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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Dr. S.M. Kantikar, Presiding Member and Dinesh Singh, Member
Future Generali India Insurance Co. Ltd. —Petitioner
versus
Inderjit Singh —Respondent
Revision Petition No.3054 of 2018 (Against the Order dated 19/04/2018 in Appeal No. 5127/2018 of the State Commission Punjab) with IA/20379/2018(Stay), IA/20380/2018 (Excemption of Annexures), IA/20381/2018 (Placing addl. documents)
Decided on 18.4.2019
Counsel for the Parties:
For the Petitioner:Mr. Navneet Kumar, Advocate
IMPORTANT POINT
If the diagnosis is after the date of the filing the proposal form, there cannot be concealment.
Headnote:Consumer Protection Act, 1986 – Section 21(b) – Insurance-repudiated on the ground of suppression of material fact, i.e. previous illness – Hence, complaint before District Forum. District Forum partly allowed the complaint and State Commission dismissed the appeal. Hence, revision.
Held, the diagnosis was after the date of filing the proposal form. There is no concealment. Hence, the order of District Forum, as maintained by the State Commission, upheld.
The opposite parties are directed to pay the amount spent on the treatment and medicines which is fully proved on the file by way of bills mark C6 to mark C60 i.e. Rs. 2,00,000 /- and further the opposite parties are directed to pay compensation to the complainant to the tune of Rs. 7,000/- and litigation expenses of Rs. 3,000/-. The entire compliance be made within 30 days from the date of receipt of copy of the order.
Result: Petition dismissed.
Dr. S. M. Kantikar, Presiding Member—Heard the learned counsel for the revisionist –insurance co. and perused the material on record.
2. The dispute relates to repudiation of an insurance claim.
3. The District Forum heard both sides, appraised the evidence and through its Order dated 24.08.2017 partly allowed the complaint:—
7. We have heard the learned counsel for the respective parties and also gone through the case file very minutely.
8. After considering the respective arguments of both the counsel for the parties , we find that the purchase of the insurance policy from the opposite party after making a payment of premium for the period 11.04.2016 to 10.04.2017 is admitted fact and even the hospitalization of the complainant in hospital Mannat Super Speciality Hospital , Jalandhar from 07.11.2016 to 09.11.2016 and then in DMC and Hospital , Ludhiana from 11.11.2016 to 26.11.2016 as indoor patient is also not denied and even it is also not denied that the complainant submitted a claim with the opposite party and it is also admitted that the claim of the complainant has been repudiated by the opposite party vide letter dated 21.12.2016 on the ground that the complainant has concealed the previous ailment i.e. Alcoholic Liver Cirrhosis on the basis of exclusion clauses III.12 & III.2. The copy of the repudiation letter is placed on the file by the opposite parties as well as by the complainant which is Ex. C3 and now , the question remains to be decided whether there is any pre- existing disease of Chronic Liver Cirrhosis and Hypertension to the complainant or not ? For that purpose , counsel for the complainant submitted that there is no pre-existing disease nor any disease has been concealed by the complainant, rather the complainant himself not aware whether there is any disease of Alcoholic Liver Cirrhosis or hypertension to the complainant nor he ever felt , rather these diseases were firstly located by the Mannat Hospital as well as DMC & Hospital while he remained admitted in the Mannat Super Speciality Hospital , Jalandhar from 07.11.2016 to 09.11.2016 and DMC & Hospital, Ludhiana from 11.11.2016 to 26.11.2016, whereas the policy was obtained by the complainant in the month of April, 2016.
9. To the contrary, learned counsel for the opposite parties referred Discharge Card of the Mannat Hospital , Jalandhar which is Ex. OPs – 5. No – doubt , there is on page No. 3, it is mentioned that chronic liver disease , but we find that simply writing chronic liver disease is not sufficient, until any previous report of the doctor is not placed on the file i.e., prior to purchase of the policy. But, the opposite parties are not able to bring on the file any medical report/treatment got by the complainant from any hospital , before the date of purchase of the policy i.e. 11.04.2016 , wherein the said hospital has reported that the complainant is having any chronic alcoholic liver disease. No doubt the opposite parties have referred in para No. 3 of the written reply that the complainant also remained admitted in Dayanand Medical College & Hospital, Ludhiana from 07.08.2007 to 12.09.2007 and also remained admitted in the hospital from 23.01.2008 to 24.01.2008 , but regarding these admissions no record has been brought on the file by the opposite parties and in the absence of any record showing that the complainant has any liver problem or liver disease prior to the date of purchase of the policy i.e., 11.04.2016 , so under these circumstances , we find that the case of the complainant is not covered under the Exclusion Clauses III.12 & III.2 , as alleged by the opposite parties in para no. 3 of the written reply. In support of above observation , we like to refer a pronouncement of Hon’ble National Commission cited in 2015(3) C.P.R. 697, New India Assurance Co. Ltd. Versus B.Y. Srikantha , wherein His Lordship held that “the insurance company failed to show any iota of evidence to show that the complainant is having a pre-exis
