NEW INDIA ASSURANCE CO LTD Vs. VASANT RAO

JUDGEMENT

(1.) THESE two Revision Petitions have been filed against the judgement and order dated 9.8.2005 passed by the Karnataka State Consumer Disputes Redressal Commission, Bangalore in Appeal Nos.1128/2005 and 1129/2005. Brief facts of the case are as follows: The Respondent, Shri Vasant Rao, is covered by a mediclaim insurance policy issued for the first time on 1.3.1995 for one year by the Petitioner, New India Assurance Company Ltd. The policy was subsequently renewed on year to year basis and the last extension being for the period 1.11.1998 to 31.10.1999. Between 28.2.1999 and 4.3.1999, the Respondent complained of chest pain and was admitted in Basaveshwar Hospital, Gulbarga. On 13th April, he underwent a diagnostic test (Angiography) at the CARE Hospital, Hyderabad for which he spent Rs.26,879.80 ps. His ailment was diagnosed as "Ischemic Heart disease" (IHT). In July-August 1999, he underwent a surgical procedure called CABG at the Madras Mission Hospital, Chennai. The Respondent claimed reimbursement of (i) charges for the Angiography and (ii) the CABG from the Petitioner. The claims were rejected by the insurance company on the ground of Exclusion Clause No.4. The Exclusion Clause was invoked basing on the fact that in October-November 1986, the Respondent underwent a by-pass surgery. This was disclosed in his proposal form for obtaining mediclaim insurance policy which he took in 1995 and in every subsequent tenure of the policy.

(2.) AGAINST the repudiation, the complainant filed two complaints before the District Forum which held that the Exclusion Clause does not apply to the case and held that the Insurance Co. is liable for deficiency in service. The appeal Nos.1128 and 1129 of 2005 filed by the Insurance Company were dismissed by the Karnataka State Commission on 9.8.2003. Hence, the Insurance Company is in revision before us.

(3.) SECONDLY , the Insurance Company went on renewing the policy from time to time.