UNITED INDIA INSURANCE COMPANY LIMITED Vs. KRISHAN NARAIN SHARMA

JUDGEMENT

(1.) KRISHAN Narain Sharma had taken mediclaim policy from the appellants for the year 1999. It was got renewed in the year 2000 -01. On 2.1.2002 the respondent was admitted in the Hero DMC Heart Institute, Tagore Nagar, Ludhiana with a complaint of chest pain radiating to left arm. Thereafter a bye -pass surgery was performed on his body and ultimately on 17.1.2002 he was discharged from the Hero DMC Heart Institute, Tagore Nagar, Ludhiana. The respondent incurred an expenditure to the tune of Rs.1,51,278 as medical expenses in the said hospital.

(2.) IT was also pleaded that the respondent lodged the claim with the appellants vide CR No. 10003 but the appellants repudiated the claim vide letter dated 14.5.2002. Hence the respondent filed the complaint in the learned District Consumer Disputes Redressal Forum, Ludhiana (in short "District Forum").

(3.) TBE appellants filed written reply. Preliminary objections were pleaded and the case was also contested onmerits. It was pleaded that the respondent has not come to the Forum with clean hands and had suppressed material facts. It was pleaded that the respondent was having heart ailment since the year 1995 and the disease was pre -existing. This fact was suppressed by the respondent while filling the proposal form. It was admitted that the respondent had taken mediclaim policy for the period from 29.12.1999 to 28.12.2000 which was got renewed from 29.12.2000 to 28.12.2001 and 29.12.2001 to 28.12.2002. It was denied if the respondent had spent an amount of Rs. 1,51,278 on his treatment. Since the heart disease of the respondent was pre -existing, therefore, the exclusionary clause of the insurance policy applied under which the respondent is not entitled to any medi -claim. Therefore, the repudiation was legal and valid. Dismissal of the complaint was prayed.