NATIONAL INSURANCE CO. LTD. Vs. GANPATBHAI SOMABHAI KADIA

JUDGEMENT

(1.) There is a delay of 33 days in filing the revision petition. For the reasons mentioned in the application for condonation of delay, the delay of 33 days is condoned. Despite service of notice, the respondent/complainant remained absent on 21.10.2016. Today again, respondent is not present.

(2.) The brief facts are that the complainant, Shri Ganpatbhai Somabhai Kadia obtained Medi-claim insurance policy for a sum of Rs. 1 lakh from National Insurance Company Ltd. (OP) on 6.11.2006. It was renewed regularly till 5.11.2011. During the subsistence of the policy, he took treatment in Lilavati Hospital, Mumbai from 14.6.2009 to 16.06.2009 and submitted claim of Rs. 1,25,000/- alongwith medical bills and documents to the OP/insurance company. The OP/insurance company repudiated the claim on the ground that the disease was pre-existing one. Aggrieved by the unlawful repudiation, the complainant filed a complaint before the District Forum, Sabarkantha, Gujarat.

(3.) The OP resisted the complaint by filing the written version and submitted that the patient was treated in 2003 for Bilateral Kidney problems. The treatment was bilateral PCNL, which was done in the same hospital. Therefore, it was not disclosed by the complainant while taking the policy in 2006. Therefore, the repudiation was proper as per exclusion clause 4.1 of the insurance policy