Lifestyle diseases cannot lead to repudiation of insurance claims if not proven pre-existing.

1. The facts of the case necessary as per the District Commission record are:
The complainant had a Mediclaim policy from 28.2.2004 to 27.2.2005, sold by OP. On 24.6.2004 the complainant experienced pain in chest and remained admitted in Escorts Hospital from 24.6.2004 to 30.6.2004, where he had undergone Angioplasty and Stenting, by incurring Rs. 3,20,126 on the treatment. He presented the claim to OP. It is alleged that the claim was repudiated on the basis that complainant, as per record was a case of Diabetic for last 15-20 years, and that was a cause of Coronary Artery Disease. It is stated by complainant that, in fact he had been suffering from Diabetic only for 2-3 years, and not since past 20 years. He took up the matter in office of Escorts Hospital about erroneous recording of ailment by the doctor, in 20 years, as against record 2-3 years. The OP - 3 demanded an affidavit, which was given by complainant. On this basis OP - 3 issued a certificate Annexure C - 6, dated 17.2.2005, stating that mentioned 20 years be read as 2-3 years. The OP still repudiated the claim, vide Annexure C - 10.
The Escorts Hospital, OP - 3 filed its affidavit, with records mentioned in the Hospital OPD, and Consulting doctor, and explained that it had mentioned DM from 15 years on the basis of cardiac claim Record, prepared on the basis of information given by complainant. The OP rejected the correction of records on the basis of affidavit of complainant as an after thought.

2. The District Forum after taking into consideration the material available on record passed the order dated 14.12.2012, whereby it held as under:
We have considered the affidavit of Doctor of Escorts Hospital and records of Cardiac clinic and other records maintained in Hospital, prepared on the basis of information given by patient or attendants. In all these records, the diabetes is mentioned for 15-20 years. In our considered view, such records prepared at a time much before the dispute arose has its own weightage and cannot be brushed aside on affidavit of person who gave earlier statement, when there was no dispute. This is evidence under S.6 and S.8 of the Evidence Act, and relevant and admissible. In our considered view, this operates as admission of complainant and estoppel, and cannot be retracted by affidavit which is self - serving. The repudiating of the claim in such circumstances in our view, OP has committed no deficiency.

3. Aggrieved by the aforesaid order of the District Commission, the Appellant / Complainant has preferred the present appeal contending that the District Commission failed to appreciate the documents produced before the commission. The Appellant further submitted that the respondent company is not justified in repudiating the claim of the Appellant on the basis of pre existing disease. Pressing the aforesaid contentions, the Appellant prayed for setting aside the order of the District Forum.

4. The Respondent, on the other hand, denied all the allegations of the Appellant and submitted that there is no error in the impugned order as the entire material available on record was properly scrutinized before passing the said order.

5. We have perused the Appeal, Reply of the Respondent and Impugned Order.

6. The main question of consideration before us is whether the Respondents are justified in repudiating the claim of the Appellant on the ground that the Appellant had suffered from pre - existing disease while getting insured against the said policy.

7. P