ORIENTAL INSURANCE COMPANY Vs. S SURINDERPAL SINGH

JUDGEMENT

(1.) It is an appeal against the order dated 7.11.2001 of the District Consumer Disputes Redressal Forum, Jalandhar (hereinafter called the District Forum ).

(2.) Admitted case of the parties is that the respondent-complainant (hereinafter called the complainant) got himself insured for mediclaim policy for Rs.2,00,000/- for the period from 21.4.1999 to 20.4.2000 as per cover note No.191450. He fell sick in March, 2000 and underwent an open heart surgery in the Escort Hospital, New Delhi. Although the expenditure, as per version of the complainant, was incurred to the tune of Rs.2,70,000/- but he demanded only Rs.2,00,000/- as per mediclaim policy insurance. The opposite party instead of sanctioning Rs.2,00,000/-, first sanctioned Rs.1,20,000/- plus Rs.11,000/- as bonus, the total amounting to Rs.1,31,000/- as per letter Ex. C-4. On his representation it was enhanced to Rs.1,52,775/- by increasing the bonus. Reason given, for lesser amount stated in the written statement as well as in the affidavit of Sh. Balraj Kapoor, Branch Manager was that the complainant had concealed the true facts that he had taken the treatment for his heart problem at two hospitals and he had enhanced the amount of risk from Rs.1,20,000/- to Rs.20,000/-. At the time of perusal of the policy of the complainant when he demanded the amount, it was revealed that the enhancement of amount of risk was done with the mala fide intention without disclosing the disease already existing. The other objection taken by the O. P. was that the complainant had accepted the medical claim for Rs.1,52,775/- with his sweet will and in cool mind and he came to the office of the O. P. of his own without any pressure and coercion and took the cheque from the O. P. against a signed receipt wherein the complainant discharged the company completely by taking the claim as full and final. The District Forum allowed the complaint and directed the O. P. to pay a sum of Rs.80,000/- on account of medical claim along with interest at the rate of 9% per annum to be calculated four months from lodging the claim till its realisation.

(3.) In the appeal the learned Counsel for the appellant has raised two objections. One, that the complainant was not entitled to any claim under the medical claim policy. Second, that the complainant had accepted the medical claim of Rs.1,52,775/- without any protest and thus he was debarred to claim any other amount beyond the one which was accepted by him. The first point raised by the learned Counsel was raised before the District Forum also. Verdict of the District Forum had gone against him and rightly so. We do not want to reiterate the reasoning given by the District Forum. On merits suffice it to so say that the O. P. had not rejected the medical claim of the complainant. It had only granted the lesser amount than as asked for by the complainant. Thus the O. P. cannot raise this question now. Raising of this question by the O. P. could be valid if it had not voluntarily paid an amount of Rs.1,52,775/- and had rejected he claim of the complainant on merits.