LIC OF INDIA Vs. RAJAN BEHAL

JUDGEMENT

(1.) FOR the reasons mentioned in the application for condonation of delay, the delay of seven days in filing this revision petition is condoned.

(2.) THE complainant who is respondent herein had obtained a Ashadeep policy bearing No. 174055813 dated 28.5.2004 for Rs. 1,00,000. He was paying premium on the policy regularly. Under the aforesaid policy, the complainant was entitled to claim compensation of Rs. 1,00,000 from the OP Insurance Co. in the event of any heart problem and treatment taken for the same. The complainant fell ill and the doctors advised him to undergo coronary angiography which revealed triple vessels disease. The doctors advised him to undergo Coronary Artery By-pass Graph (CABG) surgery which he underwent on 22.7.2005 at the Escort Heart Institute and Research Centre, New Delhi. The complainant was admitted in the Escort Heart Institute and Research Centre, New Delhi on 22.7.2005 and was discharged on 30.7.2005. He had spent Rs. 3 lakh on this treatment including cost of medicines, etc. He submitted claim to the OP Insurance Co. for payment of Rs. 1,00,000 along with relevant documents. However, the OP repudiated his claim vide its letter dated 20.12.2005. Challenging the action of the OP Insurance Co., the complainant invoked the jurisdiction of the District Forum seeking direction to the OP to pay compensation of Rs. 1,00,000 in respect of the treatment taken by him and Rs. 20,000 on account of cost and litigation expenses. On being noticed, the OP Insurance Co. resisted the claim and denied any kind of deficiency in service on its part and prayed for dismissal of the complaint. The District Forum did not find any substance in the claim of the complainant and dismissed the complaint on the ground that the complainant had taken treatment within one year from the date of actual date of policy. Aggrieved by the order of the District Forum, the complainant went in appeal against that order before the State Consumer Disputes Redressal Commission, Haryana, Panchkula ('State Commission' for short). The State Commission after hearing the parties and considering the documents filed before it accepted the complaint and allowed the appeal by setting aside the order of the District Forum. The present revision petition has, therefore, been filed by the OP Insurance Co. against the impugned order of the State Commission.

(3.) IT is contended on behalf of the Insurance Co. that as per condition No. 11(a) of the policy in question, the contingent benefit 'B' under the policy is not payable to the complainant because the contingency had occurred within one year from the date of the policy. It has been submitted that the date of registration was 9.8.2004 but the commencement of the policy was 28.5.2004 because of the back dating of the policy and the complainant took the treatment on 22.7.2005, i.e., within one year of the policy. Learned Counsel for the petitioner has argued that the back dating of the policy was requested by the complainant and agreed to by the Insurance Co. but the same was for claiming benefits under income tax purposes. Since the illness in question occurred within one year of taking the policy, the complainant was not entitled for the claim made by him in respect of his treatment because of the specific condition in Para 11(a) of the policy. In support of his contention, the Counsel has relied on the judgments of the Apex Court in the cases of LIC of India and Anr. v. Dharam Vir Anand, III (1998) CPJ 3 (SC)=VIII (1998) SLT 461=(1998) 7 SCC 3481 and LIC of India v. Mani Ram, III (2005) CPJ 31 (SC)=VI (2005) SLT 210=(2005) 6 SCC 274.