Decided on December 09,2013

Girish M Raval Appellant
Oriental Insurance Co Ltd And Ors Respondents


- (1.)THIS appeal is directed against the order passed by South Mumbai District Forum dismissing consumer complaint No. 20/2006 (old complaint No. 21/2000) by an order dated 10/05/2007. Facts which are material for deciding this appeal are as under. On 14/11/1995, the complainant initially made a proposal forgetting a medical insurance policy from the respondent Insurance Company. In the proposal form, he had stated that he was not suffering from any disease except psoriasis at joints. It appears that this form was filled up on 13/11/1995 and this date is mentioned near the appellant's signature. On the same day appellant allegedly visited a Cardiologist and the ECG showed some abnormality consistent with chest pain which has not been disclosed. The ECG strip was duly submitted by the appellant to the Insurance Company on the same day. A policy was however issued and it was subsequently renewed from time to time. In April 1998, the insured had also got him self treated and had lodged a claim of Rs. 9,949/ - for the treatment which had been cleared by the Insurance Company. In April 1999, complainant had a heart attack and angiography and angioplasty was advised, which was carried out at a cost of Rs. 3,29,000/ -. A claim was submitted for this amount by the complainant with the Insurance Company. The Insurance Company had sent a discharge voucher to the complainant on 10/08/1999 but eventually on 26/08/1999, the claim was repudiated. The complainant issued a notice and, thereafter, filed complaint.
(2.)INSURANCE Company opposed the complaint contending that the ECG strip dated 14/11/1995 had been placed by the complainant subsequently, that the complainant was already suffering from an ailment which he had suppressed and, therefore, the claim was repudiated.
(3.)AFTER considering the rival contentions, the forum held that the claim was false and frivolous and that there was no deficiency in service. Aggrieved thereby, the complainant is before us.
We have heard Mr. H.H. Trivedi -Advocate for the appellant and Mr. A.S. Vidyarthi -Advocate for the respondent -Insurance Company. The only point that arises for our determination is whether the District Forum was in error in holding that the complainant had not proved deficiency in service. The answer to this point is in affirmative for the following reasons: - -


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