Decided on July 25,2009

National Insurance Company Ltd And Anr Appellant
K J Varghese Respondents


- (1.)THE above appeal is directed against the order dated 31.03.2003 of the CDRF, Ernakulam in OP No. 103/01. The complaint in the said original petition was filed by the respondent here in as complainant against the appellants / opposite parties alleging deficiency in service on the part of the opposite parties in repudiating the insurance claim put forward by the complainant. The opposite parties entered appearance and contended that the claim was repudiated on justifiable ground that the complainant took the policy by suppressing the disease which was pre - existing. Thus the opposite parties denied the alleged deficiency in service.
(2.)BEFORE the Forum below the complainant was examined as PW1 and Exts Al to A4 documents were marked on -his side From the side of the opposite parties B1 to B7 documents were produced and marked. On an appreciation of the evidence on record the Forum below accepted the case of the complainant that there was deficiency in service on the part of the opposite parties in repudiating the insurance claim put forward by the complainant with respect to the medi -claim policy. Thereby the opposite party Insurance Company is directed to pay the insurance claim amount to the extent which is admissible taking into account Ext. B6 bill. Aggrieved by the said order the present appeal is preferred by the opposite parties.
(3.)WE heard both sides. The learned Counsel for the appellants/opposite parties submitted his arguments based on the grounds urged in the memorandum of the present appeal. He much relied on Ext. B7 statement given by the complainant to the Insurance Investigator and argued for the position that there was suppression of the material fact regarding pre -existing disease Thus the appellants justified their action in repudiating the insurance claim. On the other hand the learned Counel for the respondent/complainant supported the impugned order passed by the Forum below. He argued for the position that there is nothing in Ext.B7 statement indicative of suppression of any material fact. He much relied on Ext. A2, medical certificate issued by the doctor attached to Mary Queens Mission Hospital, Thiruvalla and A3 bill issued from the said hospital for the treatment which the complainant had in that hospital. Thus the respondent prayed for dismissal of the present appeal. The points that arise for consideration are:
1. Whether the appellants/opposite parties can be justified in repudiating the insurance claim put forward by the respondent/ complainant?

2. Whether the appellant/ opposite party Insurance Company has succeeded in establishing their defense of suppression of material fact or that there was preexisting disease at the time of taking the medi -claim policy?

3. Is there any sustainable ground to interfere with the impugned order dated 31 -03 -2003 passed by the CDRF, Ernakulam in OP. No. 103/01?

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