NATIONAL INSURANCE CO. LTD. Vs. BALKHANDI LAL SHARMA

JUDGEMENT

(1.) THIS revision petition has been filed against the concurrent decisions of the lower Fora awarding compensation of Rs. 1.00 lakh towards medical claim insurance policy issued by the petitioner to the respondent -complainant. The petitioner assails the order passed by the State Commission on two grounds, (i) the report of the investigator Dr. R.K. Kakker dated 13.7.2001, wherein he has mentioned about certain treatment undergone by the petitioner since 2.11.2000, whereas the policy was issued on 28.1.2000 for one year and on 27.1.2001 which was further renewed for one more year. Dr. Kakker has filed this report without prejudice. However, he has not chosen to file any affidavit in support of his contentions made in this report. He also quoted the letter of Dr. Jayant Gupta addressed to Dr. Kakker, which reads as follows: Yours specific queries regarding -

(2.) THIS letter is not supported by any affidavit. Further, this letter clearly states that this was issued without going through the hospital records and notes. It is not disputed by the learned Counsel for the petitioner that the mediclaim policy was issued only after medical test especially after a particular age. In this case, the insured was 69 years old and the amount claimed by him is not very big. The amount claimed was for Rs. 44,658 for the first policy and Rs. 52,234 for the renewed policy for undergoing certain procedure relating to prostrate glands, Carcinoma of Bladder. It is not his case that the patient was advised CABG as he was suffering from IHD and, therefore, he had taken the insurance policy and tricked the Insurance Company to issue policy and subsequently presented a fat bill for indemnification. The main contention of the Insurance Company is that he has taken this policy by not disclosing the material facts like IHD.

(3.) IN our view, the learned Counsel for the petitioner has not placed any new arguments other than those, which were submitted before the lower Fora. No material facts were suppressed by the complainant. The report of Dr. Kakker and Dr. Gupta do not have any evidentiary value as they have not filed any affidavits. We cannot take them into consideration while arriving at any decision in this case.