NATIONAL INSURANCE CO. LTD. Vs. SHIVAPRABHA JAYAPRAKASH SHETTY

JUDGEMENT

(1.) Aggrieved by the order dated 20.08.2019 passed in Writ Petition No. 52434 of 2018 by the learned Single Judge in allowing the writ petition, the respondent No. 2 therein, is in appeal.

(2.) The brief facts of the case are that the respondent No. 1 along with her late husband and daughter had secured a policy from the appellant herein for a period from 29.03.2013 to 28.03.2014 under which her family was insured with regard to hospitalization expenses for an amount of Rs. 2,00,000/- each. The 1st respondent's late husband thereafter got the family insured under National Mediclaim Policy under which the 1st respondent's family was given the health insurance for an amount of Rs. 2,00,000/- each for a period from 29.03.2014 till 28.03.2015. The 1st respondent's late husband was hospitalized for a period from 01.04.2014 to 02.04.2014 and thereafter from 09.04.2014 till 09.07.2014. He was diagnosed with cysticero meningitis with arthritis. Again he was hospitalized from 24.07.2014 to 06.08.2014. The National Mediclaim policy was renewed. Again he was intermittently hospitalized. The husband of appellant No. 1 sought to enhance the sum insured. The appellant was well aware of the medical history of the patient, suggested a new policy namely National Parivar Mediclaim Plus for the period from 29.03.2016 to 28.03.2017. He availed the said policy. Accordingly, the sum insured was Rs. 15,00,000/-. The said policy was renewed for a further period of one year from 29.03.2017 to 28.03.2018.

(3.) Challenging the same, respondent No. 1 preferred Writ Petition No. 52434 of 2018. In the writ petition, the learned Single Judge concluded that the husband of petitioner has not died on account of pre-existing disease before availing the insurance policy. He has been its customer for a few years and the appellant herein was fully aware about the health condition of the husband of respondent No. 1 and has renewed the National Parivar Mediclaim Plus Insurance policy under which, the money is sought to be released. On these grounds, the writ petition was allowed and the appellant herein has been directed to reimburse a sum of Rs. 14,65,999/-.