AI Structured Summary
Not yet generated for this judgment
Judgment
THIS revision petition has been filed by the Petitioner/complainant against the impugned order dated 1.9.2009 passed by the Madhya Pradesh State Consumer Disputes Redressal Commission, Bhopal (in short, ''the State Commission '') in Appeal No. 1212 of 2007 - LIC Vs. Satish Kumar by which, while allowing appeal, order of District Forum allowing complaint was set aside.
BRIEF facts of the case are that petitioner/complainant obtained "Asha Deep Policy " from respondent/OP on 15.11.1993, but policy lapsed in May, 1997 and was revived in the year 1998. On 15.5.2001, complainant was detected to be the heart patient and was operated. Complainant submitted claim for payment of amount spent by him in operation, but OP repudiated it by letter dated 8.10.2001 on the ground that complainant did not disclose that he had suffered from diabetes and hypertension. Complainant alleging deficiency on the part of OP filed complaint. OP resisted complaint on the ground mentioned in repudiation letter. Learned District Forum after hearing both the parties allowed complaint and directed OP to pay claim amount along with 6% p.a. interest and further directed to pay Rs.5,000/- as compensation and Rs.2,000/- as litigation expenses. OP/respondent filed appeal before the State Commission and learned State Commission vide impugned order while allowing appeal dismissed complaint against which, this revision petition has been filed. Heard learned Counsel for the parties and perused record.
LEARNED Counsel for the petitioner submitted that petitioner did not disclose any disease, as he was not aware of the disease and learned District forum rightly allowed complaint, but learned State Commission has committed error in allowing appeal and dismissing complaint on the ground of suppression of disease; hence, revision petition be allowed and impugned order be set aside. On the other hand, learned Counsel for the respondent submitted that order passed by learned State Commission is in accordance with law, which does not call for any interference; hence, revision petition be dismissed.
PERUSAL of record reveals that petitioner obtained insurance policy from the respondent on 15.11.1993 and after lapse in 1997, it was again revived in the year 1998. Perusal of record further reveals that petitioner was admitted in Apollo Hospital on 8.5.2001 on account of heart trouble and after operation on 15.5.2001, he was discharged on 22.5.2001. Consultant Cardiologist of Apollo Hospital submitted report on 14.8.2001 in which he mentioned that petitioner had symptoms of heart disease from 23.3.1995 and it was further mentioned that petitioner was having diabetes since 1995. Operating Surgeon of Apollo Hospital in his report dated 14.8.2001 mentioned that petitioner was diabetic since 10 years. In discharge summary dated 22.5.2001 issued by Apollo hospital the complainant was observed as under: This 44 years old gentleman, normotensive, diabetic since 10 years, was admitted with history of an old antero septal MI in March 1995, class III angina since 3 months and a positive TMT, for further cardiac evaluation. He was evaluated by cardiac cath and coronary angiography which revealed triple vessel disease with mild LV dysfunction. He was advised CABG surgery ". Thus, it becomes clear that complainant was admitted in the Apollo Hospital for treatment and was found diabetic since last 10 years meaning thereby, he was diabetic since 1991, whereas complainant obtained policy in 1993 and after lapse; he got it revived in the year 1998. At the time of taking original policy and subsequently at the time of revival of policy, complainant was under obligation to disclose previous disease of diabetes, but he has not disclosed this fact and fraudulently suppressed material facts. Learned State Commission rightly observed that complainant suppressed pre-existing disease twice, firstly at the time of taking original policy and secondly, at the time of revival of policy. Learned State Commission rightly observed in paragraph 5 as under: "It is difficult to believe that such a major ailment was not known to the complainant. The documents relating to treatment taken for these diseases for long period are filed on record, therefore, it cannot be believed that he did not know about their existence. Under these circumstances, we find that the respondent is not entitled to any relief ".
On account of suppression of material facts, respondent has not committed any deficiency in repudiating claim. We do not find any illegality, irregularity or jurisdictional error in the impugned order, which calls for any interference and revision petition, is liable to be dismissed.
CONSEQUENTLY , revision petition filed by the petitioner against the respondent is dismissed with no order as to costs.