KULWANT SINGH Vs. UNITED INDIA INSURANCE CO LTD

JUDGEMENT

(1.) -CHALLENGE in this revision is to the order dated 20. 2. 2008 of Consumer Disputes Redressal Commission, Punjab, Chandigarh allowing appeal against the order dated 15. 5. 2001 of a District Forum. The District Forum had allowed the complaint filed by the petitioner with direction to the respondent Insurance Company to pay the amount mentioned in Medi-claim policy and cost of Rs. 2,000.

(2.) PETITIONER/complainant had purchased a Medi-claim policy commencing from 19. 3. 1999 for one year from the respondent/opposite party. Petitioner alleged that on 29. 3. 1999, he felt uneasiness and on the advice of his family doctor he was admitted at PGI, Chandigarh on 30. 3. 1999. He was operated for Mesenteric Vein Thrombosisend ileostomu + Distal Stunp Closure + Resection of Gangreneous Bowel on 7. 4. 1999. Second surgery was done on 12. 10. 1999. Disbursement of amount of Rs. 60,522 was claimed for the second surgery. On that claim being repudiated by the letter dated 14. 3. 2000 on ground of pre-existing disease by the Insurance Company, the petitioner filed complaint which was contested by the respondent. It was alleged that within 10 days of the taking of policy, the petitioner was operated upon at PGI in two stages. Petitioner did not intimate the respondent regarding his admission in hospital on 30. 3. 1999 to escape inquiry by the Insurance Company. Later on mala fide claim was lodged which was validly repudiated. Reference was made to the report of Investigator-Dr. Rajpreet Singh.

(3.) SUBMISSION advanced by Mr. Vikas Mahajan for the petitioner is that appeal was allowed by the State Commission on ground of violation of condition No. 5. 3 of the policy and not on ground of non-disclosure of pre-existing disease which was the basis for repudiating the claim. Further, the report of Dr. Rajpreet Singh, Investigator cannot be believed as neither petitioner was treated by him nor did he file his affidavit in support of the report. Petitioner had duly intimated the Insurance Co. about the second surgery. Copy of the Discharge Summary of the hospital is at pages 19 to 24. History as recorded in this Discharge Summary which is material, reads thus: "46 years old businessman, a k/c/o EHPVQ with bowel gangrene with status and ileostomy. Became symptomatic in 1997 when presented with UGI bleed H/o black stools + treated endoscopically, found to have oesophagel varices. Took treatment for 6 months after which he became a symptomatic. After 2-3 months started having pain abd. Lower abd. mild intensity, non-radiating. off and on, celieved by medicines. In January 1999, pain increased in intensity, came generalized, he presented to PGI on 30. 3. 1999 with acute exacerbation. Operated on 7. 4. 1999 with a diagnosis of mesenteric vein thrombosis and ileostomy + distal sump closure = resection of gangrenous bowel dong. Was a symptomatic thereafter, now had come for ileostomy closure. "