KAPIL KUMAR AGGARWAL Vs. NATIONAL INSURANCE CO LTD

JUDGEMENT

(1.) This is an appeal by the complainant against the dismissal of his complaint by the District Forum, Udham Singh Nagar vide order dated 21.12.2004.

(2.) The facts giving rise to the case under hand are that the complainant took a mediclaim policy from the opposite party/insurance Company for himself, his wife Smt. Sarla Aggarwal and his son Puspa Kumar Aggarwal for Rs.1,00,000, 50,000 and 50,000 respectively, for which he paid the premium of Rs.2,646 to the Insurance Company. The Insurance Company issued cover note No.794455 which was valid from 28.10.2001 to 27.10.2002. It is alleged that on 21.2.2002 the complainant felt severe pain in Right Lower Limb and he was admitted in Saroj Hospital, Delhi where angiography was conducted and it was revealed that there is complete blockage in right poplileal artery. The complainant was operated upon in Apollo Hospital, Delhi and he was discharged from Apollo Hospital, Delhi on 26.2.2002, which was informed to the Insurance Company on 27.2.2002. On 9.8.2002 the Insurance Company asked the complainant to submit a certificate of the Apollo Hospital, Delhi in which the full description of the disease of the complainant should be given. It is further said that on 9.8.2002 the complainant submitted the claim form along with bills of Rs.95,634.71. On 29.8.2002 the complainant submitted the certificate issued by the doctor of Apollo Hospital. It is alleged that in spite of repeated requests, his claim was not paid and on 7.1.2003 the Insurance Company repudiated the claim of the complainant on the ground of non-disclosure of relevant facts. Thereafter he filed the complaint before the learned Forum.

(3.) The Insurance Company filed written statement before the learned Forum and admitted the issuing of policy. The claim was repudiated for non-disclosure of material facts. In para 12, it is said that the complainant did not disclose his prior illness in the proposal form. In para 16, it is alleged that the complainant has committed breach of the policy conditions and said that on 21.10.1998 the complainant took mediclaim policy No.351157 from United India Insurance Co. Ltd. , in which he mentioned that he was hale and hearty whereas he was suffering from diabetes and heart disease, which he suppressed in the proposal form which is violation of the policy conditions, therefore, the complainant is not entitled to any claim.