ORIENTAL INSURANCE CO LTD THROUHJ ITS DULY CONSTITUTED ATTORNEY MANAGER, ORIENTAL INSURENCE CO LTD Vs. PRATIK SAMAJ SEVA TRUST & ANR; SHETH NARENDRA KUMAR CHIMANLAL

JUDGEMENT

(1.) This revision petition has been filed by petitioner against the order dated 30.4.2013 passed by State Commission in Appeal No. 759 of 2011, The Oriental Insurance Co. Ltd. v. Pratik Samaj Seva Trust & Anr., by which appeal was dismissed.

(2.) Brief facts of the case are that complainant No. 2/respondent No. 2 has taken insurance policy from opposite party/petitioner which was in force till 2006-07. Opposite party agent did not inform complainant for payment of premium so policy lapsed and after one month, complainant No. 2 took policy from opposite party after conducting medical tests. On account of complainant's brother's accident, complainant suffered first heart attack and was admitted to hospital and took treatment from 7.1.2009 to 17.1.2009 and incurred expenses of Rs. 2,33,000 and was entitled to receive Rs. 1,00,000 from opposite party. He submitted claim which was repudiated by opposite party on account of exclusion clause. Alleging deficiency on the part of opposite party, complainant filed complaint before District Forum. Opposite party resisted complaint and submitted that earlier mediclaim policy expired on 18.1.2007 and complainant took new policy from 13.3.2007 to 13.2008 by filling new proposal form. It was further submitted that as complainant took treatment from 7.1.2009 to 17.1.2009, treatment for disease was not payable as per exclusion clause and claim was rightly repudiated and prayed for dismissal of complaint. Learned District Forum after hearing both the parties, allowed complaint and directed opposite party to pay Rs. 1,00,000 with 9% p.a. interest and further directed to pay Rs. 2,000 for mental torture and Rs, 1,000 as cost. Appeal filed by opposite party was dismissed by learned State Commission vide impugned order against which this revision petition has been filed along with application for condonation of delay.

(3.) Heard learned Counsel for petitioner and Authorized Representative of respondents and perused record.