NATIONAL INSURANCE COMPANY LIMITED Vs. MIMMI DEVI

JUDGEMENT

(1.) Appellant is aggrieved by the order dated 24.07.2013, of learned District Consumer Disputes Redressal Forum, Shimla, whereby a complaint, under Section 12 of the Consumer Protection Act, 1986, filed against it, by respondent -Mimmi Devi, has been allowed and a direction given to it (the appellant) to pay a sum of Rs.1,38,818/ -, with interest at the rate of 9% per annum, on account of insurance money and also to pay Rs.5,000/ -, as litigation expenses.

(2.) Respondent -Mimmi Devi, purchased a medi -claim policy from the appellant, insuring her own health, in March, 2006. Policy was renewed in March, 2007, for a further period of one year, on payment of requisite premium. When the policy was in force, respondent had some gynae problem. She visited Fortis Hospital at Mohali, where she was admitted on 29.01.2008 and operated upon for uterine prolapse. A sum of Rs.1,00,896/ -, was spent on her treatment during the period, she remained admitted to Fortis Hospital, Mohali. In addition, she alleged to have spent a sum of Rs.38,000/ - approximately, as an outdoor patient. She lodged a claim with the appellant for reimbursement of the amount, incurred by her on the treatment for aforesaid ailment.

(3.) Claim was repudiated on the ground that she was having the disease, for which treatment was taken at Fortis Hospital, Mohali, prior to the purchase of insurance policy, and this fact had not been disclosed by her, while seeking the insurance. She, therefore, filed a complaint, under Section 12 of the Consumer Protection Act, 1986, seeking a direction to the respondent to pay insurance money and also to pay damages for wrongful repudiation of the claim.