COURT NO: 03 Appeal No. 892 of 2018

1. Dhanak Soni Ranjitbhai K.

2. Dhanak Soni Disha R. A/16, Madhuram Duplex, Daxini Cross Road, Maninagar, Ahmedabad- 380008. ...Appellants.

V.s

1. Religare Health Insurance Co. Ltd.

B/305-306, Shivalik Plaza, Opp. AMA, Above Jai Hind Sweet Mart, IIM Road, Panjarapol, Ahmedabad-380009.

2. Religare Health Insurance Co. LTD.

Vipul Tech Squere, Tower-C, 3^rd Floor, Sector- 43, Golf Course Road, Gurgaon- 122009. …Respondents.

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BEFORE: Mr. I. D. Patel, Judicial Member.

APPERANCE: A. M. Dave, Ld. Advocate for the appellants.

S. S. Parekh, Ld. Advocate for the respondents.

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ORDER BY Mr. I. D. PATEL, JUDICIAL MEMBER.

1. The appellants/original complainant has preferred the present appeal as per the provisions of Section 15 of the Consumer Protection Act 1986 against the impugned order of Consumer Complaint No. 532/2017 passed by the Ld. Consumer Disputes Redressal Forum, Ahmedabad City (Additional), vide order dated 08.08.2018 on the ground stated in the appeal memo. The appellant is original complainant where as the respondent is the original opponent in this appeal. Hence for the sake of the convenience, parties are hereinafter referred to by their original nomenclature/status.

2. That it is the case of the complainants that they had taken mediclaim insurance policy, from 2012-13 to 2016-17 from the United India Insurance Company and at the time of renewal of the said United India Mediclaim Policy the complainant switch over their mediclaim policy as a Portability Policy with of accrued earlier benefits from United India Insurance Company from Religare Health Insurance Company for the period of 13.01.2017 to 12.01.2018 for the sum insured of 3,00,000/-.

3. It is further the case of the complainant that during the said year of the policy complainant consulted Dr. Falguni Vora, for the complainant No. 2 Dhanak Soni Disha R. for fever and abdomen pain and admitted in the Shlok hospital from 23.03.2017 to 27.03.2017 and during the said hospitalization complainant No. 2 diagnosed with Spesis, UTI, Urinary Track Infection and Left Phelone Phritis and for the said treatment complainants spent Rs. 22,649.67/- therefore, the lodged the claim with the opponent Insurance Company but opponent Insurance Company vide letter dated 30.05.2017 repudiated the claim of the complainant on the ground of suppression of Pre-existing disease and therefore, the complainant filed the complaint against the opponent Insurance Company and claim relief as mentioned in the complaint.

4. The opponent insurance company has appeared before the Ld. District Forum, and resisted the allegations made by the complainant in the complaint for deficiency in service and unfair trade practice of opponent insurance company. Furthermore, opponent insurance company has also justified the ground stated in the repudiation letter and contended that since the complainant had suppress the Pre-existing disease of Urinary Track Infection (UTI) in the new proposal form submitted with the opponent insurance company and therefore, the insurance company has rightly repudiated the claim of the complainant for violation of 7.1 Terms and Conditions Clause of the insurance policy and therefore, the insurance company prays for the dismissal of the complaint filed by the complainant.

5. After hearing the Ld. Advocate of the parties and after perusing the material on record the Ld. District Forum, Ahmedabad city (Additional), had dismissed the complaint filed by the complainant therefore, being aggrieved and dissatisfied by the said impugned order passed by the Ld. Consumer Disputes Redressal Forum, Ahmedabad City(Additional), the appellant/original complainant has filed the pre