Decided on January 27,2006

Mithlesh Kumawat Appellant
National Insurance Co Ltd And Ors Respondents


- (1.)THIS appeal has been filed by the complainant appellant against order dated 17.2.2005 passed by the District Forum, Jaipur II by which the complaint of the appellant was dismissed.
(2.)THE complainant appellant had filed a complaint before the District Forum, Jaipur II on 4.8.2004 against the respondents inter alia starting that the complainant appellant had taken a medi -claim policy from the respondents for the period from 26.2.2003 to 25.2.2004 and thereafter for the period from 26.2.2004 to 25.2.2005.
It was further stated in the complaint that policy was taken by the complainant for himself as well as for his wife and each one was insured to the tune of Rs. 50,000. It was further stated in the complaint that for the period from 27.4.2004 to 7.4.2004 the complainant had remained as an indoor patient in the hospital known as Santokba Durlabhji Memorial Hospital (SDMH) and during that period he had incurred Rs. 42,172 for his treatment.

It was further stated in the complaint that thereafter the claim was preferred by the complainant but the claim of the complainant was repudiated by the respondents through letter date 25.5.2004 inter alia stating that the complainant had been admitted in the hospital on 27.4.2004 with complaints of T initus and haziness in vision for eight years along with imbalance during walking for 4 -5 years and claim was repudiated as per terms of Clause 4.1 of the policy. Thereafter the claim was preferred before the District Forum.

(3.)A reply was filed by the respondents and they have taken the same plea as they have taken in the repudiation letter dated 25.5.2004 and apart from that since before issuance of the policy the complainant was aware of the diseases should be treated as pre -existing disease before issuance of the policy and thus the claim was rightly repudiated.
After hearing both the parties the District Forum through impugned order dated 17.2.2005 had dismissed the complaint inter alia holding that the deceased had suppressed his pre -existing diseases at the time of issuance of the policy.

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