NATIONAL INSURANCE COMPANY LIMITED Vs. SURAJ PARKASH

JUDGEMENT

(1.) BRIEF facts giving rise to the present appeal may be noticed.

(2.) RESPONDENT -complainant had purchased a Medi -claim Insurance Policy from the appellant -Insurance Company in the sum of Rs. 1,00,000/ - on 18.10.2000 for a period of one year. He approached Batra Hospital and Medical Research Centre, New Delhi for checkup on 19.2.2001. He was admitted there on 23rd of February, 2001 and was diagnosed as having disease known as Aorto Occlusive Disease. Since there was blockage in the arteries his bye -pass surgery was done on 26.2.2001 and was discharged on 9.3.2001. He was again admitted on 19.3.2001 for treatment of bedsore and discharged on 23.3.2001. He lodged his Medi -claim with the Insurance Company But the same was repudiated on the ground that the complainant was suffering from pre -existing disease, which he had not disclosed in the proposal form. This led the complainant to approach the District Forum, which vide the impugned order dated 22.12.2004 accepted the complaint and granted the following relief:

(3.) THE same arguments, which were addressed before the District Forum on behalf of the Insurance Company have been addressed before us. Learned Counsel submitted that the respondent, as per the discharge report from the Batra Hospital, was suffering from bilateral calf claudication, which had been progressively worsening. The doctor whose opinion was later on taken by the Insurance Company (Dr. N.P. Singh) also opined that the patient might have been suffering. This report was again based on the discharge report of Batra Hospital. From the above the learned Counsel for the appellant argued that the complainant knew about the pre -existing disease when he took the Medi -claim policy.