ORIENTAL INSURANCE COMPANY LTD Vs. RAJIV BHADANI

JUDGEMENT

(1.) This revision petition has been filed by the Oriental Insurance Company Ltd., (hereinafter referred to as Petitioner ) against the order of the Bihar State Consumer Disputes Redressal Commission, Patna (in short the State Commission ), whereby the appeal of Shri Rajiv Bhadani (hereinafter referred to as Respondent ) was allowed.

(2.) The brief facts of the case are that the Respondent took a medi-claim policy for the period 09.04.2002 to 08.04.2003. On 11.04.2002, while the Respondent was in Calcutta, he felt uneasiness coupled with chest pain. Therefore, he consulted a doctor who advised him to consult a heart specialist Dr Ashok Dhar at Surakasha Nursing Home. Tests were conducted at the Nursing Home. On the advice of Dr Dhar, the Respondent under went Coronary Angiography/ Angioplasty on 15.04.2002 and was under treatment in that Nursing Home till 25.04.2002. On his return to Gaya on 26.04.2004, Respondent informed the Petitioner about his treatment at Calcutta vide letter dated 28.04.2002 and thereafter he filed a claim on 21.06.2002. The Petitioner repudiated the claim on the grounds that as per exclusion clause 4.2 and 4.3 of the Insurance Policy any medical treatment/ hospitalization claim made within 30 days of the commencement of the policy is not maintainable. In the instant case, the claim was made for treatment only five days after the medi-claim policy was taken by the Respondent.

(3.) Aggrieved by the repudiation of his claim, the Respondent filed a complaint before the District Forum which dismissed the complaint and concluded that the Respondent/ complainant s case is hit by the exclusion clause and therefore, the claim was rightly repudiated.