ORIENTAL INSURANCE CO. LTD Vs. SHOBHA MUKHIA

JUDGEMENT

(1.) THIS revision petition has been filed by the Petitioners/OP against the impugned order dated 8.2.2008 passed by the M.P. State Consumer Disputes Redressal Commission, Bhopal (in short, 'the State Commission ') in Appeal No. 2268 of 2005 - Smt. Shobha Mukhia Vs. The Oriental Insurance Co. Ltd. by which, while allowing appeal, order of District Forum dismissing complaint was set aside.

(2.) BRIEF facts of the case are that Complainant 's/Respondent 's husband obtained Medi -claim policy for himself and complainant for Rs.1,00,000/ - and for his son for Rs.50,000/ - for a period commencing from 12.10.1999 to 11.10.2000 and further renewed it from 18.10.2000 to 17.10.2001. Later on, on the request of complainant, coverage of complainant was enhanced to Rs.3,00,000/ - from Rs.1,00,000/ - on the request of complainant by letter dated 22.11.2000. It was further alleged that complainant was admitted in the hospital first time on 3.8.2000 and later on was admitted in hospital from time to time and incurred expenses of Rs.4,13,992/ - in the treatment. Complainant sent intimation by post to OP/petitioner regarding hospitalisation on 10.8.2000 and on subsequent dates. By letter dated 18.12.2001, complainant submitted claim, but claim was repudiated by OP vide letter dated 17.1.2002 on flimsy grounds. Complainant alleging deficiency on the part of OP filed complaint before District Forum. OP/petitioner resisted claim, filed written statement and submitted that complainant has violated terms and conditions of the insurance policy and no intimation was given regarding hospitalization within prescribed period and claim was also not preferred within 30 days of discharge. It was further alleged that complainant suppressed material facts regarding previous disease and treatment and gave untrue answers; hence, complaint be dismissed. Learned District Forum after hearing both the parties dismissed complaint. Appeal filed by the complainant was allowed by learned State Commission vide impugned order and petitioner was directed to pay Rs.2,00,000/ - to the respondent against which, this revision petition has been filed.

(3.) LEARNED Counsel for the petitioner submitted that respondent has suppressed disease in the proposal form while obtaining first policy and has not revealed previous hospitalization, disease and treatment while obtaining second policy and further violated conditions of policy and learned District Forum has rightly dismissed complaint, even though, learned State Commission has committed error in allowing appeal; hence, revision petition be allowed and impugned order be set aside. On the other hand, learned Counsel for the respondent submitted that no conditions have been violated by respondent and there was no suppression of previous disease and in such circumstances, order passed by learned State Commission is in accordance with law which does not call for any interference; hence, revision petition be dismissed.