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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
REVISION PETITION NO. 2957 OF 2012
 
(Against the Order dated 26/04/2012 in Appeal No. 1194/2008 of the State Commission Punjab)
1. REENA KANSAL
R/o 83 The Mall Civil Lines
Ludhiana
Punjab
...........Petitioner(s)
Versus 
1. UNITED INDIA INSURANCE CO. LTD. & ANR.
92, The Mall Through its Authorized Signatory
Ludhiana
Punjab
2. Paramount Health Services Pvt Ltd
New Delhi, Through its Branch,SCO 138,3rd floor, Feroze Gandhi Market
Ludhiana
Punjab
...........Respondent(s)

BEFORE: 
 HON'BLE MR. JUSTICE AJIT BHARIHOKE, PRESIDING MEMBER
 HON'BLE MRS. REKHA GUPTA, MEMBER

For the Petitioner :
Mr. J.S.Bhola. Advocate with
Mr.N.K.Choudhary, Advocate
For the Respondent :
Mr. M.N.Singh, Advocate with
Mr.Raja Ram Sethi, Branch Manager of R-1

Dated : 01 Dec 2014
ORDER

1.         This revision is directed against the order of the Punjab State Consumer Disputes Redressal Commission in First Appeal No.1194 of 2008 whereby the State Commission concurred with the decision of the District Forum Ludhiana and dismissed the appeal resulting in dismissal of the complaint of the petitioner complainant.

2.         Briefly stated facts relevant for the disposal of the revision petition are that the petitioner obtained a mediclaim policy from respondent no.1 insurance company effective for the period 19.09.2006 to 18.09.2007.  During the subsistence of the insurance policy, the petitioner underwent surgery for knee implant replacement at Beach Candy Hospital Trust Mumbai. The cost of surgery implant was Rs.6,26,062/-. The petitioner filed an insurance claim but  her claim was repudiated on the ground that petitioner obtained the insurance policy by concealment of material facts that she got one lateral total knee replacement (TKR) in the year 1990.  As such, the insurance contract having been obtained on the basis of concealment was invalid.

3.         The District Forum Ludhiana on consideration of the pleadings and evidence dismissed the consumer complaint vide order dated  04.09.2008.

4.         Aggrieved by the order of the District Forum, the petitioner approached the State Commission in appeal and the State Commission dismissed the appeal on two counts, namely, that the insurance contract was invalid because the petitioner had obtained the insurance policy by concealing the material facts relating to her previous knee transplant and secondly on the ground that she was not entitled to any claim in view of exclusion clause 4.1 of the insurance policy.

5.         Mr. J.S Bhola has assailed the impugned order on the ground that both the foras below have ignored the material factual aspects of the case. In support of this contention, learned counsel for the petitioner has drawn our attention to a letter addressed by doctor of Rapid Diagnostic Lab to the Senior Manager, United India Insurance Company informing that he has examined patient Reena Kansal 53 yrs. / F on 16.09.2003 regarding past history : knee replacement 13 years back both legs, now in left leg again.  In the aforesaid letter, it is clear that the information regarding the past knee replacement surgery undergone by the petitioner was within the knowledge of the respondent insurance company at the time of issue of first insurance policy from 19.09.2003 to 18.09.2004.  Therefore, it cannot be said that the respondent / insurance company was misled due to some incorrect information in the proposal form while issuing the mediclaim insurance policy.

6.         It is further contended that the foras below have committed an error in declining the insurance claim to the complainant in view of clause 4.1 of the latest insurance policy valid from 19.09.2006 to 18.09.2007.  It is contended that the foras below have failed to appreciate that from 2003 onwards, the petitioner was continuously renewing the mediclaim policy from year to year.   Therefore, she would be governed by the terms and conditions of the first policy under which exclus

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