NEW INDIA ASSURANCE CO LTD Vs. ANIL BARUAH

JUDGEMENT

(1.) This appeal has been filed by appellant New India Assurance Co. Ltd. under Sec.15 of the Consumer Protection Act, 1986 , against the judgment dated 6.9.1996 of District Consumer Disputes Redressal Forum (for short, District Forum), Kamrup in C. P. Case No.107/95.

(2.) To state briefly the facts of the case are as follows. Complainant Shri Anil Baruah (respondent herein) took a mediclaim policy from opposite party (for short O. P.) Insurance Company (appellant herein) covering his four family members including his son Sumeet Baruah for a period of one year only from 7.2.1995 to 6.2.1996. In May, 1995 his son Sumeet fell ill and he was admitted to a private hospital for medical treatment. It was detected by the doctor that the complainant's son was suffering from bleeding internal morrhoids (internal piles ). He had undergone treatment by blood transmission followed by surgical operation. The opposite party Insurance Company was duly informed of the hospitalisation and medical treatment on 8.5.1995 on discharge of the patient from the hospital after medical treatment the complainant filed a claim to opposite party for Rs.11,423/- only against medical bill of the hospital.

(3.) The opposite party Insurance Company (appellant herein) repudiated the claim on the ground that the disease was pre-existing and that is occurred in the first year of the policy, which is excluded under Clause 4.12 of the policy conditions. The complainant objected to it and wrote a letter to opposite party No.2 on 25.7.1995 stating that the existence of the disease prior to taking of the policy was not known either to the complainant or to his son Sumeet. So, he requested for review of the decision on his claim. On 22.8.1995 the opposite party No.2 informed the complainant that his claim could not be entertained as per opinion of the panel doctors of the Insurance Company