VIJAY KUMAR JAIN Vs. NATIONAL INSURANCE COMPANY LTD

JUDGEMENT

(1.) PETITIONER was the complainant before the District Forum. His claim for medical insurance was allowed by the District Forum, but appeal filed by the respondent-opposite party to the State Commission, was allowed and complaint was dismissed. Aggrieved of the order of the State Commission, petitioner has come to this Commission.

(2.) PETITIONER said that he underwent TMT test at Ahuja Nursing Home and Hospital on 25.4.1992 which was positive and he was advised to get treatment from the Escorts Heart Institute and Research Centre, New Delhi. Petitioner went for treatment. Angiography was done on him which was followed by surgery. He was under treatment from 12.5.1992 to 30.5.1992. He claimed a sum of Rs. 1,21,722/- towards medical expenses incurred by him which claim was repudiated by the respondent-Insurance Company. It was the case of the Insurance Company that when the petitioner took the Mediclaim Insurance Policy he did not disclose the illness he was suffering from. For the first time petitioner got TMT test at the Ahuja Nursing Home and Hospital on 19.3.1992 which was found positive. He got the insurance on 24.3.1992 and again went for TMT test on 25.4.1992 which was also positive. Contention of the Insurance Company which has been accepted by the State Commission was that after having come to know that TMT test conducted on 19.3.1992 was positive, he got insurance done and did not disclose this fact of his severe heart ailment.