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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
AVM J. RAJENDRA, PRESIDING MEMBER, MR. ANOQP KUMAR MENDIRATTA, MEMBER
Kodali Gopala Krishna – Appellant
Versus
The Oriental Insurance Company Ltd. – Respondent
| Table of Content |
|---|
| 1. claim for reimbursement of medical treatment under overseas policy. (Para 1 , 2 , 3) |
| 2. assertions of insurer regarding pre-existing conditions withheld by the insured. (Para 4 , 5 , 6) |
| 3. insurance duty of utmost good faith and implications of non-disclosure. (Para 8 , 10 , 11 , 12 , 13 , 16) |
| 4. court upheld insurer's repudiation of claim based on prior undisclosed medical history. (Para 19 , 20) |
ORDER
1. Aggrieved against the repudiation of claim for sum of 4,76,715.02 U.S. Dollars (Rs.3,24,37,263/- in Indian currency), by the opposite party/lnsurance Company, in respect of medical treatment undertaken by the complainant under mediclaim policy at US, complaint has been preferred under Section 21 (a)(i) of the Consumer Protection Act, 1986
2. In brief, complainant had been obtaining health insurance policies from Oriental Insurance Company Ltd. (opposite parties) since 2000, and an 'Overseas Mediclaim Business and Health Policy’ was obtained on 14.12.2016 for travelling to USA from 18.12.2016 to midnight of 14.01.2017, by paying a premium of Rs.2494/-. During the currency of the policy on 07.01.2017 complainant developed cardiac palpitations and was rushed to Alexi
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