UNITED INDIA INSURANCE COMPANY LIMITED Vs. CHANDRA KANT KHARATE

JUDGEMENT

(1.) THE complainant s husband obtained a Universal Health Insurance on 26.2.2004 valid up to 25.2.2005. However, the policy could not be renewed on due date. The complainant again took a fresh policy for the period from 14.3.2005 to 13.3.2006. The appellant was confined in the hospital for treatment and the treatment charges were claimed from the Insurance Company. The Insurance Company however repudiated its liability on the ground that there was material suppression of a pre -existing illness and, therefore, she was not entitled to be reimbursed the expenses made by her. She, therefore, claimed this amount Rs. 21,038 under Section 12 of the Consumer Protection Act, 1986.

(2.) THE only contention raised by the learned Counsel for the appellant is that suppression of pre -existing disease is a material suppression and the Insurance Company was, therefore, justified in repudiating its liability. Learned Counsel has also placed reliance on the decisions of the Supreme Court in Satwant Kaur v. New India Assurance Co. Ltd., 2009 4 CPJ 8, and P.C. Chacko v. Chairman, L.I.C., 2008 3 CPJ 78. Reference has also been made to the decisions of the State Commissions , LIC of India v. Maya, 2004 3 ACC 229. We may point out that these decisions are distinguishable and as rightly found by the District Forum because the abnormal menstruation cannot be classified as a disease, therefore, the suppression of the fact that the wife of the policy holder had abnormal menstruation cannot be taken as a ground for repudiating the claim of the complainant. In Kaur s case the deceased was found diabetic for the past 16 years and case of chronic renal failure. This was a serious illness which needed to be disclosed. Likewise in P.C. Chako s case there was suppression of the fact that four years prior to the filling of the proposal form he had undergone major operation which he did not disclose in the policy. The other three cases cited by the learned Counsel are also different on facts.

(3.) IN the present case, we find that the illness was not such which would have caused anxiety in the mind of the person that it may reach to such a serious consequence. These disorders are normal amongst ladies and, therefore, in our opinion it was not necessary to disclose the said disease.