JUDGEMENT
K. Kannan, J. -
(1.) THE petition challenges the order of the State Consumer Disputes Redressal Commission, Punjab allowing the appeal filed by the National Insurance Company and sustaining its decision to reject the claim made by the Petitioner for a Mediclaim insurance policy. During the currency of a policy for covering the risk for medical expenses arising out of heart ailment requiring hospitalization and surgery, the Petitioner suffered heart attack on 14.12.1990 and underwent an operation on 22.12.1990. The policy had been taken on 16.07.1990. It was renewal of earlier policy that originally commenced on 31.01.1986. The subsequent renewals had been made on 03.03.1987, 30.03.1988, 09.05.1989 before it was last renewed on 16.07.1990. The Insurance Company disowned the liability on a plea that the Petitioner had suppressed the fact that he had a serious ailment requiring treatment at Escort Hospital on 21.06.1990 that was just about a month prior to the commencement of the policy but this fact had not been disclosed at the time when fresh policy was undertaken.
2 The claim of the Petitioner was declined after the Petitioner filed a complaint of deficiency in service and applied for appropriate reliefs including the amount assured under the terms of the policy before the District Consumers Disputes Redressal Forum, Jalandhar; the complaint had been earlier allowed on 31.12.1996 finding that though in the discharge summary of Escort hospital it has been mentioned that the Petitioner was "known case of ischaemic heart disease since 21.06.1990 when he had inferior wall MI ..... the TMT done on 13.12.1990 was strongly positive for reversible ischaemic", there was no fraudulent or intentional falsehood made by the Petitioner. In the appeal filed before the State Commission, the Bench held that the Petitioner had completely ignored the factum of heart ailment on 21st June, 1990 for treatment thereof and the non -disclosure at the time of taking new policy amounted to concealment of material fact that justified the rejection of the claim by the Insurance Company. The Petitioner has challenged this decision stating that admittedly at the time when he had an incident of heart ailment, there was a valid policy commencing from the previous year. He did not made willful suppression when he took a policy on 16.07.1990.
3. Learned Counsel appearing for the Petitioner justifies the challenge to the order of State Commission through a writ petition by referring to the decision of Madras High Court in a case titled "The Managing Director, Nadippisai Pulavar K.R. Ramaswamy Sugar Mills v. Fareed Bawa and others, : AIR 1997 Mad 204" that held that an order passed by the State Commission filed against the order of District Forum was not appealable or revisionable and consequently, the writ petition was maintainable. The counsel also argues that since the writ petition has already been admitted, the issue of maintainability does not arise. There is a right of appeal against the order of State Commission to National Commission under the provisions of Consumer Protection Act. However, I am not examining the issue of maintainability of the writ petition and it could be taken up in some other appropriate case.
4 I proceed to examine the issue of whether the Petitioner is justified in his contention that the Insurance Company was bound to satisfy the claim for the expenses under the terms of the Mediclaim policy. It is not denied that the hospital records that were produced before the Court and in the claim for operation expenses, they clearly disclosed the history of the heart ailment of the Petitioner before the commencement of the policy. It may be that it was not serious enough or that it was not itself a heart attack but if it was relevant to the Insurer for undertaking the risk or for determination of the appropriate premium payable in a case where a new ailment developed during the currency of the period of the earlier policy, such a fact ought to have been disclosed. The nature of ailment as illustrated in the clinical history of the Petitioner, which has been extracted in the order of State Commission is also reproduced here as under:
Sehgal is a 49 year old normotensive, nondiaabetic, exsmoker, pleasant gentleman. He is a known case of ischaemic heart disease since 21.06.1990 when he had inferior wall MI. There was no antecedent angina and patient was asymptomatic thereafter. TMT done on 13.12.90 was strongly positive for reversible ischaemia.
5. There are sufficient authorities to the effect that the Insurance Company is bound to renew a Mediclaim policy even if, insured developed some ailment during the immediate preceding year. While the Insurance Company could have been compelled to take a renewal of the policy, if they had refused to renew the same when the Petitioner was taking a new policy on 16.07.1990, they could do so on different terms, which might be applicable in a case to cover the solvency margin of net incurred claiming the concept of commercial insurance and degree of commercial prudence are necessary in deciding appropriate premium to be charged. If the same incident of heart ailment had been disclosed and the policy still had been issued on different terms, it would not become possible for the Insurance Company to deny the Petitioner's entitlement that would have been only on the terms that the Petitioner had an ischaemic heart disease and the Insurance Company was still compelled to cover the risk. However, if the fact was not disclosed at all, the Petitioner cannot be heard to say that it was a very ordinary ailment and there was no willfulness on his part. Learned Counsel refers me to the decision of the Bombay High Court in a case titled "Smt. Dipashri v. Life Insurance Corporation of India and others, : AIR 1985 Bom 192" that found the non -disclosure of prevalent ailment like influenza, dysentery, bleeding piles and fever on some occasions could not be construed as fraudulent suppression of material facts. The ailment referred to above are not in the same league as ischaemia heart. Learned Counsel also refers to a decision in case titled "Smt. Saraswati Devi v. Life Insurance Corporation of India, : AIR 1996 Delhi 68" that held that no bad faith can be imputed to insured deceased as he was never aware of his ailments. A person who had taken treatment in the Escort hospital for heart ailment one month prior to the commencement of a policy cannot be a person who could claim that he was unaware of the illness.
6. It could have been a different situation, when he had reported to a doctor with chest pain and doctor treated him as a case of some ailment of no consequence, although by a wrong diagnosis. In such a situation, it could be stated that he was himself not aware of his ailing heart condition. The Petitioner cannot make such a claim in a case where he had actually reported pain in the chest and it was actually diagnosed as a case of ischaemic heart ailment. The non -disclosure in this case was an instance of lack of good faith and the denial to satisfy the claim by the Insurance Company was perfectly justified. The decision of the State Commission in rejecting the claim was under the circumstances tenable and there is no scope for intervention through the writ petition.
5. The writ petition is consequently dismissed.;
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