NEW INDIA ASSURANCE CO LTD Vs. RUBI PURI

JUDGEMENT

(1.) THIS appeal arises out of order dated 25.7.2005 passed by the District Consumer Forum (DCF), Ajmer wherey the complaint was allowed in the manner that the Assurance Co. was directed to pay to the Complainant a sum of Rs. 88,880 with interest @ 9% per annum along with Rs. 1,000 as cost of litigation.

(2.) IT was a Mediclaim Policy under which a claim was filed but the amount has not been paid on the ground that the disease for which the treatment was taken pre -existed before taking the policy and therefore as per Clause 4.1 of the policy, the claim was not payable.

(3.) AFTER hearing both the parties, we feel that the matter needs to be remanded back to the learned DCF. It was to be seen whether the disease for which the treatment was taken was pre -existing or not at the time when the policy was obtained. The learned DCF has misdirected itself, only coming to this conclusion that there was no evidence to show that the insured had suppressed material facts from the Assurance Co. at the time - of taking the policy. The question was not whether there was suppression of material fact or not out the question for consideration was whether the disease was preexisting or not. The learned DCF has not addressed itself to the main issue whether the disease was already existing or not.