NCDRC

NCDRC

RP/2144/2010

ORIENTAL INSURANCE COMPANY LTD. - Complainant(s)

Versus

RAJNIBEN ISHVARLAL MODI - Opp.Party(s)

MR. R.S. RANA

10 Sep 2010

ORDER


NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSIONNEW DELHIREVISION PETITION NO. 2144 OF 2010
(Against the Order dated 10/12/2009 in Appeal No. 1195/2009 of the State Commission Gujarat)
1. ORIENTAL INSURANCE COMPANY LTD.Oriental House, P.B. No. 7037, A-25/27, Asaf Ali RoadNew Delhi - 110002Delhi ...........Petitioner(s)
Versus
1. RAJNIBEN ISHVARLAL MODIC/o. Ishvarlal Modi, Sparex Pvt. Ltd., 119, Rajlaxmi Complex, 16, Vijay Plot, Gondal RoadRajkot - 360002Gujarat ...........Respondent(s)

BEFORE:
HON'BLE MR. JUSTICE ASHOK BHAN ,PRESIDENTHON'BLE MRS. VINEETA RAI ,MEMBER
For the Petitioner :MR. R.S. RANA
For the Respondent :NEMO

Dated : 10 Sep 2010
ORDER

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          Respondent/complainant had taken mediclaim policy from the petitioner insurance company in the month of June/July 1999.  Acute pain started in the knee of the respondent, so she consulted Dr.Ketan Thakkar.  Doctor checked her and informed that there is need for knee replacement and, accordingly, operation was performed.  Respondent lodged a claim with the insurance company along with the bill of expenses and other necessary documents.  Petitioner insurance company repudiated the claim on the ground of suppression of fact by the respondent.  That she was suffering from osteoarthritis, which must have taken a long time to develop, which the respondent failed to disclose at the time of taking the policy.  Aggrieved by this, respondent filed a complaint before the District Forum.

          District Forum allowed the complaint and directed the petitioner to pay Rs.2,43,753/- along with running interest at the rate of 8% and costs of Rs.2,000/-.  Appeal filed by the petitioner has been dismissed by the State Commission by observing that “osteoarthritis is not a disease but it is part of changes which occur in the human body naturally and everybody faces such condition generally after the age of 25 years but it does not require operation”.

          We agree with the view taken by the fora below.  Respondent was not suffering from a disease as such.  It was a normal wear and tear of the body which occurs due to age.  Dismissed.

 



......................JASHOK BHANPRESIDENT
......................VINEETA RAIMEMBER