NATIONAL INSURANCE COMPANY LIMITED Vs. SHIV CHARAN GUPTA

JUDGEMENT

(1.) The whole controversy swirls around the issue 'whether the circumstantial ground will absolve the insurance company from the liability of insurance claim in absence of production of proposal form ?"

(2.) Mr. Shiv Charan Gupta, the complainant took insurance policy from National Insurance Co. Ltd. During the subsistence of the policy, on 23.1.2006, he underwent hip replacement in G. M. Modi Hospital, Delhi. He was hospitalised from 21.2006 to 29.1.2006 and spent Rs. 1,72,648.00. The policy was renewed and again, he was operated for hip joint at the same hospital and spent Rs. 1,63,641.00. He was admitted there from 04.04.2007 to 10.04.2007. The complainant submitted the claim with bills to the OPs but the claim was repudiated stating that his case was covered by exclusion clause 4.1. of Medi-claim policy. Hence, the complainant filed a complaint before the District Forum, Faridabad.

(3.) The District Forum allowed the complaint and directed the OPs to pay Rs. 1,63,641.00 with interest @ 9% p.a. from the date of filing the complaint, also awarded compensation of Rs. 5500.00 and Rs. 2200.00 as litigation charges.