IN THE HIGH COURT OF PUNJAB AND HARYANA AT CHANDIGARH

121 CWP-34766-2024 (O&M)

Date of decision : 03.03.2025 Bajaj Allianz General Insurance Company Limited ...Petitioner Versus Kashmir Singh Gill and another .. Respondents CORAM : HON'BLE MR. JUSTICE ANUPINDER SINGH GREWAL HON'BLE MR. JUSTICE DEEPAK MANCHANDA Present:- Mr. Sandeep Suri, Advocate for the petitioner.

***

Anupinder Singh Grewal, J. (Oral)

The petitioner-Insurance Company has challenged the order dated

30.09.2024 (Annexure P-1) of the National Consumer Disputes Redressal Commission (for short ‘National Commission’) whereby the appeal preferred by the respondent No.1-complainant challenging the order dated 01.09.2016 (Annexure P-3) of the State Consumer Disputes Redressal Commission (for short ‘State Commission’) has been allowed.

2. Learned counsel for the petitioner-Insurance Company submits that the respondent No.1-complainant had purchased a Mediclaim Travel Insurance Policy (hereinafter referred to as Policy) having validity from 17.08.2013 to 14.11.2013 from the petitioner-Insurance Company and the same was extended for a further period of two months i.e., from 15.11.2013 to 13.01.2014. He then bought a similar policy for the period 20.06.2014 to 21.09.2014 after payment of the premium of Rs.13,693/-. After due medical examination was carried out by the panel of doctors of the petitioner-Insurance Company, the respondent No.1- complainant was declared fit. The respondent No.1-complainant extended his stay in the USA and had sought extension of the above policy. The extension was granted and the policy extended for the period from 23.09.2014 to 27.10.2014. He also submits that the respondent No.1-complainant was suffering from a pre- existing disease of ‘Haematuria’ which he had not disclosed at the time of submitting the proposal form, although, he ought to have disclosed his pre-existing ailment at the time of renewal of the policy on 23.09.2014 as he had become aware of this medical condition on 20/21.09.2014. In support of his submissions, learned counsel for the petitioner-Insurance Company has relied upon the judgment of the Supreme Court in case of Biman Krishna Bose vs. United India Insurance Co.

Ltd. And another, (2001) 6 SCC 477.

3. Heard.

4. The respondent No.1-complainant who was then aged about 72 years, had obtained a travel insurance policy from the petitioner-Insurance Company for the period of his travel to the United States of America. He had obtained the insurance policy on 17.08.2013 under the nomenclature “Travel Super Age Elite- US$50000”, and it was renewed several times. However, a fresh policy under the same nomenclature was obtained by the respondent No.1-complainant on 24.06.2014 which was valid only upto 21.09.2014 and thereafter, it was renewed on 23.09.2014 extending it till 27.10.2014. During his travel abroad, the respondent No.1-complainant is stated to have developed a medical condition. On 25.09.2014, he had approached the Fairfield Urgent Care Centre, and from there he was referred to the Emergency Department of Bridgeport Hospital, Bridgeport, Connecticut, USA. Although, in the medical reports the diagnosis is stated to be ‘Hematuria, Gross’ but no medicines were prescribed for its treatment. He had incurred medical expenses of $11,516 during the hospital visits and therefore, submitted a claim for reimbursement of these expenses. The claim of the respondent No.1-complainant was rejected by the petitioner-Insurance Company by its letter dated 27.02.2015 (Annexure P-8) in view of the exclusion stipulated in Clause 2.4 of the Policy. The ground taken in the letter is reproduced below:

“...You have lodged a claim for medical expenses incurred towards Hematuria. As per received medical records you are known to be suffering from prostatic. Hypertrophy and you had suffered from similar complaints last year. Policy incepted on 23^rd September, 2014 and started with treatment for hematuria from 25^th September, 2014. You are suffering from H