PER SHRI.S.M.SHEMBOLE, HON’BLE JUDICIAL MEMBER
This appeal is an exception to the judgment and order dated 20/6/2011 passed by the District Consumer Forum, Nagpur partly allowing the complaint No.683/2010 directing the appellant/Opponent Insurance Company to pay Insurance amount of Rs.78,750/- to the Respaondent/complainant. Feeling aggrieved by the impugned judgment and order, Original Opponent New India Assurance Co. has preferred this appeal.
Heard Adv.Jain counsel for the appellant and perused the copy of impugned judgment and order and the copies of complaint, reply submitted by the opponent, Insurance policy and other documents produced by the appellant alongwith appeal.
There is no dispute that the Ori.complainant had taken mediclaim policy of sum assured of Rs.75000/- with hospitalization benefit for the period 17/4/2008 to 16/4/2009. As complainant was kidney patient, he was hospitalized in January,2009 for haemodialysis and later on renal transplant operation was conducted. It was on 16/4/2009. However, his claim for the assured amount was repudiated on the ground that he had pre existing disease of sickle cell. Hence the complainant filed complaint before the District Consumer Forum, Nagpur.
Complainant’s claim was resisted by the Opponent Insurance Company on the ground that the complainant was suffering from kidney disease since prior to taking the policy and he suppressed the material fact about his ailment etc.
On hearing both the sides, the District Consumer Forum partly allowed the complainat directing the appellant to pay compensation of Rs.78,750/- to the complainant and further pay Rs.2000/- towards cost of proceeding.
Being aggrieved by the same judgment, the Opponent Insurance Company has preferred this appeal.
Mr.Jain, ld. Counsel for the Appellant submitted that since the complainant has suppressed material facts i.e. his ailment of sickle cell, anemia by which he was suffering, he was not entitled for any claim but the Forum, without considering this material fact, allowed the claim. But Mr.Jain could not point out as to how the complainant has suppressed the material fact. However, he has fairly conceded that at the time of accepting the policy, the Insurance Company has not obtained medical certificate. No explanation is given by the appellant as to why no medical certificate was obtained before accepting the policy. Therefore, the contention of the appellant that the complainant has suppressed material facts can not be accepted. Therefore, the District Consumer Forum has rightly negatived the defense of the Insurance Company. Hence we find no reason to interfere with the impugned judgment and order.
In the result, the appeal being devoid of any merit is summarily rejected.
Delivered on 16/09/2011
