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A. C. RAVAL
Oriental Insurance Company Ltd. – Appellant
Versus
Patel Hiral Raghunath – Respondent
ORDER
A.C. Raval, Presiding Member—The appellants – original respondents have filed this appeal under section 15 of the consumer protection Act being aggrieved by and dissatisfied with the order dated 07.10.2015 passed by the learned District Consumer Disputes Redressal Forum, Ahmedabad City (hereinafter referred to as “learned District Forum”) in Consumer Complaint No.13 of 2015.
2. Heard learned advocate Mr. N.M. Shinroja for the appellants – original respondents and also heard learned advocate Mr. R.U. Nahar for the opponents – original complainant.
Facts of the case:
3. It is the case of the complainant that complainant no.2, who is the father of complainant no.1, has taken the mediclaim policy from the Oriental Insurance Company on 14.11.2005. It is continuously renewed till 2008-09 without any break. Thereafter, complainant no.1 became major and policy was taken in his name for the period from 14.11.2009 to 13.11.2010 insured with United India Insurance Company Ltd. In the said policy, renewal number is mentioned of the previous insurance company’s policy. Thereafter, policy was renewed with the Oriental Insurance Company Ltd., for the period from 14.11.2010 to 19.11.2011. Th
Existence of Disease – There is no reason for the insurance company to connect the existence of diabetes with the disease for which treatment has been taken.
Medically examined - insurance company has not submitted any such document of any such doctor, who has ever medically examined the insured and prescribed the medicine of diabetic disease during such ....
(1) Health Insurance Policy [Mediclaim Policy] – Repudiation based on exclusion clause which was not communicated to insured can never be pressed into service to deprive insured from claiming relief.....
Insurance Policy must be read holistically so as to give effect to reasonable expectations of all parties including insured & beneficiaries.
(1) Insurance – A contract of insurance is one of utmost good faith. (2) Proposer – Proposer who seeks to obtain a policy of life insurance is duty bound to disclose all material facts bearing upon t....
(1) Significance of Policy Documentation – Policy documents issued by the appellant contained a “dash” in the column for pre-existing diseases. This serves as an admission by the insurer that no such....
(1) Proof of delivery - In the absence of proof of delivery, therefore, Commission cannot rely solely on the Respondent’s statement before the District Commission that it had duly supplied the terms ....
Medical Examination – Insurance company is responsible for conducting a medical examination of the policyholder in advance.
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