not denied if Tarsem Lal Gupta was admitted in Pate1 Hospital, Jalandhar for the period from 8.10.2002 to 11.1 0.2002 but it was pleaded that the insured was suffering from diabetes mellitus for the last 13 years and he had been taking medical treatment for the said disease. It was admitted that the information was giver by the insured to the respondents and the insurance claim was also lodged for an amount of Rs.7,934.55 P. Since Tarsem Lal Gupta was having a pre-existing disease, therefore, the said claim was repudiated by the respondents.

4. The admission of Tarsem Lal Gupta in Patel Hospital, Jalandhar on 13.12.2002 and his ultimate death on 20.12.2003 were not denied. It was denied for want of knowledge if the respondents were the legal heirs of Tarsem Lal Gupta insured. It was pleaded that since the disease of Tarsem Lal Gupta was pre-existing, therefore, reimbursement of the medical expenditure was not legal and valid. It was rightly repudiated by the respondents and dismissal of the complaint was prayed.

5. The appellants proved the additional affidavit of appellant No.2 as Ex.C1. The appellants also proved documents Ex.C2 to Ex.C69. The affidavit of Ashwani Gupta appellant was produced as Ex.C70. On the other hand, the respondents proved the affidavit of Shri A.K. Dhar, Senior Divisional Manager as Ex.R1. The respondents also proved documents Ex.R2 to Ex.R3, Ex. RJ 3A, and Ex.R4 to Ex. R 11. The affidavit of Jagtar Singh, Divisional Manager was also filed as Ex. R 12.

6. After considering the pleadings of the parties and the affidavits/documents placed on the file by them, the learned District Forum dismissed the complaint vide impugned order dated 14.10.2004.

7. Hence the appeal.

8. The submission of the learned counsel for the appellants was that the exclusionary clause was never communicated to the appellants. Therefore, the claim of the appellants cannot be repudiated. It was submitted that where two views are possible one in favour of the consumer has to be taken in view of the law laid down by the Hon’ble Supreme Court.

9. On the