MADHVI SHARMA Vs. NEW INDIA ASSURANCE CO

JUDGEMENT

(1.) MR. Justice Sunil Kumar Garg, President-This appeal has been filed by the complainant appellant against order dated 26. 12. 2003 passed by the District Forum, Jaipur Camp, Jaipur by which the complaint of the appellant for claiming medi-claim was dismissed.

(2.) IT arises in the following circumstances: that the complainant appellant had filed a complaint before the District Forum, Jaipur IInd on 23. 4. 2001 against the respondents inter alia stating that her husband Sh. Anand Kumar Bhardwaj (now deceased) had taken a medi-claim policy from the respondents for the period from 30. 12. 1998 to 29. 12. 1999 and thereafter that policy was renewed for the period from 30. 12. 1999 to 29. 12. 2000. It was further stated in the complaint that since the deceased felt some trouble in his throat and nose, he was admitted in the Monilek Hospital, Jaipur on 3. 3. 2000 and he was discharged from the hospital on 5. 3. 2000. Thereafter he was referred to the Mahaveer Cancer Hospital, Jaipur where he had taken the treatment up to 2. 4. 2000 and on that day he had died. For the expenses which were incurred by the deceased a claim was made before the respondents but their claim was repudiated by the respondents through letter dated 13. 10. 2000 inter alia stating that since the deceased was having the disease for which he had taken treatment in the Mahaveer Cancer Hospital, therefore, medi-claim was not found payable. Thereafter the complaint was filed before the District Forum. A reply was filed by the respondents and they have taken the same plea which they have taken in the repudiation letter dated 13. 10. 2000 and it was further stated by the respondents in their reply that the disease for which the deceased was suffering was a pre-existing disease since 1997. Hence the claim was rightly repudiated. The District Forum through its impugned order dated 26. 12. 2003 has dismissed the complaint inter alia holding that since the disease was pre-existing disease, therefore, medi-claim was not payable. Aggrieved from this order of the learned District Forum this appeal has been filed.

(3.) IN this appeal the main contention of the learned Counsel for the complainant appellant is that the findings of the District Forum are erroneous one as the deceased if he was having any pre-existing disease before issuance of the policy in question, the deceased was not aware and this disease was made only known to him when he was admitted in the hospital. Therefore, repudiation of the claim by the respondents through letter dated 13. 10. 2000 was an arbitrary exercise on the part of the Insurance Company.