SHIV KUMAR GAUR Vs. RELIGARE HEALTH INSURANCE CO LTD
LAWS(NCD)-2020-8-67
NCDRC
Decided on August 26,2020

Shiv Kumar Gaur Appellant
VERSUS
Religare Health Insurance Co Ltd Respondents

JUDGEMENT

PREM NARAIN,J. - (1.) This revision petition has been filed by the petitioner Shiv Kumar Gaur challenging the order dated 18 May 2017 passed by the Rajasthan State Consumer Disputes Redressal Commission th Jaipur, (in short 'the State Commission') in First Apple No. 673 of 2016.
(2.) Brief facts of the case are that the petitioner complainant was insured with respondent opposite party and the policy was issued on 20th February 2014. The proposal was prepared on sixth February 2014. This was a health insurance plan. On 5th June 2014, the complainant suffered left side chest pain and was admitted In the Chennai Apollo Hospital for treatment where his coronary angiogram was conducted and he was advised CABG/ PTCA. The complainant was admitted in this hospital on 9th June 2014 and was relieved on 11th June 2014. For CABG operation, the complainant was admitted in MIOT International Hospital on 26th June 2014 and was discharged on 5th.July 2014. The complainant submitted his claim under the policy for Rs.3,03,003. Insurance company got the matter investigated and repudiated the claim vide their letter dated 2 December 2015 on the ground that the complainant did not disclose the material nd information at the time of filing of the proposal.
(3.) Aggrieved by the rejection of the claim, the complainant filed a consumer complaint before the District Forum. The complaint was resisted by the insurance company on the same grounds as mentioned in the repudiation letter. The Insurance Company claimed that in the discharge summary of MIOT hospital, it is clearly written that the complainant had a history of chest pain from one week of January 2014. Thus, the discharge summary of MIOT hospital confirmed that the complainant was suffering from the heart disease since January 2014 and the proposal form was filled on 6th February 2014 wherein no information about the heart disease was given and therefore this is a clear case of suppression of material information. It was requested to dismiss the complaint.;


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