TIRATH DASS Vs. NEW INDIA ASSURANCE CO LTD

JUDGEMENT

(1.) APPELLANT has directed this appeal against impugned order dated 5.12.2001 passed by District Forum whereby his claim against mediclaim policy was rejected on the ground that he gave false information that the disease for which he got the treatment was not pre -existing.

(2.) RELEVANT facts, in brief, are that the appellant obtained a Medical Policy on 10.6.1998 for a period of one year from the respondent Insurance Company and after two months of taking the insurance policy, the appellant started developing some pain in the Hip and contacted Dr. B.P. Sood, who advised some medicines and admission. He remained under treatment upto 12th November, 1998 without any improvement and was referred for check up to Sant Parmanand Hospital. On 29.11.1998 he was examined by Dr. Shekhar Aggarwal, who diagnosed that the appellant was suffering with pain in the left hip for the last two months which had started incidiously. There was no history of trauma and infection. Subsequently operation was performed and cemented total hip replacement was done on 30.11.1998. He was discharged from the hospital on 6.12.1998 with follow up treatment.

(3.) RESPONDENT company was informed about the hospitalization and a claim as to the expenses incurred by the appellant amounting to Rs. 99,166/ - was filed vide letter dated 28.5.1999. The appellant visited the office of the respondent many times but his claim was not allowed on the ground that at the time of obtaining the mediclaim insurance policy, he was suffering from the disease in the past for which false and wrong declaration was made as he was under the treatment of Dr. B.P. Sood and was referred to another Doctor Dr. Shekhar Aggarwal, a qualified orthopedician who noted that the ailment of the appellant was about two years old.