NATIONAL INSURANCE CO.LTD. Vs. V.G.DHANAPALAN

JUDGEMENT

(1.) THE above appeal is preferred from the order dated 11th March 2004 passed by CDRF, Alappuzha in OP No. A 256 of 2002. The complaint therein was filed by the respondent as complainant against the appellant/opposite party, claiming the insurance amount under A1 medi -claim policy. The complainant alleged deficiency in service on the part of the opposite party/insurance company in repudiating the claim made under the medi -claim policy. The opposite party/ insurance company entered appearance and contended that they repudiated the claim on valid grounds and that there was no deficiency in service in repudiating the medi -claim. The Forum below on an appreciation of the evidence upheld the case of the complainant that there was deficiency in service on the part of the opposite party in repudiating the claim. Thereby the impugned order was passed directing the opposite party to pay an amount of Rs.65,518.28 with interest at 10% per annum from the date of the complaint with cost of Rs. 400. Aggrieved by the said order the present appeal is preferred by the opposite party insurance company.

(2.) THE learned counsel for the appellant/ opposite party submitted his arguments based on the grounds urged in the memorandum of the present appeal. He much relied on Ex B4 discharge summary dated 15.10.2001 issued from Amritha Institute of Medical Science and Research Centre and argued for the position that the complainant insured suppressed material facts regarding pre -existing disease. Thus, the appellant justified its action in repudiating the insurance claim. On the other hand, the respondent/complainant supported the findings and conclusions of the Forum below. He canvassed for the position that there was no suppression of material facts and that there was no pre -excising disease as contended by the opposite party/insurance company. He also relied on Ex B3 medical certificate issued by the doctors attached to Amritha Institute of Medical Science and Research Centre and pointed out that the complainant as patient had no information about his illness of coronary artery disease and pheripheral vascular disease before his admission at Amritha Institute of Medical Science and Research Centre. Thus, the respondent/complainant prayed for dismissal of the present appeal.

(3.) THE points that arise for consideration are: