ORIENTAL INSURANCE CO. LTD. Vs. BABY SIMRAN KAUR

JUDGEMENT

(1.) This revision petition has been filed under section 21(b) of the Consumer Protection Act, 1986 against the impugned order dated 09.08.2007, passed by the Delhi State Consumer Disputes Redressal Commission (for short 'the State Commission') in FA No. A-476/2003, "Baby Simran Kaur versus Oriental Insurance Co. Ltd.", vide which, while allowing the appeal, the order dated 24.03.2003, passed by the District Consumer Disputes Redressal Forum, dismissing the consumer complaint in question, was set aside.

(2.) Brief facts of the case are that the complainant/respondent Baby Simran Kaur daughter of Nirmal Jeet Singh, was a minor and she filed the complaint in question through her father for reimbursement of the expenses incurred on her treatment availed against medi-claim policy, obtained in her favour and other members of the family for the period from 16.06.99 to 15.07.2000. Baby Simran Kaur was admitted in the hospital on 10.09.99 for operation of Lumber Spine. A total sum of Rs. 1,46,520/- was spent on the treatment, alongwith other expenses and a claim was lodged for reimbursement with the OP Insurance Company. However, the claim was repudiated by the OP on the ground that the claimant had a pre-existing congenital disease, which was not disclosed, while taking the policy in question. The claim of the complainant is based on the opinion of Dr. Rajendra Prasad, Surgeon, Apollo Hospital who stated that the disease for which the appellant was operated upon, was not congenital. The Insurance Company renewed the mediclaim policy for the next year, without settling her claim. The complainant / respondent filed the consumer complaint in question before the District Forum, requesting for a sum of Rs. 1,46,350/- to be paid for treatment/medicines/operation, Rs. 20,000/- for sundry expenses and Rs. 50,000/- as compensation for harassment, alongwith interest. The OP took the stand before the District Forum that the complainant was guilty of withholding material information, as she had been already suffering from a congenital disease. The claim received from the complainant was referred to the panel doctor, Dr. Prem Nath, who stated that the patient was first seen on 28.08.90 in Apollo Hospital for 'enuresis urgency' and was having 'dribbling inconvenience' since birth with fever and swelling of lower back. The claim was repudiated on the basis of affidavit filed by Dr. Pran Nath. The District Forum dismissed the complaint in question, saying that the claim had been rightly repudiated by the OP as the complainant was suffering from that disease since birth. An appeal was filed against the order of the District Forum before the State Commission, which was allowed vide impugned order dated 09.08.2007 and it was directed that payment of Rs. 1,46,520/- should be made to the complainant alongwith Rs. 5,000/- as compensation for mental harassment and cost of litigation. It was observed by the State Commission that as per the opinion of experts of Apollo hospital, the complainant was not suffering from a congenital disease, but even if it was so, there was no question of concealment made by the policy-holder. It is against this order that the present petition has been made.

(3.) At the time of arguments before us, learned counsel for the petitioner stated that they had filed an application for taking additional documents on record and the same should be allowed. These documents included a copy of bill for registration fee of Rs. 50/- issued by the Indraprastha Apollo Hospital in the name of Baby Simran Kaur, a copy of cover-note of the file dated 07.07.99, issued by the Department of Neurology, Apollo Hospital, a copy of repudiation letter dated 3.3.2000, sent by the OP to father of Simran Kaur and a copy of the claim form, filed before the Insurance Company. It was also stated that the discharge summary and prescription issued by the Apollo Hospital were already on record. Learned counsel for respondent stated that these documents were not authenticated and no parentage of Simran Kaur had been stated in the additional documents filed. However, he admitted that the prescription issued by the Apollo Hospital vide ID No. 99039747 dated 20.08.99 related to Simran Kaur only. After considering the arguments of the learned counsels, the application for additional documents was ordered to be taken on record.