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Judgment
AGGRIEVED by the order dated 16.9.2011 passed by the Maharashtra State Consumer Disputes Redressal Commission (for short ''the State Commission '') in FA No. 10/1312, the original complainant has filed the present petition. The appeal before the State Commission was filed against the order dated 19.10.2010 passed by the District Consumer Disputes Redressal Forum, Mumbai, in complaint No. 252/2007 by which order the District Forum had allowed the claim in the complaint and directed the Insurance Company to settle the medical claim of the complainant by paying a sum of Rs. 3 lakh within two months from the date of the order. In appeal, the State Commission has reversed the order and dismissed the complaint holding that in view of the terms and conditions of the policy, in particular the exclusionary clause, the complainant was not entitled to the reimbursement of the expenditure incurred by him at Ashirwad Hospital and Asian Heart Institute, Mumbai because the complainant had suppressed the material fact about his pre-existing disease and the treatment he had undergone for his heart ailment in the year 1994 and then in 2000.
WE have heard Mr. Mahaling Pandarge, Counsel for the petitioner and have considered his submissions. He would assail the findings of the State Commission primarily on the ground that the same is not based on correct and proper appreciation of the facts and circumstances of the case and the evidence and material brought on record. It is contended that the terms and conditions of the Policy which have been referred to in the order of the State Commission were never supplied to the complainant and in any case, no proposal form was filled and obtained by the complainant. We must reject this contention because the complainant has disclosed his particulars, may be online and had informed the insurer that he was only suffering from Hypertension and no other disease. However, from the treatment record the complainant received at Ashirwad Hospital and Asian Heart Institute, Mumbai, it has become clear that the complainant had a history of a pre-existing heart disease for which he had undergone an ''Aertoilac by-pass surgery '' in 1994 and thereafter TURBT was done in 2000. These facts were within the knowledge of the complainant still he chose to suppress them from the insurer company; reasons for doing so are not difficult to understand. This must be with the sole motive of obtaining a medi-claim which he would not have been granted, had he disclosed the correct facts. The State Commission has done well in setting aside the findings of the District Forum and has given cogent reasons for doing so. We see no illegality, material irregularity, much less any jurisdictional error in the impugned order passed by the State Commission, which calls for any interference of this Commission in exercise of its supervisory jurisdiction. The Revision Petition being devoid of any merit, is dismissed. Revision Petition dismissed.