STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARAKHAND, DEHRADUN The New India Assurance Company Limited Branch Office: Khuran Building, Nainital Road, Haldwani Divisional Office: Opposite Judges Court, Nainital Road, Haldwani Through Regional Office The New India Assurance Company Limited Gulfam House, 8/6-7, Asltey Hall, Dehradun ……Appellant / Opposite Parties Versus Sh. Vijay Kumar Trehan C/o S.N.T. Plywood Industries Village Chakarpur, Tehsil Gadarpur Udhamsingh Nagar ….…Respondent / Complainant Sh. R.K. Garg, Learned Counsel for the Appellant None for Respondent Coram: Ms. Kumkum Rani, Judicial Member II Mr. Bhagwat Singh Manral, Member Dated: 27/04/2022

ORDER

(Per: Ms. Kumkum Rani, Judicial Member II):

This appeal has been directed against the impugned judgment dated

22.02.2012 passed by the learned District Consumer Forum (now District Commission), Udham Singh Nagar in consumer complaint No. 35 of 2007 styled as Sh. Vijay Kumar Trehan vs. The New India Assurance Co. Ltd. and another, wherein and whereby the complaint was allowed directing the opposite parties (insurance company) to pay the insured amount to the complainant within a month from the date of judgment alongwith costs of litigation Rs. 2,500/-.

Revision Petition No. 16 / 2019

2. The facts giving rise to the appeal in hand, in brief, are as such that the respondent – complainant has filed a consumer complaint before the District Commission, Udham Singh Nagar alleging that the respondent purchased a medi-claim policy from the National Insurance Company Limited for the first time in the year 1994-95; continued till 2004-05 with the said company, but subsequently in the year 2005, the complainant had taken the Hospitalisation and Domiciliary Hospitalisation Benefit Policy from the appellant - The New India Assurance Company Limited on 16.02.2005 for himself and his wife Smt. Sudha Trehan for insured amount of Rs. 3,00,000/- (Rupees Three Lacs only) each, which was valid till 15.02.2006. The respondent was admitted in Escorts Artery Bypass Institute & Research Centre, New Delhi for Coronary Artery Bypass and was discharged on 16.04.2005; thereafter the respondent lodged the claim with the appellant for reimbursement of the expenses incurred by him in his treatment, but the claim was not settled by the appellant, hence, the complaint was filed before the District Commission, Udham Singh Nagar to grant the relief prayed in the complaint herein. The opposite parties has conceded that the respondent has purchased a medi-claim policy ‘Hospitalisation and Domiciliary Hospitalisation Benefit Policy’ from the appellant for himself and his wife for insured amount of Rs. 3,00,000/- each. It is also admitted fact that the above policy was valid till 15.02.2006. 3. In the written statement, the appellant has averred that at the time of taking the policy on 14.02.2005, respondent has concealed and suppressed the material fact about his illness that he was suffering from pre-existing disease, which he intentionally did not disclose. It is also averred in the written statement that the policies which he mentioned in the complaint were not purchased from the appellant and the allegations of the complainant are incorrect that he purchased the medi-claim policy continuously since 1993-94 without any discontinuity. It is further averred in the written statement that the complainant has purchased the policy first time from the appellant on 14.02.2005 concealing the fact of his illness, thereby he has breached the terms and conditions of the insurance policy; as per the terms and conditions, the pre-existing disease before purchasing the insurance policy, cannot be indemnified, therefore, the complaint of the complainant is liable to be dismissed.

4. After hearing both the parties, the District Commission has allowed the consumer complaint on 22.02.2012 and cancelled the repudiation letter of the appellant company directing the appellant company to settle the claim of the complainant and