KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM. APPEAL No. 105/2009 JUDGMENT DATED:11-06-2010 PRESENT: JUSTICE SHRI. K.R. UDAYABHANU : PRESIDENT SHRI. M.K. ABDULLA SONA : MEMBER United India Insurance Company Ltd., Mannarkkad Branch, R/by Dr.Mohan Shankar, Sr. Divisional Manager, : APPELLANT United India Insurance Company Ltd., Divisional Office – 1, LMS Compound, Palayam, Thiruvananthapuram. (By Adv:Sri.R.Jagadeeshkumar) Vs. Kuttysankaran, Dhanya, Kumaram Puthoor, : RESPONDENT Mannarkkad, Palakkad. (By Adv:Sri.Dhananjayan) JUDGMENT JUSTICE SHRI. K.R. UDAYABHANU: PRESIDENT The appellant is the opposite party/United India Assurance Company Ltd in CC.146/2006 in the file of CDRF, Palakkad. The appellants are under orders to pay a sum of Rs.1,00,000/- being the claim amount and Rs.10,000/- as compensation and Rs.1000/- as cost. 2. It is the case of the complainant that he was covered by the medi claim policy issued by the opposite party and during the period he had to undergo a Coronary Artery Bypass operation. The claim submitted towards the medical expenses was repudiated alleging that he was having pre-existing diseases which were allegedly suppressed. 3. The opposite parties/appellants has asserted with the complainant was having hyper tension for the last 10 years and asthma from 1973 onwards. The above facts were suppressed. 4. The evidence adduced consisted of the proof affidavits of the respective sides, testimony of DW1 and Exts.A1 to A4 and B1 to B3. 5. The Forum has rejected Ext.B3 investigation report relied on by the appellants/opposite parties as DW1 the investigator has testified that the complainant was not having any pre-existing disease and that he was able bodied. Of course in the investigation report it is mentioned that when he questioned the complainant the complainant told him that he was ailing from bronchial asthma and hyper tension. But the same was not put to him by the opposite parties and clarification sought nor was he sought to be treated as hostile and cross-examined. Further no previous treatment records would be produced, complainant was also not cross-examined. Hence we find that there is no patent illegality in the appreciation of evidence in this regard. 6. All the same as pointed out by the counsel for the appellant the amount assured per person of the family of the complainant vide Ext.B1 policy is Rs.50,000/-. Hence we find that the complainant is entitled only for a sum of Rs.50,000/- vide Ext.B1 policy. In the circumstances the order of the Forum is modified as follows:- 7. The complainant will be entitled for a sum of Rs.50,000/- the assured sum with interest at 9% from the date of order of the Forum ie 10/12/2008. The direction to pay Rs.1000/- as cost is sustained. The direction to pay compensation of Rs.10,000/- is set aside. The appeal is allowed in part as above. Office will forward the LCR along with the copy of this order to the Forum. JUSTICE K.R. UDAYABHANU: PRESIDENT M.K. ABDULLA SONA : MEMBER VL. | 
