Per – Hon’ble Mr. P. N. Kashalkar, Presiding Judicial Member
None present for the Appellant/original Complainant. Heard Adv. R. P. Bafna on behalf of the Respondents/original Opponents.
[2] This is an appeal filed by the original Complainant, whose consumer complaint No.283 of 2009, Mr. Amit Paras Bohra Vs. The Branch, The New India Assurance Company Ltd. & Anr., was dismissed by the District Consumer Disputes Redressal Forum, Nashik (hereinafter referred to as ‘the District Forum’ for the sake of brevity) by an order dated 8/4/2010.
[3] We are finding that the Appellant/original Complainant (hereinafter referred to as ‘the Complainant’ for the sake of brevity) had taken a mediclaim insurance policy from the Respondent No.1/original Opponent No.1, namely – The New India Assurance Company Ltd. (hereinafter referred to as ‘the insurance company’ for the sake of brevity) for the period from 14/8/2008 to 13/8/2009. On 26/1/2009, the Complainant was admitted to the Lilavati Hospital. On the following day, he underwent a surgery in Lilavati Hospital for removal of kidney stone. He paid bill for an amount of `2,68,861/- of the Lilavati Hospital. Thereafter, the Complainant lodged a claim for reimbursement with the insurance company. However, the insurance company was pleased to repudiate the claim by a letter dated 28/2/2009 mentioning therein that the Insured (the Complainant) had not disclosed pre-existing ailment and, therefore, the insurance policy is void as per Clause No.(4.1) of terms & conditions of the insurance policy. Feeling aggrieved by such repudiation of his insurance claim, the Complainant filed a consumer complaint.
[4] The consumer complaint was contested by the insurance company filing its written version. Insurance company pleaded that since the Complainant had deliberately suppressed material pre-existing ailment from the insurance company while filling-in the proposal form and since after lodging of the complaint the insurance company found that as per Discharge Card issued by the Lilavati Hospital, the Complainant was suffering from ‘Renal Calculi’ since 10 years, the insurance company pleaded that because of suppression of material fact, the insurance company had rightly repudiated the claim lodged by the Complainant.
[5] The District Forum agreed with the submissions made by the insurance company and was pleased to dismiss the consumer complaint. Feeling aggrieved by such dismissal of his consumer complaint, the Complainant has filed this appeal.
[6] Upon hearing the Learned Counsel for the Insurance Company and upon perusal of the impugned order in question we are finding that there is no merit in the appeal preferred by the Complainant. The Complainant had suppressed material pre-existing ailment from the insurance company when he filled in the proposal form. Contract of insurance is based on utmost good faith. The principle of utmost good faith has been violated by the Complainant while supplying information regarding his health in the column specifically incorporated in the proposal form. It was the duty of the Complainant to disclose that he was suffering from ‘Renal Calculi’ illness for the last 10 years. Since the Complainant had suppressed it and since the insurance company came to know from the papers submitted by the Complainant himself that he was suffering from ‘renal calculi’ for the past 10 years, we are of the view that the insurance company was within its rights to repudiate the claim on the ground of suppression of material fact regarding the Complainant’s pre-existing ailment. In the circumstances, the order of dismissal of the consumer complaint passed by the District Forum is appearing to be just, proper and sustainable in law. There is no merit in the appeal preferred by the Complainant.
ORDER
Appeal stands dismissed.
No order as to costs.
Inform the parties accordingly.
Pronounced and dictated on 8th February, 2012
