ORIENTAL INSURANCE CO. LTD. Vs. MOHINDER SINGH

JUDGEMENT

(1.) RESPONDENT obtained medi -claim policy from the appellant which was effective from 10.7.2000 to 9.7.2001 for a sum of Rs. 1,00,000. On 22.10.2000 i.e. after three months, respondent felt some chest pain in his both arms, he was immediately taken to Sir Ganga Ram Hospital where angioplasty was carried out on left artery and stent was placed. He was discharged on 24.10.2000. Admittedly he incurred expenses of Rs. 1,34,148 and after discharge he filed the claim for reimbursement of the insurance amount. The claim was repudiated on the ground of concealment of factum of pre -existing disease for which he had taken treatment hardly 20 days before the taking of policy. Consequently he filed the instant complaint before District Forum.

(2.) VIDE impugned order dated 7.1.2008, the District Forum held the repudiation of the claim as unjustified and without any basis. The District Forum allowed the complaint by giving following directions to the appellant: (i) To pay a sum of Rs. 1,00,000 with interest @ 9% per annum from 15.3.2001 date of repudiation till date. (ii) To pay a sum of Rs. 5,000 as compensation to the complainant. (iii) To also pay a sum of Rs. 2,000 as cost of litigation to the complainant.

(3.) THROUGH this appeal, the finding of fact returned by the District Forum that it was not a case of concealment of disease nor did the respondent suffer from any disease has been challenged much less the heart disease. Impugned order shows that the respondent referred to report of National Heart Institute, where he undertook TMT Test on 1.8.2000. The report showed negative effect. The report diagnosed uneasiness due to Dyspepsia which is result of indigestion. Doctor of National Heart Institute prescribed Pentacid tablet which is an anti -acidity tablets.