NCDRC

NCDRC

RP/2906/2011

UPENDRA SHARMA - Complainant(s)

Versus

BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD. - Opp.Party(s)

MR. BARUN PRASAD

31 Jul 2012

ORDER

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
REVISION PETITION NO. 2906 OF 2011
 
(Against the Order dated 01/07/2011 in Appeal No. 694/2010 of the State Commission West Bengal)
1. UPENDRA SHARMA
Teascher Darjeeling Hindi high School, R.N Sinha Road, Near GDNS
Darjeelinmg - 734101
West Bangal
...........Petitioner(s)
Versus 
1. BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.
G.E Plaza Airport Road, yerawada
Pune - 411006
Maharastra
...........Respondent(s)

BEFORE: 
 HON'BLE MR. JUSTICE R.C. JAIN, PRESIDING MEMBER
 HON'BLE MR. JUSTICE V.B. GUPTA, MEMBER

For the Petitioner :
Ms. Rupali S. Ghosh, Advocate
For Mr. S.K. Ghosh, Advocate
For the Respondent :
Mr. Joy Basu, Advocate

Dated : 31 Jul 2012
ORDER

Counsel for the petitioner states that she has already informed the petitioner through a registered notice about his inability to pursue this matter on behalf of the petitioner and to seek discharge from this case. That apart, a notice was also issued to the petitioner by this Commission for today hearing which has been duly served on the petitioner through a registered post with acknowledge due card, received back. That would show that the petitioner is not serious / interested in prosecuting this revision petition. Even then, we have examined the grounds set-up in the Memorandum of revision petition in order to assail the findings and impugned order of the State Commission. In our view, the State Commission going by the evidence and material produced on record more particularly from the Wockhardt Hospital, Bangalore has rightly come to a conclusion that the petitioner had suppressed the material fact about his suffering from a heart-disease for which he received a certain treatment as late as on 28.06.2009 which he did not disclose to the respondent insurance company at the time of taking the insurance policy on 11th July 2009, i.e., 12 15 days after the said procedure. In this regard, the State Commission has observed as under:- n the proceeding before the Forum below the Complainant in support of his case has filed the Discharge Certificate issued by the said hospital at Bangalore which has been made Annexure to the memo of appeal. The said Discharge Summary in an unambiguous manner has disclosed that the Appellant before being fell ill in the month of July had an Inferior Wall Myocardial Infarction (Thrombolysed) on 28.06.2009 with systemic hypertension and he was treated for such acute Inferior Wall Myocardial Infarction at elsewhere before being admitted in the aforesaid Wockhardt Hospital at Bangalore. This very document, which has been relied upon by the Complainant himself to substantiate his claim for disbursement of the expenses incurred for his medical treatment has clearly revealed that the Complainant had such Inferior Wall Myocardial Infarction recently before taking of the Insurance Policy from the O.P. Insurer without disclosing the fact of such recent Inferior Wall Myocardial Infarction of the Complainant. It has been consistently held in claim cases arising out of repudiation of the medical insurance claim that where insured has suffered heart problem from which he was suffering from before taking of the Policy and has not disclosed his suffering at the time of taking of the Insurance Policy, it is a case of material suppression of facts which would justify repudiation of the claim. It has nowhere been established by the Complainant that before inception of the above Insurance Policy the factum of suffering of the Complainant of such Inferior Wall Myocardial Infarction was made known to the Insurer. The District Forum below has thus failed to notice from the aforesaid Discharge Summary issued by the hospital itself in which the Complainant was treated that there was clear material suppression of facts by the Complainant at the time of taking of the Insurance cover. In our view, the findings recorded by the State Commission are fully justified on record and are otherwise in consonance with the settled law laid down by the Supreme Court in the case of .C. Chacko & Anr. Vs. Chairman, LIC of India[(2008) 1 SCC 321] and atwant Kaur Sandhu Vs. New India Assurance Co.[(2009) 8 SCC 316]. We see no good ground to upset the said findings of the State Commission. The revision petition is accordingly dismissed.

 
......................J
R.C. JAIN
PRESIDING MEMBER
......................J
V.B. GUPTA
MEMBER

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