IN THE DELHI STATE CONSUMER DISPUTES REDRESSAL COMMISSION Date of Institution:24.09.2020 Date of Hearing: 10.05.2023 Date of Decision: 11.10.2023 FIRST APPEAL NO. -118/2020 IN THE MATTER OF MR. RAJIV SHARMA, S/O LATE MR. P.C. SHARMA, R/O C-702, GEETANJALI APARTMENT, KARKARDOOMA, NEW DELHI-110092.

(Through: Mr. Masood Hussain, Advocate)

…Appellant VERSUS RELIGARE HEALTH INSURANCE CO. LTD., Regd. Office: D-3, P3B, District Centre, Saket, New Delhi-110017.

(Through: Mr. Sanjay K. Chadda, Advocate)

…Respondent CORAM:

HON’BLE JUSTICE SANGITA DHINGRA SEHGAL (PRESIDENT)

HON’BLE MS. PINKI, MEMBER (JUDICIAL)

HO’BLE MR. J.P. AGRAWAL, MEMBER (GENERAL)

Present: Mr. Subodh Jha, counsel for the Appellant.

None for the Respondent.

PER: HON’BLE JUSTICE SANGITA DHINGRA SEHGAL, PRESIDENT JUDGMENT

1. The brief facts of the case as per the District Commission record are:

“1. As stated the case of the complainant in nutshell is that the complainant purchased an Insurance Policy on 31.12.15 from Religare Health Insurance Company Ltd. hereinafter referred to as OP. The said policy was issued for the period from 30.12.15 to 29.12.16 and providing coverage upto Rs.8,00,000/-.

1. It is next averred that on 08.03.2016 the complainant got ill and was admitted in National Hospital Bhopal due to back and chest pain. Thereafter, he was referred to Max Hospital Saket New Delhi for further evaluation and management where he was operated on 16.03.2016 and was discharged from the hospital on 26.03.2016. Pursuant to the treatment the complainant filed the claim for medical reimbursement amounting to Rs.6.38 lakhs on 06.05.2016 along with the Hospital charges and Medicine bills. After consistent follow up, the complainant was informed by OP on 11.05.2016 that his claim has been rejected on account of non-disclosure of material facts/ pre-existing ailments at the time of proposal. It is averred that the complainant clarified to the OP that he had no pre-existing ailment or disease prior to the said treatment taken in the hospital. Despite reminders and follow-ups the claim of the complainant was finally rejected on 20.06 2016 without any reasonable ground.

2. Aggrieved, the complainant approached this Forum with the prayer that OP be directed to pay the complainant amount of Rs.6.38 lacs along with interest @18% PA from the date of due till realization and to pay a sum of Rs.1,00,000/- towards harassment and mental agony and Rs.25,000/- towards cost of litigation.”

2. The District Commission after taking into consideration the material available on record passed the order dated 06.02.2020, whereby it held as under:

“On perusal of the pleadings it is noticed that complainant has been denying the fact that he had Hypertension and Diabetes. Rather, after having received the repudiation letter from OP, complainant again stated that he had no pre-existing disease. We are of the opinion that the complainant's stand in the complaint is apparently false as during his treatment in Bhopal and Max Hospital he had himself disclosed that he had pre-existing ailments and was taking medicine for the same. Complainant in his pleadings had made false assertions and is found to be cooking up stories. The legal notice sent by the complainant through his counsel also states that he was neither suffering from hypertension nor and diabetes.

Further in rejoinder the complainant has stated that he signed a blank proposal form which was subsequently filled up by Executive of OP. This Forum is the opinion that the complainant is trying to wriggle out of the signed contract by saying that he had left it blank. No prudent man would sign blank documents. By leaving the document blank he has given an authority to OP to fill in the blanks and by signing the documents, he is now bound by the contract arrived at.

There is no denying the fact that the Contracts of Insurance is contract of Uberrimaefidei, and by not declaring correct and accurate information even when it is specifically asked complainant is guilty