- (1.) - This is insurer's appeal under Section 15 of the Consumer Protection Act, 1986 against the order dated 19.2.2007 passed by the District Forum, Udham Singh Nagar, partly allowing consumer complaint No. 54 of 2005 and directing the opposite party No. 1 -appellant to pay to the complainant compensation of Rs. 1,91,661 together with interest @ 6% p.a. from 28.3.2005 till the date of actual payment and also to pay litigation expenses of Rs. 1,000. The consumer complaint was, however, dismissed against the opposite party No. 2.
(2.) IN brief the facts of the case are that the complainant purchased a mediclaim policy for himself and his wife from the opposite party No. 1 The Oriental Insurance Company Limited covering the period from 3.5.2003 to 2.5.2004. The complainant took an insurance cover for sum of Rs. 2,00,000 for himself and for sum of Rs. 1,00,000 for his wife. In the month of February, 2004, the complainant suddenly fell ill and on the advice of local medical practitioners, got himself admitted in Pushpawati Singhania Research Institute, New Delhi on 12.2.2004 for specialized treatment, intimation whereof was given to the Insurance Company on 13.2.2004. Thereafter, the complainant got himself treated at Dhanwantari Tomer Hospital, Bareilly from 12.2.2004 to 27.2.2004 and the complainant submitted bills/cash memos for sum of Rs. 66,649 to the Insurance Company towards part claim. Thereafter, from time -to -time, the complainant submitted his claim with the Insurance Company for reimbursement of the medical expenses incurred by him in his treatment. The total amount spent by the complainant in his treatment was to the tune of Rs. 1,91,660.73, but the Insurance Company did not settle the claim. Alleging deficiency in service on the part of the opposite parties, the complainant filed the consume complaint before the District Forum.
(3.) THE Insurance Company filed written statement and pleaded that the complainant was suffering from kidney disease from before three years from the date of purchasing the mediclaim policy, but this fact was suppressed by him and the complainant got the policy issued by making false representation. Therefore, the Insurance Company repudiated the claim of the complainant vide their letter dated 20.1.2005 and no deficiency in service was made. The District Forum, on an appreciation of the material on record, allowed the consumer complaint against the Insurance Company vide order dated 19.2.2007 in the above terms. Aggrieved by the said order, the Insurance Company has filed this appeal.;