PRAVEEN DAMANI Vs. ORIENTAL INSURANCE CO LTD

JUDGEMENT

(1.) THIS Revision Petition is filed by the Complainant, Mr. Praveen Damani, against the opposite party, M/s. Oriental Insurance Company Ltd. (herein after referred to as the Insurance Company) alleging deficiency in service for wrongly repudiating his mediclaim. His complaint in Bilaspur District Forum in Case No.61 of 2002 was dismissed by order dated 3.3.2002 and his Appeal No.1089/2003 before the State Commission also met with the same result vide its order dated 31.5.2005. Aggrieved by the same, he is in revision before us.

(2.) MR . Praveen Damani had obtained a Mediclaim Insurance Policy No.2001/300 with effect from 9.6.2000 to 8.6.2001 from the Oriental Insurance Company Ltd., Bilaspur, for himself, his wife, Sarla and son, Ashish, for a sum assured of Rs.3,50,000/- and paid a premium of Rs.5,174/-. This policy was renewed for a further period of one year from 9.6.2001 to 8.6.2002. It is the contention of the Revision Petitioner that before the issuance of the policy, he had undergone a complete medical check-up by the Doctors nominated by the Insurance Company and this fact has not been rebutted. The Revision Petitioner, a resident of Bilaspur, Madhya Pradesh, visited Bangalore in August 2000 to see his daughter and on the 11th August, he suddenly developed chest pain and uneasiness. He consulted Dr. Dhanwant Kumar on 15.8.2000 who, suspecting some heart ailment referred him to the Manipal Heart Foundation (MHF). Revision Petitioner attended MHF on 17.8.2000 as an out-patient and was examined by Dr. Ashutosh Dwivedi. As one of the tests, i.e. Tread Mill Test (TMT) showed strong positive, he was advised "Coronary Angiography".

(3.) IN the light of the facts stated above, the issues to be decided in this matter are: