^{UNIONTERRITORY,CHANDIGARH}

^{1.      MariwalaTown, Manimajra, U.T. Chandigarh.}

^{2.     The Oriental Insurance Company Limited,SurindraBuilding, Sector 17-D,Chandigarh.}

^{---- Appellants/Opposite Parties}

^Versus

^{Vinod Garg son of Late Sh. Sumer Pal Garg, SCF No.45, Grain Market, Pehowa, District Kurukshetra.}

^{---Respondent-Complainant}

^BEFORE:

^{Argued by:}

^{PER PADMA PANDEY, MEMBER}

^“10.   

^{[a]     To reimburse the remaining claim amount}

^{[b]     To pay compensation of Rs.15,000/- on}

^{[C]     To pay Rs.7,000/- as cost of litigation;}

^{11.        The above said order shall be complied within 45 days of its receipt by the Opposite Parties; thereafter, they shall be liable for an interest @18% per annum on the amount mentioned in sub-para [a] & [b] of para 12 above, apart from cost of litigation of Rs.7,000/-, from the date of institution of this complaint, till it is paid”.} 

^{2.                    In brief, the facts of the case, are that the complainant obtained a PNB Oriental Royal Mediclaim Policy from the Opposite Parties, which he continued to renew from time to time and currently, the same was valid from 13.07.2012 to 12.07.2013 covering himself and his wife for a sum assured of Rs.5.00 lacs (Policies C-1, C-1/A & C-1/B).} 

^{3.                    In their written reply, the Opposite Parties, while admitting the factual matrix of the case stated that the complainant was covered under the Insurance Policy, which was running in the third year from the date of inception of the same. It was further stated that as the same had not completed the period of three years by virtue of which the pre-existing diseases, existing at the time of inception of the first policy would have been covered, the present claim being the result of pre-existing disease existing prior to the inception of the policy, was not payable and   the claim of the complainant was rightly repudiated vide Annexure C-5 explaining clear reasons for the same and after due application of mind and after seeking opinion from the medical expert/ doctor. It was further stated that, therefore, there was no deficiency in service on their part. It was further stated that the complainant had concealed the material fact that he had been suffering from the disease/ailment hypertension for the last ten years, which was a leading cause of Renal Failure due to which he was hospitalized and the said fact was mentioned by the doctor concerned in the ‘Progress Note’ dated 13.3.2013 of Alchemist Hospital prepared by him at the instance of the Complainant (Annexure R-1). It was further stated that} 

^{4.                    The Parties led evidence, in support of their case.}

^{5.                    After hearing the Counsel for the parties, and, on going through the evidence and record of the case, the District Forum, allowed the complaint, as stated above.} 

^{6.                    Feeling aggrieved, the instant appeal, has been filed by the appellants/Opposite Parties.}

^{7.                    We have heard the Counsel for the appellants/Opposite Parties, and have gone through the evidence and record of the case, carefully.} 

^{8.                    The Counsel for the appellants/Opposite Parties submitted that the District Forum erred in not relying upon Ex.R-1 produced by the appellants/Opposite Parties, and in relying upon Annexures Ex.C-7 and Ex.C-8 produced by the respondent/complainant. He further submitted that the complainant concealed the material fact that he had been suffering from the disease/ailment hypertension for the last ten years, which was a leading cause of Renal Failure due to which he was hospitalized and the said fact was mentioned by the doctor concerned, in the ‘Progress Note’ dated 13.3.2013 of Alchemist Hospital prepared by the doctor concerned at the instance of the complainant (Annexure R-1) and, as such, the order of the District Forum is liable to be set aside.}  

^{9.                    In this view of the matter, we are of the considered view that the District Forum was right in placing reliance on the certificates i.e. Annexures C-7 and C-8, which were supported by the affidavit and ignoring Annexure R-1 relied upon by the appellants.}

^{10.                  The District Forum was also right in holding that the Opposite Parties while allowing a partial claim of the complainant and denying him the remaining amount of Rs.1,51,201/- and that too on feeble and baseless observations, certainly amounted to deficiency in rendering service on the part of the appellants.} 

^{11.                  For the reasons recorded above, the appeal, being devoid of merit, must fail, and the same is dismissed in limine, with no order, as to costs. The order of the District Forum is upheld.}

^{12.                  Certified Copies of this order be sent to the parties, free of charge.}

^{13.                  The file be consigned to Record Room, after completion.}

Pronounced.

24.03.2014  [JUSTICE SHAM SUNDER [RETD.]

                                                                                                           [DEV RAJ]

Sd/-

^{[PADMA PANDEY]}

^MEMBER

cmg