ORIENTAL INSURANCE CO LTD Vs. HEMANT BHANDARI

JUDGEMENT

(1.) The appellant is an Insurance Company. It appears that every Insurance Company has started taking undue advantage of its wrong. Whenever they cover a person under medi-claim insurance policy and the person suffers from some or the other ailments or even dies a stereotype defence is taken by the Insurance Company that the insured had concealed the factum of the pre-existing disease he was suffering from. On this short ground alone Insurance Company repudiates the rightful claim of the insured. Any person who desires to be covered by the insurance policy is required to be medically examined by the doctors of the company and if the Insurance Company fails to do the same it cannot be allowed to take advantage of its wrong.

(2.) In the instant case the respondent was insured for mediclaim policy. After 2 days of obtaining the policy the respondent felt breathlessness and was taken to the hospital but was discharged after 3-4 days. This happened in the month of April. Again in the month of September the respondent complained breathlessness and was admitted in the hospital but unfortunately he expired there. As a consequence the claim was filed with the appellant but the appellant kept on sitting on the claim for about three years and ultimately repudiated it on the ground of non-disclosure of pre-existing disease. We have perused the medical record and the treatment of the respondent produced before the District Forum. Medical record points out that some time back before obtaining this policy the respondent had complained of breathlessness. This was not such a disease, which the respondent was expected to disclose. Only those diseases are covered under this head for which the person gets long treatment or gets admitted in the hospital for treatment. The circumstance of the respondent having been discharged from the hospital after 3 days in the month of April and again having developed breathlessness after five months itself indicates that the respondent was not suffering from such pre-existing disease which he was required to disclose.

(3.) It appears that the Insurance Companies have the tendency of insuring each and every person under mediclaim policy without verifying or getting examined from their doctor only to enhance their premium and business. No Insurance Company for that purpose the employer can take advantage that the policy was obtained through connivance of their employee to escape the direct or vicarious liability. Once the Insurance Company insures person under its mediclaim policy it is obliged to pay the actual expenses incurred by the assured. However, the District Forum has awarded Rs.37,690/- against the claim of Rs.42,506/- subject to production of No Objection Certificate from other legal heirs of the deceased by calculating the actual expenses incurred, which he was entitled to receive from Insurance Company. The respondent has already furnished the No Objection Certificate from the other legal heirs of the deceased.