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New India Assurance Co. Ltd. Through Its Manager Vs. Mohinder Kaur Widow of Mohan Singh - Court Judgment

LegalCrystal Citation
CourtNational Consumer Disputes Redressal Commission NCDRC
Decided On
Case NumberRevision Petition No. 1979 of 2008
Judge
AppellantNew India Assurance Co. Ltd. Through Its Manager
RespondentMohinder Kaur Widow of Mohan Singh
Excerpt:
.....and claim was rightly repudiated by letter dated 31.3.2002 and prayed for dismissal of complaint. learned district forum after hearing both the parties, allowed complaint and directed op to pay rs.1,00,000/- along with 18% p.a. interest and awarded cost of rs.2500/-. appeal filed by the petitioner was partly allowed by learned state commission vide impugned order and interest awarded @ 18% p.a. by district forum was modified to 9% p.a. and rest of the order was upheld against which, this revision petition has been filed. 3. heard learned counsel for the parties and perused record. 4. learned counsel for the petitioner submitted that on account of suppression of pre-existing disease, petitioner rightly repudiated claim of the insured; even then, learned district forum committed error in.....
Judgment:

K.S. Chaudhari, Presiding Member

This revision petition has been filed by the Petitioner/OP against the order dated 07.02.2008 passed by the Punjab State Consumer Disputes Redressal Commission, Chandigarh (in short, the State Commission) in Appeal No. 1077/2002 “ M/s. The New India Assurance Co. Ltd. Vs. Mohinder Kaur by which, while allowing appeal partly, order of District Forum allowing complaint was modified.

2. Brief facts of the case are that complainant/respondents husband Mohan Singh obtained medi-claim insurance policy from the OP/petitioner on 24.10.2000 for a period of one year for a sum of Rs.1,00,000/-. During the subsistence of the insurance policy, Mohinder Singh developed brain tumor and spent more than Rs.1,20,000/- on his treatment and ultimately died on 06.11.2001. Mohan Singh during his life time approached OP for reimbursement of medical expenses, but to no effect. Later on, complainant filed complaint before District Forum alleging deficiency on the part of OP. OP resisted complaint and submitted that deceased Mohan Singh did not disclose that he was suffering from aforesaid disease and in such circumstances, was not entitled to reimbursement of the medical expenses and claim was rightly repudiated by letter dated 31.3.2002 and prayed for dismissal of complaint. Learned District Forum after hearing both the parties, allowed complaint and directed OP to pay Rs.1,00,000/- along with 18% p.a. interest and awarded cost of Rs.2500/-. Appeal filed by the petitioner was partly allowed by learned State Commission vide impugned order and interest awarded @ 18% p.a. by District Forum was modified to 9% p.a. and rest of the order was upheld against which, this revision petition has been filed.

3. Heard learned Counsel for the parties and perused record.

4. Learned Counsel for the petitioner submitted that on account of suppression of pre-existing disease, petitioner rightly repudiated claim of the insured; even then, learned District Forum committed error in allowing complaint and learned State Commission further committed error in upholding order; hence, revision petition be allowed and impugned order be set aside, complaint be dismissed. On the other hand, learned Counsel for the respondent submitted that order passed by learned State Commission is in accordance with law; hence, revision petition be dismissed.

5. Learned Counsel for the petitioner submitted that it is well proved by evidence that complainants husband while taking medi-claim policy fraudulently suppressed pre-existing disease. In such circumstances, petitioner has not committed any deficiency in repudiating claim. In support of his contention, he has placed reliance on “

i) III (2011) CPJ 43 (NC) “ Maya Devi Vs. Life Insurance Corpn. of India;

ii) IV (2011) CPJ 71 (NC) “ Bhanwari Devi Vs. Bharatiya Jeevan Bima Nigam and Anr.

iii) IV (2011) CPJ 603 (NC) “ Life Insurance Corpn. of India Vs. Francis Antony Dsouza

iv) IV (2012) CPJ 354 (NC) “ New India Assurance Co. Ltd. Vs. K.M. Babu Reddy

v) I (2012) CPJ 547 (NC) “ National Insurance Co. Ltd. Vs. Ashok Kumar Gupta.

6. We agree with the principle laid down in the aforesaid judgments, but the question is whether deceased suppressed pre-existing disease at the time of taking medi-claim policy or not. Admittedly, in the proposal form, he has denied that he was having any cancer, malignant growth which did not heal or improve despite treatment. As per Annexure P2, discharge summary issued by Rancan Gamma Knife Centre, deceased was having Stereotactic contrast MRI on the date of treatment (20.7.2001) which revealed right frontal basal region enhancing meningioma measuring 7.6 cubic cm in volume. Operation was conducted and he was discharged on 21.7.2001 with history which runs as under:

œThe patient presented with history of severe headache in June 2001. He consulted a physician at the Punjab Health Systems Corporations, Ropar, who advised MRI head. MRI dated 2.7.2001 revealed a right-sided basifrontal enhancing meningioma with surrounding edema. He was given the option of both microncurosurgery and Gamma Knife Radiosurgery and the patient opted for Gamma Knife Radiosurgery for tumor control?.

7. In this history, operating doctor and other doctors has nowhere stated that disease dates back to 1998, whereas in response to investigators letter Dr. M.S. Gaur, who conducted surgery has intimated to the investigator by letter dated 1.11.2001 i.e. almost after 27 months as under:

œ1. History of patients disease as given to us dates back to 1998 when he had a epileptic attack and CT scan was taken which showed a right basifrontal meningioma. No definitive time of existence of this tumor, before this can be imagined or suggested.

2. Growth rate of Meningioma cannot be standardized like that as it vary from patient to patient.

3. We know that there is a Meningioma in patients brain since 1998, so already more than 2 years?.

8. This report has been given by Dr. Gaur after 27 months in which it has specifically mentioned that there was epileptic attack and CT scan was taken which showed a right basifrontal meningioma, but petitioner has not placed on record CT scan taken in 1998 and record of any treatment taken in 1998. In such circumstances, this report which has been given after 27 months and that too just before 5 days of death of Mohan Singh cannot be believed. Investigator has also submitted in his report that he also discussed the case with Dr. Jindal, Neuro Surgeon on 27.10.2001 and according to him, disease was at least two years old, but he has also mentioned that Dr. Jindal did not give him any opinion in writing. Dr. Jindal has not been examined by the petitioner before District Forum. In such circumstances, no reliance can be placed on the investigators report regarding Dr. Jindals opinion.

9. Learned District Forum has elaborately discussed evidence and allowed complaint and reasons given by District Forum have been reiterated in the impugned order and we do not find any reason to differ with the opinion given by learned District Forum and upheld by learned State Commission.

10. Consequently, revision petition filed by the petitioner is dismissed with no order as to costs.


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