Per Shri P.N. Kashalkar – Hon’ble Presiding Judicial Member:

(1)                By consent we have decided to hear appeal for admission.  We are finding that the mediclaim policy was purchased by Respondent and Respondent in the proposal form clearly mentioned that he had undergone operation because he had an infection in lower left mandible region in 1995 and in column no.7 he had clearly mentioned that presently he was not having any ailment which would require medical attention.  He had purchased policy for sum of `5 lac and when he had lodged the claim for the amount of `67,226/-, the Insurance Company repudiated the claim wrongfully and illegally citing that the illness is covered under the exclusion clause 4.1 of the policy.  In our view when he had clearly disclosed that he had suffered infection in left lower left mandible region in 1995, it was the duty of the Insurance Company to mention in mediclaim policy issued to the Respondent that any ailment pertaining to any sort of infection or disease sustained to the Respondent towards previously operated area would stand excluded from the policy.  This was not mentioned anywhere in the policy issued to the Respondent and therefore, the District Forum rightly allowed the complaint directing the Insurance Company to pay sum of `67,226/- as per insurance policy issued to him.  The order of the District Forum is just and proper and therefore, at the stage of admission, we summarily reject the appeal preferred by the Insurance Company

(2)                We direct Insurance Company to pay the said amount in terms of award besides `2,000/- imposed today for condoning the delay in filing appeal.

(3)                This order should be complied with within one month from the date of receipt of the copy of the order.

Pronounced on 16^th October, 2012.