NEW INDIA ASSURANCE COMPANY LIMITED Vs. ASMA KHATOON

JUDGEMENT

(1.) BEING aggrieved by the order dated 27.7.2001 made by the Sundargarh II, Rourkela District Forum directing the appellant to pay to the respondent a sum of Rs. 1,20,313 with a default clause to pay interest at the rate of 14 per cent per annum, it has filed this appeal.

(2.) THE respondent is the widow of Md. Samsul Haque who was a practising lawyer in Rourkela Bar. During his lifetime he made a medi -claim policy under the scheme floated by the appellant. The risk was covered for the period from 13.2.1995 to 12.2.1996. He had gone to Hyderabad to attend a marriage ceremony. As he developed heart problem there, he took admission in Appolo Hospital at Hyderabad. During his treatment from 18.2.1995 to 10.3.1995 he incurred expenses amounting to Rs. 1,20,313. After he came to Rourkela he informed the appellant regarding the treatment he underwent at Hyderabad and asked for payment under the medi -claim policy. At this stage he suffered from Hepatitis -B and while undergoing treatment for it he died on 16.6.1995. The respondent being the nominee of her husband submitted the claim with relevant documents but after lapse of three years the claim was repudiated on the ground of non -disclosure of material fact regarding the health condition at the time of signing the proposal. Being aggrieved by the said decision the respondent filed the complaint.

(3.) THE appellant in its written version admitted issue of medi -claim policy which was valid for the period from 13.2.1995 to 12.2.1996. As the claim was an early one, it was investigated and it was found that the deceased was suffering from hypertension since last five years and diabetes mellitus since last 12 years. But this fact was not disclosed in the proposal submitted by him and under Clause 4(2) of the exclusion of policy, the claim is not entertainable.