UNITED INDIA INSURANCE CO LTD Vs. KANTA GUPTA

JUDGEMENT

(1.) THIS revision petition is directed against the order dated 08.09.2010 of by the Punjab State Consumer Disputes Redressal Commission, Chandigarh (in short, ?the State Commission?) in First Appeal no. 1370 of 2004.

(2.) (i) The respondent in this petition was the complainant before the District Consumer Disputes Redressal Forum, Ludhiana (in short, ?the District Forum?). In her complaint, she alleged deficiency in service on the part of the opposite party (OP ? petitioner herein) insofar as the OP repudiated the claim for reimbursement of the expenditure of Rs.1,21,124/- that was incurred on the medical treatment availed of by the insured Sohan Lal, husband of the complainant. The mediclaim insurance policy for Rs. 2 lakh obtained by Sohan Lal was valid for the period 22.12.2000 - 21.12.2001. During 21 - 23.05.2001 and 06 - 11.11.2001 the insured had to be admitted to a local hospital for treatment of his renal problem. Despite treatment (including haemodialysis) on these two occasions and thereafter, the insured unfortunately expired on 21.06.2002. The claim of Rs.1,21,124/- was in respect of the expenditure incurred by the deceased insured for the aforesaid treatment and was filed with the OP/petitioner on 27.12.2001. However, the OP repudiated the claim, leading to the complaint. (ii) On consideration of the pleadings, evidence and documents produced on record, the District Forum partly allowed the complaint by its order dated 15.09.2004 and directed the OP "to decide the claim of the complainant as per the rules and regulations as well as terms and conditions of the policy", within one month of receipt of the copy of the order. (iii) Against this order, the OP/petitioner went up in appeal to the State Commission. After hearing the parties and considering the pleadings, etc., the State Commission, however, passed the following order dismissing the appeal:

(3.) MR. De has stated that the petitioner would press its general point regarding non-admissibility of an insurance claim under a mediclaim insurance policy in the event of the insured failing to disclose the material facts relating to the status of his health at the time of submitting the proposal for insurance. However, without prejudice to its above-mentioned stand, the petitioner would not object to a direction to pay to the respondent the sum of Rs. 1,21,124/- without any interest thereon.