UNITED INDIA INSURANCE CO LTD Vs. KAPIL KUMAR

JUDGEMENT

(1.) THIS is Insurance Company's appeal against the order dated 24.6.2003 passed by the District Forum, Almora whereby the complaint of the complainant was allowed.

(2.) THE brief facts of the case are that the complainant has filed a complaint with the allegations that he had taken a mediclaim policy on 21.10.1998 for a sum of Rs.2,00,000/ - (Rupees two lakhs ). In the night of 31.5.1999/1.6.1999, he felt serious heart attack. He was hospitalized in Apollo hospital on 10.6.1999, wherein he spent a sum of Rs.1,95,000/ - (Rupees one lakh ninety -five thousand ). He has spent a total sum of Rs.2,08,939.95 (Rupees two lakhs eight thousand nine hundred thirty -nine and ninety five paise ). He lodged his claim but his claim was repudiated. He gave a registered notice. Thereafter filed a complaint for recovery of Rs.2,00,000/ - (Rupees two lakhs) as mediclaim amount and 18% interest and also any other relief which can be granted to the complainant.

(3.) THE opposite party filed written statement. The insurance is admitted. It is further alleged that the complainant is not entitled to mediclaim amount because it is his duty to prove that he was not having heart attack before 21.10.1998. The complainant did not submit consent letter for the verification of medical expenses. He has taken the bills by fraud and misrepresentation. It is alleged that in the proposal form, the complainant has given wrong information. The declaration form as given by Dr. T. C. Gaur, B. A. M. S. at the time of proposal is not duly verified and he was not an authorized doctor to give medical history. It is admitted that the complainant has submitted medical bills of Rs.1,89,000/ - (Rupees one lac eighty -nine thousand ).