NEW INDIA ASSURANCE COMPANY LIMITED Vs. TARSEM CHAND

JUDGEMENT

(1.) This is an appeal filed against judgment and order dated 1.7.2004 passed by the District Consumer Disputes Redressal Forum-I, U. T. , Chandigarh (for short hereinafter to be referred as District Forum) in Complaint Case No.910 of 2002.

(2.) The respondent Shri Tarsem Chand took a medi-claim policy for the period from 30.11.1998 to 29.1.1999 from the appellant-New India Assurance Company Limited (for short hereinafter to be referred as Assurance Company), Divisional Office-I, SCO No.462-463, Sector 35-C, Chandigarh and paid a premium of a sum of Rs.3,827/-. Initially a cover note No.496585 was issued on 30.11.1998 by one Shri Gandhi, an agent of the appellant Assurance Company. Shri Tarsem Chand was got medically examined from a doctor and necessary forms and documents were filled up by the aforesaid agent Shri Gandhi. This was followed by issuance of a policy of medi-claim insurance bearing No.4835010004235 and the same was sent to the respondent Shri Tarsem Chand. This policy was further renewed up to 29.11.2000. It is alleged that on 13.2.1999 i. e. , during the continuance of the earlier policy, Shri Tarsem Chand felt pain in his chest and was admitted in General Hospital at Panchkula from where he was referred to Escort Heart Hospital at New Delhi for treatment. On 1.3.1999 Angiography was conducted and some other tests were conducted by Dr. T. S. Kler. It was found that three arteries were blocked to the extent of 99% and as such Angiography was done on the respondent Shri Tarsem Chand at Escort Heart Hospital, New Delhi.

(3.) During the last quarter of November 1999, the complainant again felt pain in his chest and was taken to Escort Heart Hospital for checkup and treatment. Angiography was again done on the complainant. After recovering from his illness, the complainant submitted details of expenses in the treatment before the appellant-Assurance Company and sought the reimbursement of the said amount vide letter dated 25.2.1999. All the bills and other details were submitted and mentioned. The claim was, however, not settled by the appellant-Assurance Company and the complainant filed Complaint Case No.993 of 1999. The said complaint case was disposed of on the basis of an application moved by the complainant wherein he stated that he wanted to put forth his claim with the Assurance Company with regard to the expenditure incurred after 25.2.1999 and also to make a representation for settling his claim. The complaint was accordingly disposed of without prejudice to the rights of the complainant to make representation before the appellant-Assurance Company for release of the claim amount within the stipulated period who instead repudiated the claim vide letter dated 29.10.1999 on the ground that the complainant is suffering from the disease before the commencement of the policy. It was contended that at the time of commencement of the policy dated 30.11.1998, the complainant was duly examined by the doctor of the Assurance Company as well as the agent of the Assurance Company and the form was filled up by the agent of the Assurance Company after examining the complainant from every aspect and got it signed from the complainant.