New India Assurance Co.Ltd. vs NIHAL CHAND KHATRI

THIS is an appeal against the judgment and order dated 30.8.1997 passed by District Consumer Forum, Saharanpur in Complaint Case No. 182/ 1993.

THE facts of the case are that the complainant took a Mediclaim policy and deposited a premium of Rs. 1,500/- on 5.3.1990. During the months of June and July the complainant fell seriously ill and he consulted Escorts Heart Institute and Research Centre on 5.7.1990 and he was advised surgical operation. On 16.10.1990 the complainant got himself operated at Batra Hospital, Delhi and remained in the hospital till 27.10.1990. He spent a sum of Rs. 64,000/- in all and submitted a claim to the Insurance Company on 1.11.1990. THE complainant also claimed a sum of Rs. 5,000/- as Misc. expenses and a sum of Rs. 769/- as fare from Saharanpur to Delhi and back. THE claim was repudiated and hence the claim petition for recovery of Rs. 69,000/- as damages was filed. On the other hand opposite party has alleged that on enquiry being made by the Insurance Company, it was revealed that the complainant was ill for a very long time and he has concealed material facts. Hence the claim was rightly repudiated.

The learned District Forum, after considering the case of the complainant, decreed the claim petition for Rs. 65,000/-.

AGGRIEVED against the order of the learned District Forum, the Insurance Company has come in appeal and has challenged the correctness of the order. We have heard the learned Counsel and perused the order of the learned District Forum.

LEARNED Counsel for the appellant, has referred Exhibit Nos. 3 and 4 filed alongwith affidavit of stay application to show that the deceased was suffering from heart ailments for a long time and material facts were concealed. Exhibit No. 3 is the report of the Surveyor who has reported that the complainant remained in the hospital between 16.10.1990 to 26.10.1990 on account of complaints of breathlessness, exertion and cough etc. Exhibit 4 is a form of the Insurance Company filled by somebody. It is alleged that it was filled up by the doctor who has treated the complainant but there is nothing to indicate that this is a report of the doctor who treated the complainant. There is no seal of the hospital and the name of the doctor who wrote this report is not indicated in the report. Both these documents cannot be relied upon and hence cannot be accepted. These documents are waste papers. Hence the appellant could not prove that the material facts were concealed or suppressed by the complainant. The case of the complainant was rightly decreed by the learned District Forum. The appeal has no force and is liable to be dismissed. ORDER The appeal is dismissed and the judgment and order of the learned District Forum are confirmed. Let copy be made available to the parties as per rules. Appeal dismissed.