NIRMAL JAIN Vs. UNITED INDIA INSURANCE COMPANY LIMITED

JUDGEMENT

(1.) This revision petition has been filed by the petitioner Nirmal Jain against the order dated 11.6.2013 of the State Consumer Disputes Redressal Commission, Madhya Pradesh, (in short 'the State Commission') passed in Appeal No.1035 of 2010.

(2.) Brief facts of the case are that the petitioner/complainant has taken a medi-claim policy from respondent/opposite party and the same was valid from 29.5.2007 to 28.5.2008. The petitioner/complainant got himself treated for by-pass surgery of heart and was admitted in S.A.L. hospital on 23.6.2007. He was operated on 26.6.2007 and was discharged on 6.7.2007. The claim under the medi-claim insurance was submitted by the complainant after the Insurance Company repudiated on 18.03.2008 and then again on 07.5.2008 the claim was repudiated on two ground that under Clause 4.2 of the exclusion clause, the claim was not admissible as the treatment started within 30 days of the commencement of the policy. The other ground of repudiation was that the claim is not admissible for any pre-existing disease as per the Exclusion Clause No.4.1. The petitioner filed a consumer complaint bearing No.14/2009 before the District Consumer Disputes Redressal Forum, Ratlam, (in short 'the District Forum'). The complaint was resisted by the opposite party on the same grounds as mentioned in the repudiation letter dated 07.05.2008. The District Forum allowed the complaint and passed the following order on 26.2.2010:-

(3.) Being aggrieved, the opposite party/Insurance Company preferred an appeal before the State Commission being Appeal No.1035/2010. The State Commission allowed the appeal and set aside the order of the District Forum vide its order dated 11.06.2013.