United India Insurance Co. Ltd. vs MANOJKUMAR S.SHETH

THIS appeal arises from order dated 19th March, 2001 rendered by the learned Panchmahal District Consumer Disputes Redressal Forum at Godhra in Complaint Application No. 58/1999 directing the opponent Insurance Company to pay to the complainant Rs. 82,000/- by way of treatment expenses, Rs. 5,000/- by way of compensation on the head of mental agony and hardship and Rs. 2,000/- by way of cost of the complaint, in all Rs. 89,000/- with interest @ 9% p.a. from the date of complaint till payment and also penal interest @ 15% upon the opponent Insurance Company committing default in making payment as directed.

WE have heard the learned Advocates for the parties. The short question which requires to be dealt with is whether the heart ailment for which the claim under mediclaim policy was preferred by the complainant was in existence prior to the date of first policy and whether it was known to the insured prior to the date of proposal of the first policy of mediclaim. WE have gone through the impugned order. WE have gone through the medical certificates shown to us by the learned Advocate for the opponent Insurance Company. There are a couple of infirmities on the part of the opponent Insurance Company in not presenting its, case before the learned Forum or in not supporting the repudiation of the claim. In the first place there is no investigation or evidence collected for supporting the ground of repudiation namely, that there was pre-existing disease as aforesaid and that it was known to the insured before the first policy. In the second place even before the learned Forum no affidavit of any Doctor has been filed to show the aforesaid two facts. Even from the papers, which we have been shown, it could not be spelt out whether the disease in question had set in at any time prior to the first policy and that the insured knew about it and had suppressed the fact at the time of first insurance. However, with regard to the award of compensation on the head of mental agony and hardship there is no justification either on facts or in law. We, therefore, pass following order :

Impugned order dated 19th March, 2001 rendered by the learned Panchmahals District Consumer Disputes Redressal Forum at Godhra in Complaint Application No. 59/1999 is hereby maintained except with regard to compensation in the sum of Rs. 5,000/- on the head of mental agony and hardship and except with regard to penal interest.

THE opponent Insurance Company is stated to have deposited Rs. 82,000/- in this Commission. Office to verify the same and pay that amount to the complainant by A/c payee cheque. Balance amount shall be paid by the opponent Insurance Company to the complainant within 8 weeks from today. This appeal is accordingly partly allowed with no further order as to cost. Appeal partly allowed.