ORIENTAL INSURANCE COMPANY LTD Vs. SUNIL KUMAR SHARMA

JUDGEMENT

(1.) PRESIDING MemberThis appeal arises out of order dated31.7.2002 passed by the District Consumer Forum (DCF), Sirohi whereby the Appellants have been directed to pay to the Complainant a sum of Rs. 1,45,291 which were spent on his treatment and further to pay interest @ 12% per annum from 19.5.1997 and Rs. 2,000 as cost of litigation.

(2.) THERE is no dispute on this point that the Complainant had purchased a Mediclaim Policy for the period from 21.12.1996 to 20.12.1997. In January, 1997, he fell ill and contacted Medical Officer at Palanpur who referred him to Sir Hurkisondas Nurrotumdas Hospital and Research Centre (SHNHRC), Mumbai where his urine and blood were tested and on the basis of report, kidney transplantation was advised. The Complainant got his kidney transplanted and spent the above amount on his treatment. He submitted his mediclaim but the claim was denied on the ground that he had been suffering from hypertension for the last two years which fact had not been disclosed in the proposal form submitted by him. As per the Insurance Co., the hypertension could be the cause of the Chronic Renal Failure (CRF) for which the claim was submitted.

(3.) THE question for consideration is whether the denial of the claim by the Insurance Co. is justified or not. The learned Counsel for the Appellants submitted that the CRF does not occur in a short period. Chronic means that the disease had been inexistence since long. The policy was obtained on 21.12.1996 and immediately after obtaining the policy in the month of January, he fell ill and was referred to a Hospital in Mumbai. His urine and blood reports dated 15.1.1997 indicate that it was a case of renal failure and required kidney transplantation, As per the learned Counsel, all these facts narrated above go to show that the disease the Complainant was suffering from, was pre -existing at the time of taking the policy and therefore as per the terms and conditions of the policy, the claim was not allowable.