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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
J. M. Malik, Presiding Member, Dr. S. M. Kantikar, Member
Subhash B. Jatania —Petitioner
versus
National Insurance Co. Ltd. —Respondent
Revision Petition No. 3515 of 2009
(From order dated 04.07.2009 in First Appeal No. 1158 of 2008 of the Maharashtra State Consumer Disputes Redressal Commission, Mumbai)
Decided on 12.1.2015
Counsel for the Parties:
For the Petitioner:Mr. Kabir Hathi, Advocate
For the Respondent: Nemo.
IMPORTANT POINT
Insured should not conceal any pre-existing disease while taking policy.
Headnote:Consumer Protection Act, 1986—Sections 15, 17, 19 and 21—Insurance—Mediclaim Policy—Non-reimbursement of hospitalisation charges—Myasthenia Gravis was found present and complainant was suffering from it as per history given since form month of February, 2000—Disease relates to Muscular Paralysis and patient must be experiencing and aware of it—It is not a silent disease which is may go unnoticed—When proposal form was filled in on 20/06/2001, not disclosing of same mischief was committed—Observation of State Commission is supported by medical certificate—Order passed by State Commission cannot be faulted. (Paras 2 to 4)
Result: Revision Petition dismissed.
J. M. Malik, Presiding Member—Learned counsel for the petitioner present. Shri Subhash B. Jatania, the complainant obtained Medi claim policy covering hospitalisation charges from National Insurance Co., the OP and which was renewed to 21.6.2003. The complainant was hospitalised from period 6.11.2001 to 6.12.2001 for the known case of myasthenia gravis. His claim was repudiated.
2. The State Commission passed the following order:
“Coming to the merit of the case, we find the Forum below did not appreciate the facts properly nay the appreciation of evidence lead is rather perverse and as such arrived at a wrong conclusion. The Insurance Company, to justify the repudiation, has produced on record the documents inter alia including the insurance policy and the proposal form, where admittedly there is no disclosure of any pre-disease condition. Myasthenia Gravis was found present and the complainant was suffering from it as per the history given since form the month of February, 2000. The disease as it seems relates to Muscular Paralysis and therefore, the patient must be experiencing and aware of it. It is not a silent disease which is may go ununotied. Dr. B. S. Singhal, a renowed NeuropPhysician examined the complainant on 01/08/2001 also categorically noted that the complainant treating doctor confirmed and gave history of symptoms of Myasthenia Graves for duration of six months prior to his examination. Therefore, when the proposal form was filled in on 20/06/2001, not disclosing of the same the mischief was committed and thus, Insurance Company rightly inferred after careful investigation of the case that there being a breach committed by the complainant of utmost good faith, the claim needs to be repudiated.”
3. The observation of the State Commission is supported by medical certificate Ext-E, which runs as follows:
“This is to certify that Mr. Subhash B. Jatania is under my treatment from 4/11/01. The observations made on your reply of 22/2/2002 “implies that hypertension is the cause of his illness. This is absolutely stupid Myasthenia gravis is an auto immune disease and hypotonia has no relation whatsoever to his present illness. I recommend that you should refer your files to qualified doctors for operation
Sd/-
R. No. 31037”
4. We see no flaw in this context. The order passed by the State Commission cannot be faulted. The revision petition is hereby dismissed.
Revision Petition dismissed.
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