IMPORTANT POINT
Since medical insurance policy was issued after examination of insured, policy claim cannot be repudiated on ground of pre-existing disease.

ORDER

C. Viswanath, Presiding Member.—The present Appeal is filed by the Appellant against Order passed by the Punjab State Consumer Disputes Redressal Commission, Chandigarh (hereinafter referred to as the “State Commission”) in MA/1857/2019 in/and CC/127/2019 dated 18.03.2020.

2. Father of Respondent No.1/Complainant obtained Medical Insurance Policy No.404000501810000094 from the Opposite Party/Insurance Company, which was valid from 05.05.2018 to 31.10.2018. The Policy covered medical expenses of USD 2,50,000/- for Illness, USD 2,50,000/- for accident, USD 25,000/-, for Personal Accident, USD 1,000/- for loss of checked in Baggage, USD 100/- for delay of checked in Baggage, USD 250/- for Loss of Passport and USD 2,00,000/- for Personal Liability. At the time of taking the Policy, the insured had disclosed that he was suffering from hypertension and diabetes. Opposite Parties got the insured medically examined and thereafter issued the Medical Insurance Policy.

3. On 05.05.2018, the Insured went to Birmingham alongwith his family. On the night of 30.08.2018, he suffered heart attack and was taken to the hospital. On 01.09.2018, Angiography was done and claim for reimbursement was filed on 03.09.2018. The Complainant’s father expired on 14.09.2018. Opposite Parties repudiated the claim on the ground that the deceased father of the Complainant was having pre-existing disease. Claiming deficiency in service on the part of the Opposite Parties, the Complainant filed a Complaint before the State Commission with the following prayer: -

i. Pay the medical expenditure to the tune of Sterling Pounds 39549.63, Sterling Pounds 3645 for Repatriation services of late father of the complainant total amounting to Rs.36,30,656/- and Rs.3,34,611, as per the prevalent exchange rate total amounting to Rs.39,65,267/-

ii. Pay compensation to the tune of Rs.10,00,000/- on account of pain, mental agony and harassment suffered by the complainant.

iii. To pay litigation cost of Rs.1,00,000/-

4. Opposite Parties contested the Complaint and took preliminary objection that the Complaint was not maintainable, as the deceased father of the Complainant obtained the Medical Insurance Policy concealing the facts regarding pre-existing disease. On merits, the Opposite Parties admitted that the father of the Complainant had taken the Policy which was valid from 05.05.2018 to 31.10.2018. Insured father of the Complainant died during the currency of the Policy on 14.09.2018. Opposite Parties repudiated the claim on the ground that the insured had supressed the material fact of pre-existing disease at the time of taking the Policy.

5. The State Commission after going through the evidence and documents on record and hearing the arguments of both the Parties directed as follows:-

“i) To pay £39,549 minus 100 USD

It is made clear that the exchange rate in rupees shall be prevailing as on the date of repudiation of claim i.e. 14.11.2018. The amount so calculated shall be paid along with interest at the rate of 9% per annum from the date of repudiation of the claim i.e. 14.11.2018 till realization.

ii) To pay Rs.50,000/- as compensation on account of mental agony and harassment.”

6. Aggrieved by the order of the State Commission, the Appellant/Insurance Company filed the present Appeal. Heard the learned Counsel for the Parties and carefully perused the record.

7. Learned Counsel for the Appellant submitted that the State Commission passed the impugned order without properly appreciating the terms and conditions of the Insurance Policy and the extent of indemnification. It was submitted that the proposal form was to be completed by the proposer and the competent Doctor was to certify that the proposer is fit to travel abroad. In the proposal form the proposer had wrongly answered the question at A2 “Have you ever suffered from any illness or disease upto the date of making this proposal” as “No.” It was further submitted that the deceased insured had also