NATIONAL INSURANCE CO. LTD. Vs. AMARESH MISHRA

JUDGEMENT

(1.) Arguments are heard in this matter. It is argued by the petitioner that procedure of LSG (Laproscopic Sleeves Gastrectomy) is a cosmetic procedure and hence not covered under the policy. It is also argued that while taking the policy, the respondent / complainant had concealed his medical history and, therefore, the findings of the State Commission in the impugned order suffers with illegality and is also perverse and liable to be set aside.

(2.) It is argued on behalf of the respondent / complainant that petitioner had not raised any objection in its written version filed before the District Forum that the complainant had taken the policy by fraud and by suppressing any pre existing disease. It is submitted that since this contention was never raised, the parties did not lead any evidence on this issue and there was no occasion for the District Forum and the State Commission to reflect upon this contention of the petitioner. It is argued for the first time in the revision petition and the petitioner cannot raise a fresh contention which is not solely legal but finding on which depends on the facts and circumstances of the case which needs to be proved before the trial court. It is submitted that the petitioner's arguments to this effect should be outrightly rejected. It is further argued that procedure of LSG is not a cosmetic procedure but was necessary for controlling the diabetes and, therefore, squarely covered under the policy. It is submitted that this Commission has limited jurisdiction and is not required to re-appreciate and reassess the evidence and substitute its own opinion to the State Commission's decision.

(3.) I have given my thoughtful consideration to the arguments of the learned counsel for the parties and have perused the record.