ORIENTAL INSURANCE CO LTD Vs. BEAUTY DASGUPTA

JUDGEMENT

(1.) These two appeals have arisen out of order dated 17.12.1998 passed by C. D. F.-II. By the said order, the claim of the complainant was allowed in part and the Insurance Company was directed to pay Rs.16,318/- to the complainant together with interest @ 12% p. a. from the date of communication of the order till payment. A sum of Rs.300/- was awarded as cost of the proceeding. Being aggrieved by the said order the Insurance Company appealed challenging the decision of the Forum. The complainant has also filed the second appeal claiming interest and compensation.

(2.) Since these two appeals arose out of the same order and common question of fact and law are involved they are heard together and disposed of.

(3.) The case of the complainant was that she was covered under a Medical Insurance Policy for the period from 8.9.1994 to 7.9.1995. She fell ill on 28.11.1994 and was examined by her family physician Dr. Ashim Chatterjee who referred her to Dr. Ashis Mukherjee for examination and treatment. Dr. Mukherjee advised Gall-bladder operation and the operation was done in a Nursing Home on 23.12.1994. The patient was discharged from the said Nursing Home on 26.12.1994. Thereafter, the complainant lodged claim for Rs.16,318/- with the Insurance Company by a letter dated 27.1.1995. The Insurance Company repudiated the claim on 28.2.1995 on the ground that the disease was pre-existing at the time of taking out the policy. The repudiation was done on the basis of opinion of two senior doctors of repute having long standing experience in medical field. It was claimed that the repudiation was not arbitrary since it was based on the opinion of two eminent doctors and as such there is no deficiency in service. The Forum, however, rejected the contention of the Insurance Company and allowed the claim in full. But it did not allow the claim for compensation.