KHIMANIBAI SOHANLAL MEHTA Vs. NEW INDIA INSURANCE COMPANY

JUDGEMENT

(1.) This revision petition has been filed by the petitioner against the order dated 30.04.2013 passed by the Gujarat State Consumer Disputes Redressal Commission, Ahmedabad (in short, 'the State Commission') in Appeal No. 668/2009 Mrs. Khimanibai Sohanlal Mehta Vs. The New India Assurance Co. Ltd. & Anr. by which, while dismissing appeal, order of District Forum dismissing complaint was upheld.

(2.) Brief facts of the case are that Complainant/petitioner is taking medi-claim insurance policy from OP/respondent since last 15 years and getting insurance renewed by paying premium. During currency of policy, insured was admitted in Mahavir hospital and was discharged on 20.12.2004. As per opinion of the hospital, angiography and angioplasty was done on 6.1.2005 and claim of Rs.2,66,814/- was submitted to OP in 2005. It was further submitted that on account of heart problem complainant was again admitted in Mahavir hospital on 3.9.2005 for angiography and angioplasty and was discharged on 8.9.2005 and incurred expenses of Rs.2,34,817/-. Complainant submitted total claim of 5,01,632/- to OP which was repudiated by OP vide letter dated 3.6.2006 on the ground that complainant had been suffering from hypertension and CABG which was pre-existing disease. Alleging deficiency on the part of OP, complainant filed complaint before District Forum. OP resisted complaint and submitted that claim was rightly repudiated on account of pre-existing disease and prayed for dismissal of complaint. Learned District Forum after hearing both the parties, dismissed complaint. Appeal filed complainant was dismissed by learned State Commission vide impugned order against which this revision has been filed along with application for condonation of delay.

(3.) Heard learned Counsel for the parties finally at admission stage and perused record.