Decided on December 10,2013

Ashok M Ahuja Appellant
United India Insurance Co Ltd And Ors Respondents


- (1.)THIS appeal filed by the Appellant/original Complainant, Mr. Ashok M. Ahuja (hereinafter referred to as 'the Complainant' for the sake of brevity) questions dismissal of Consumer Complaint No. 519 of 2010 by the District Consumer Disputes Redressal Forum, Pune by an order dated 30/05/2012. Facts which are material for deciding this appeal are as under: - -
Complainant had taken out a mediclaim insurance policy for himself from the Respondent No. 1/original Opponent No. 1 - United India Insurance Company Ltd. (hereinafter referred to as 'the Insurance Company' for the sake of brevity) for the period 27/06/2008 to 26/06/2009. Said insurance policy was renewed for the period from 27/06/2009 till 26/06/2010. On 06/01/2010 the Complainant was admitted to the Bombay Hospital and on 07/01/2010 he underwent lumber decompression surgery. He was discharged from the hospital on 12/01/2010. He spent an amount of Rs. 3,08,043/ - for this treatment and he lodged a claim with the Insurance Company for reimbursement of this amount. Insurance Company made necessary enquiries, caused the claim to be investigated and ultimately repudiated the claim on 17/02/2010. This repudiation letter was, however, received by the Complainant on 07/04/2010. The Complainant then, filed a consumer complaint before the District Forum at Pune for recovery of an amount of Rs. 3,08,043/ - together with interest thereon @ 18% p.a. besides an amount of Rs. 5,00,000/ - by way of compensation towards physical and mental agony.

(2.)THIS claim was contested the Insurance Company by filing a written version inter -alia contending that the Complainant was obliged to disclose if any other policy was taken out by him before taking the policy in question with effect from 27/06/2008 till 27/06/2009. It was also stated that the Complainant had suppressed the material information that he had taken out an MRI of lumbo -sacral spine on 09/10/2008. It was stated that the Complainant had suppressed that he was suffering from neurological 'claudication' for the past three years i.e. before the date of commencement of the policy. The Insurance Company relied on Clause No. 4.1 of the terms and conditions of the policy for repudiating the Complainant's claim because the Complainant was suffering from an ailment for the past three years i.e. since before the date of commencement of the policy. It was also stated that the Complainant caused the words 'Three years' changed to 'Three months' in the medical certificate.
(3.)AFTER considering the rival contentions and the material tendered before the Forum, the Forum came to dismiss the complaint holding that the pre -existing disease is the one which was shown to have been existing during the period of 48 months before taking out the policy, and, as per the certificate of Bombay Hospital, the Complainant had such an ailment/disease for a period of at -least three years before the date of consultation in the Bombay Hospital. Aggrieved thereby, the Complainant is before us.
We have heard Appellant's son and power -of -attorney holder, Mr. Deepak Ahuja on behalf of the Appellant and Adv. Asim S. Vidyarthi on behalf of the Respondents and with their help we have also gone through the material placed on the record.


Click here to view full judgement.
Copyright © Regent Computronics Pvt.Ltd.