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2019 Supreme(Online)(Bom) 2802

GOA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PANAJI
Mr. R. Gomes Pereira, Judge
Assumption Sebastian D'Souza v. Bharti Axa Gen. Ins. Co. Ltd.


Advocates:
For the Appellants/Petitioners: Mr. R. Gomes Pereira
For the Respondents: Mr. J. Lopes

Table of Content
1. context of the appeal related to a dismissed claim for medical treatment. (Para 1 , 2)
2. claims made regarding treatment and basis for rejection by the op. (Para 3 , 4 , 5)
3. discussion on the duty of disclosure and miscommunication by the insurer. (Para 6 , 10 , 12 , 14)
4. concluding decision of the court and implications on the claims. (Para 18)

1. This Appeal is directed against the Judgment and Order dated 20.10.2017 passed by the Consumer Disputes Redressal Forum, North Goa (the Forum, for short) in Consumer Complaint No. 50/2016. The Appellant was the Complainant and Respondent was the Opposite Party (OP, for short) in the said Complaint. Parties shall hereinafter be referred to as per their status in the said Complaint.

2. The Complainant had purchased Smart Health Insurance Policy from the OP for the period from 26.7.2013 to 25.7.2014 and the assured amount was Rs. 2,00,000/-. According to the Complainant, when the executive of the OP was filling up the proposal form, the Complainant had informed him that he had a condition of diabetes mellitus and hypertension since April 2013 and the executive informed him that he will take care to fill up all the neces

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