ORIENTAL INSURANCE COMPANY LIMITED Vs. CHAIN SINGH

JUDGEMENT

(1.) This is an appeal by the Oriental Insurance Company against the judgment and order of the District Forum, Amritsar, dated 10.10.2005, by which the complaint of the complainant, Chain Singh, was allowed in the following terms :

(2.) Brief facts, which are taken from the complaint, are that the complainant had been purchasing medical insurance policies for himself and for his wife from the Oriental Insurance Company since 1st of August, 1998. Every year the mediclaim policy was renewed without any break. The last policy was taken which was valid from 2.10.2003 to 1.10.2004. In November, 2003, the complainant had to be admitted in the Escort Heart and Super Speciality Institute, Amritsar where he underwent CABG operation. He remained in the hospital from 30.11.2003 to 12.12.2003. Prior to his admission to the hospital, the complainant had started feeling uneasiness only for a couple of days and prior thereto he had never felt any illness which needed treatment. The mediclaim policy was in the sum of Rs. 1.50 lacs. He had also earned bonus @ 5% for five years. Complainant lodged his mediclaim with the Insurance Company but the same was repudiated vide communication Ex. C-2. The repudiation letter reads as under :

(3.) It will be evident from the repudiation letter that the claim had been repudiated primarily on the basis of the discharge summary of the complainant prepared at Escorts hospital. In the resume of the history in the discharge slip it was mentioned as under :