NATIONAL INSURANCE CO LTD Vs. SWARAJ JAIN

JUDGEMENT

(1.) THIS appeal under Section 15 of the Consumer Protection Act, 1986 (hereinafter referred to as "the Act of 1986") has been filed by the appellant against the order dated 23. 11. 2006 passed by the learned District Forum, Udaipur in case No. 12/2000 by which the complaint filed by the complainant-respondent under Section 12 of the Act of 1986 was allowed in the manner that the appellant was directed to pay to the complainant-respondent a sum of Rs. 1,04,500 along with interest @ 8% p. a. from the date of repudiation letter i. e. 28. 2. 2000 till payment was made and Rs. 2,500 as cost of litigation.

(2.) IT may be stated here that on 18. 12. 1999, the complainant-respondent had filed a complaint under Section 12 of the Act of 1986 before the District Forum, Udaipur stating inter alia that her husband Rajendra Kumar Jain (hereinafter referred to as "the deceased") had first taken Mediclaim policy on. 2. 4. 1996 from the appellant-Insurance Company for the period from 2. 4. 1996 to 1. 4. 1997 and that policy was got renewed by the deceased from the appellant on 2. 4. 1997 for the period from 2. 4. 1997 to 1. 4. 1998 and, thereafter, on 2. 4. 1998, that policy was again got renewed by the deceased from the appellant for the period from 2. 4. 1998 to 1. 4. 1999 and in that policy, the sum assured was Rs. 95,000 and cumulative bonus of Rs. 9,500. It was further stated in the complaint that even third time the policy in question was renewed by the appellant after making inquiry regarding health of the deceased. It was further stated in the complaint that on 5. 7. 1998, the deceased felt pain in chest and, therefore, he was got admitted in RNT Medical College and Maharana Bhupal Government Hospital, Udaipur where he remained upto 10. 7. 1998 and many tests were got done there and since deceased did not feel relief, therefore, he was taken to Escort Heart Institute and Research Centre, New Delhi, where he was got admitted on 24. 7. 1998 and discharged on 6. 8. 1998 and a sum of Rs. 1,88,000 was spent by the deceased in taking treatment at Escort Heart Institute, New Delhi, but unfortunately, deceased had died on 6. 8. 1998 at New Delhi. After death of the deceased, a claim was preferred by the complainant-respondent being wife and nominee of the deceased, but that claim was repudiated by the appellant through letter dated 28. 2. 2000, the contents of which read as follows:

(3.) A reply was filed by the appellant-Insurance Company on 26. 2. 2001 and the appellant took the same plea, which was taken by it in the repudiation letter dated 28. 2. 2000. Apart from this, it was further submitted by the appellant that as per discharge ticket of RNT Medical College and Maharana Bhupal Government Hospital, Udaipur, it was clear that deceased was suffering from hypertension, diabetes mellitus with coronary artery disease for the last ten years. Thus, deceased was having heart trouble before issuance of the first Medi-claim policy on 2. 4. 1996, but he deliberately concealed that fact. Furthermore, as per the death summary of Escort Heart Institute, New Delhi, the deceased was not only suffering from hypertension, diabetes mellitus Type II and ischemic heart disease, but he had also suffered an anteroseptal wall myocardial infarction 14 years back and these facts were deliberately not disclosed by the deceased at the time of taking the first Mediclaim policy on 2. 4. 1996 and, thus, it was a case of suppression of material facts regarding health and on that ground, the claim was rightly repudiated by the appellant through letter dated 28. 2. 2000 and the present complaint deserves to be dismissed.