NATIONAL INSURANCE CO LTD Vs. SURINDER LAL AROR

JUDGEMENT

(1.) This is an appeal directed against the order of 30th May, 1992 passed by the State Commission of Uttar Pradesh in Complaint Case No. 117/SC/90.'

(2.) The relevant facts are that the respondent complainant Shri Surinder Lal Arora had taken out a Hospitalisation and Domicialiary Hospitalisation benefit policy from the appellant-Insurance Company on the 9th of February, 1988. This policy was renewed on the basis of a proposal form the insured on the 8th of February, 1989.

(3.) The respondent complainant underwent a bye pass heart surgery in the Escorts Heart Institute and Research Centre on the 3rd of March, 1989 and remained admitted in the Institute till 13th March, 1989. He made a claim on 10th of April, 1989 on insurer for a sum of Rs. 65,000/-. The appellant-Insurance Company in March, 1990 repudiated the claim on the ground that prior to the taking of the policies the respondent had already been suffering from heart disease and hypertension and that these facts were concealed in the proposal form made by the respondent-complainant. The respondent-complainant thereafter filed a complaint before the State Commission, Uttar Pradesh alleging wrongful repudiation of his claim on his insurance policy and alleging deficiency in service on the part of the appellant-Insurance Company. He asked for relief by way of reimbursement on the expenditure incurred by him with interest at 18% thereon and compensation of Rs. 50,000/-. The State Commission came to the conclusion that the complainant was not having the knowledge of the heart disease prior to the taking of the policy and that the evidence indicated that he was suffering from chest pain only from which it could not be guessed that the chest pain related to the heart disease. It, therefore, directed the appellant to pay a sum of Rs. 65,000/- to the insured with an additional sum@ 12% w.e.f. 20.5.1989 and 18% from 1.8.1992.