HARI OM AGARWAL Vs. ORIENTAL INSURANCE CO LTD

JUDGEMENT

(1.) THE petitioner seeks appropriate directions to the respondent (hereinafter called 'the insurer')to reimburse the expenses incurred by him for his medical treatment, in accordance with the policy of insurance (hereinafter called 'mediclaim' ).

(2.) THE respondent is in the business of insurance. The petitioner is a chartered accountant by profession. He was retained for the job carrying auditing the respondent's Division Office No. 7, Delhi. At that time, i. e. , May 2001 the insurer's agents/ employees allegedly represented to petitioner that he should take an individual mediclaim policy to cover his health. On a pointed query from petitioner that, if he could be insured, as he was a diabetic, a hypertensive and had undergone a cataract operation of an eye, he was assured by respondent's representative that he would be eligible for such a policy and that he had to furnish complete details of the medication being undergone by him at that point of time.

(3.) THE petitioner filled up the proposal form, underwent the necessary medical tests suggested by the respondent and fully disclosed his existing medical condition. An ECG was also conducted, as required, on 3. 5. 2001 and supplied to the respondent. The said ECG showed 'nad' in the heart condition. After satisfying itself as to the insurable interest of the petitioner, individual mediclaim policy No. 2002/34 was issued to him effective from 10. 5. 2001. No claim was under the said policy, it was renewed w. e. f. 10. 5. 2002 through policy No. 2003/31. No claim was preferred against the said policy also. Again the cover was renewed effective from 10. 5. 2003 through the policy No. 2004/17. Yet again it was extended w. e. f. 10. 5. 2004 by policy No. 2005/30. No claim was made against this policy too. Finally the policy was extended for the period 10. 5. 2005 to 9. 5. 2006 through policy No. 2006/44. This policy carried a cumulative bonus of 15 per cent due to 'no claim' against for the previous four years. The sum insured against the said policy was Rs. 2,30,000 inclusive of the bonus.