Chandubhai C. Shah vs United India Insurance Co. Ltd.

CHALLENGE in this revision petition is to the order dated 10.09.2009 passed by the Gujarat State Consumer Disputes Redressal Commission, Ahmedabad (''State Commission'' for short) dismissing the appeal filed by the original complainant who is petitioner herein against the order dated 30.09.2006 of the District Forum. Briefly stated, the facts of this case are that the original complainant had taken a mediclaim policy for Rs.1,00,000/- from the OP Insurance Co. for the year 1994-95. In the year 1997-98, the cover amount was increased from Rs.1,00,000/- to Rs.1,50,000/-. The cover amount was further increased from Rs.1,50,000/- to Rs.3,00,000/- when this policy was renewed from the date 8.12.1998 to 7.12.2000. It is the case of the complainant that he had filled up the proposal form for such renewal and increase in the cover amount on 1.12.1999, which was later accepted by the OP Company and the renewed policy became effective from 8.12.1999. The day on which the renewed policy came into force, i.e., on 8.12.1999, the complainant suffered a CV stroke and was admitted into Dr. Bhailal Amin Hospital, Vadodara and was there from 8.12.1999 to 21.12.1999. Thereafter, he was taken for treatment to Navneet Memorial Hospital for the period from 21.12.1999 to 18.01.2000. After his discharge from Navneet Memorial Hospital on 18.1.2000, he was again taken to Navneet Memorial Hospital for treatment for the period from 07.03.2000 to 14.03.2000 for acute breathlessness. The complainant, therefore, filed two claims under his mediclaim policy bearing nos. 233 of 1999 and 1953 of 1999 wherein the first claim was of old policy amounting to Rs.1,50,000/- which was duly paid by the OP Company by releasing an amount of Rs.1,57,500/- (with 5% cumulative bonus) but the second claim under the renewed policy was not paid up. The complainant, therefore, lodged a consumer complaint with the District Forum, which, after appraisal of the issues and the evidence adduced by the parties, rejected the complaint. When this order of the District Forum was carried by the complainant in appeal before the State Commission, the State Commission also upheld the order of the District Forum and dismissed the appeal of the complainant by its impugned order and hence the present revision petition.

WE have heard learned counsel for the petitioner and the respondent. WE have also gone through the concurrent orders of the fora below. The main ground on which the complainant/petitioner herein has been unsuited by the lower fora is that while getting his mediclaim policy renewed w.e.f. 8.12.1999 with an enhancement in the cover from Rs.1,50,000/- to Rs.3,00,000/-, the complainant had suppressed the fact of his previous illness and had given incorrect replies to specific questions regarding his health condition in response to question nos. 12 and 12.1 thereby suppressing material information in respect of existing problems pertaining to his health. Not only this, admittedly the complainant also suffered CV stroke and was admitted into Dr. Bhailal Amin Hospital, Vadodara on 8.12.1999, i.e., the day on which the increase cover under the renewed policy had come into force. The OP Insurance Co., therefore, carried an investigation through Dr. Himanshu P. Choliya who after looking to the treatment papers of the complainant and the discharge card, filed an affidavit in support of this report which was neither challenged by the complainant nor any evidence was adduced by an expert doctor against it. The OP Company, therefore, had opposed the complaint of the complainant on the ground of breach of the principle of ''utmost good faith'' under the insurance agreement by the complainant by hiding the material information regarding his suffering from hypertension and diabetes mellitus while renewing the policy for enhanced cover w.e.f. 8.12.1999. It is to be noted that in all fairness, the OP Company has already settled the claim of the petitioner to the extent of Rs.1,50,000/- covered by the mediclaim policy before its renewal. No fresh ground has been put fourth by the petitioner in his revision petition in support of his claim. WE, therefore, do not see any reason to interfere with the concurrent finding of facts of the fora below while exercising the revisional jurisdiction. The revision petition of the petitioner/complainant is devoid of substance and hence dismissed with no order as to costs.