NEW INDIA ASSURANCE CO LTD Vs. VISHWANATH MANGLUNIA

JUDGEMENT

(1.) The plea advanced by the present petitioner/New India Assurance Company Limited before the Consumer Disputes Redressal Forum-II, Jaipur (District Forum for short) in their written submissions to the complaint and also in appeal before the Rajasthan State Consumer Disputes Redressal Commission, Jaipur (State Commission for short) that the claim of the respondent has been rightly repudiated as the diseases were pre-existing, has been rejected by both the fora below, resulting in the passing of a concurrent order vide which the petitioner/opposite party/New India Assurance Company Limited has been directed to pay a sum of Rs.1,00,000/- to the respondent/complainant within two months from the date of the order and in default the said amount shall carry interest @ 9% per annum from the date of the order till realization, besides a sum of Rs.5000/- as compensation for mental agony and Rs.1000/- for cost of litigation.

(2.) The facts of the case in nutshell are that the respondent/complainant has been purchasing mediclaim policy from the petitioner/New India Assurance Company Limited from time to time. His first mediclaim policy covered his entire family, which included his wife, two sons, one daughter-in-law and a grandson for varying amounts, initially for the period from 14.09.1999 to 13.09.2000. This was renewed only for a year upto 13.09.2001. Yet, the respondent/complainant is alleged to have obtained another mediclaim policy covering the period from 17.01.2001 to 16.01.2002 after submitting a fresh proposal. After expiry of this policy, he again obtained another medicalim policy on 15.01.2003 for the period from 17.01.2003 to 16.01.2004. While in all the earlier policies the sum insured for himself was only for Rs.25,000/-, in the policy obtained for the period from 17.01.2003 to 16.01.2004 the sum insured was increased abruptly to Rs.1,00,000/- for the respondent/complainant without any change in respect of the other family members, which continued to remain at the earlier level of Rs.25,000/Rs.15,000. Since the respondent/complainant had undergone Coronary Artery Bypass Graft (CABG) within 40 days of obtaining the last mediclaim policy, enhancing the amount of insurance, the petitioner/New India Assurance Company Limited got the claim investigated and found that the respondent/complainant had deliberately failed to disclose that he had a medical history of suffering from Hypertension and Ischaemic Heart Disease (IHD) for a number of years. In particular, he had suppressed the fact that he was admitted into Saket Hospital at Jaipur for the period from 20.06.2002 to 22.06.2002. The hospital records revealed that he was suffering from Coronary Artery Disease (CAD), particularly, Antero-Septal Myocardial Infarction (Ant.-Septal MI) with Hypertension Stage-Iic and Left Bundle Branch Block (LBBB). Again he had been admitted in Tongia Heart & General Hospital, Jaipur on 08.07.2002 and was found to be suffering from IHD with unstable angina. These facts, however, were suppressed from the petitioner/New India Assurance Company Limited at the time of obtaining the last mediclaim policy covering the period from 17.01.2003 to 16.01.2004.

(3.) The District Forum, however, rejected the plea of the petitioner/New India Assurance Company Limited that there was any suppression of material fact as the ailments suffered by the respondent/complainant were totally new and were not related to pre-existing diseases. The District Forum also held that the respondent/complainant was not aware of any such disease at the time of obtaining the policy. This view was upheld by the State Commission. It was in this background that the petitioner/New India Assurance Company Limited is before is in revision petition.