Rajasthan

StateCommission

A/664/2018

The Oriental Insurance Company Ltd. - Complainant(s)

Versus

Girdhari Lal Agarwal s/o late Shri Baijnath - Opp.Party(s)

Virendra Saraswat

13 Aug 2019

ORDER

BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION,RAJASTHAN,JAIPUR BENCH NO.1

 

FIRST APPEAL NO: 664 /2018

 

The Oriental Insurance Co. Ltd. Regional office, Anand Bhawan, Sansar Chander Road, Jaipur.

Vs.

Girdhari Lal Agarwal s/o latge Baijnath r/o House No. 95, Vijaibari, Sikar Road, Jaipur.

 

 

Date of Order 13.8.2019

 

Before:

Hon'ble Mrs. Justice Nisha Gupta- President

Mrs. Meena Mehta -Member

 

Mr. Virendra Saraswat counsel for the appellant

Mr. Rajbihari Gehlot counsel for the respondent

 

BY THE STATE COMMISSION ( PER HON'BLE MRS. JUSTICE NISHA GUPTA,PRESIDENT):

 

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This appeal is filed against the order of the learned District Forum, Jaipur 3^rd dated 27.7.2018 whereby the claim is allowed against the appellant.

 

The contention of the appellant is that prior to filing of the proposal form the insured was suffering from hypertension which was excluded under the terms of the policy. Hence, the claim should have been dismissed.

 

Per contra the contention of the respondent is that hypertension is only a life style disease and the claim has rightly been allowed. He was undergone for angina and hypertension was not a risk factor for the same.

 

Heard the counsel for the parties and perused the impugned judgment as well as original record of the case.

 

There is no dispute about the fact that the insured purchased the policy on 24.5.2012 and the declaration has been signed by the insured that he has read the prospectus and have understood the same and as per prospectus pre-existing diseases were excluded from the claim and the list has also

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been shown wherein hypertension was excluded for two years and it is not in dispute that within two years the insured has admitted for cardiological treatment. A request for cashless hospitalization was made by the insured himself wherein it has been mentioned that he is suffering from hypertension since ten years.

 

The contention of the insured is that he was undertaken treatment for angina and hypertension was not risk factor of the same. Be that may be the case it is clearly established from the record that insured was suffering from hypertension for last ten years but he has not disclosed the same in the proposal form and the claim has rightly been dismissed by the insurance company for non-disclosure of the material facts.

 

The appellant has relied upon judgments passed by the Hon'ble National Commission in Revision Petition No. 2957/2012 Reena Kansal Vs. United India Insurance Co. and Revision Petition No. 3725/2013 National Insurance Co. Vs. Abdul Razak.

 

 

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The respondent has relied upon I (2012) CPJ 84 (NC) Tarlok Chand Khanna Vs. United India Insurance Co. where no credible evidence or medical opinion was submitted on behalf of the insurance company but here in the present case the appellant has submitted the discharge summary of Fortis Hospital which has not been disputed by the insured.

 

Further reliance has been placed on I (2008) CPJ 501 (NC) National Insurance Co. Vs. Rajnarain where exclusion clause was not disclosed to the insured wherein in the present case the insured has signed the declaration that he has read the prospectus and has understood the same. Hence, there is no question of non-supply of the terms and conditions.

 

Further reliance has been placed on I (2000) CPJ 1 (SC) Modern Insulators Ltd. Vs. Oriental Insurance Co. where fundamental principle is explained that utmost good faith must be observed by contracting parties.

 

In view of the above when the insured was suffering from hypertension prior to purchase of the policy, the claim

 

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should have been dismissed on non-disclosure of the material facts.

 

In view of the above ,the appeal is allowed and the order of the Forum below dated 27.7.2018 is set aside.

 

(Meena Mehta) (Nisha Gupta)

Member President

 

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