NATIONAL INSURANCE CO LTD Vs. PRAKASH SHAH

JUDGEMENT

(1.) It is the Insurance Company who is petitioner before us in a complaint arises out of medi-claim of the respondent-complainant. Complainant had been taking medi-claim insurance policy right from 1991. In June, 2000 he went for a operation of enlarged prostate and was discharged from the hospital on 15.6.2000. His claim under the policy was repudiated by the petitioner-insurer on the ground that relevant facts have been suppressed by the complainant relating to his suffering from the ailment from earlier date.

(2.) District Forum allowed the complaint and directed payment of Rs. 1,18,279/- with interest. Against this order appeal was filed by the insurer which was dismissed. The order of the District Forum was, however, modified and instead the award of Rs. 1,18,279/- was reduced to Rs. 1,04,900/-. Interest and cost as awarded by the District Forum were confirmed. Aggrieved, insurer has now come before us.

(3.) We do not find it is a fit case for us to exercise our jurisdiction under Clause (b) of Section 21 of the Consumer Protection Act, 1986 as no error of jurisdiction or any illegality in the impugned order of the State Commission has been pointed out. As a matter of fact, we find that revision is barred by 65 days and there is no application seeking condonation of delay. We find that Dr. A.G. Phadke, Senior Urologist in the Bombay Hospital who had performed operation on the complainant had contradicted the stand of the insurer which was based on the opinion of consultant Dr. M.S. Kamath. Opinion of Dr. Kamath was that complainant was suffering from the ailment from much earlier date. However, Dr. Phadke who in fact performed the operation said that it was not so. In the opinion of Dr. Phadke, if there was a complaint of enlargement of prostate causing retention of urine from much earlier period it was highly unlikely that complainant could have carried on comfortably for all this period without developing another retention of urine in the absence of any hypertrophic drug. Dr. Phadke added that investigation done by him revealed that complainant had developed enlargement of prostate only since his previous examination. Both the District Forum and the State Commission relied on the statement of Dr. Phadke who was in fact the person performed the operation and not Dr. Kamath, consultant. There is no error in the reasoning of the State Commission for us to take a different view. This revision petition is, therefore, dismissed. Revision Petition dismissed.