DRAUPADI DEVI S CHAUDHARI Vs. UNITED INDIA INSURANCE CO LTD

JUDGEMENT

(1.) The Appellant here was the successful complainant before the State Commission which has awarded a sum of Rs. 28,250/- as payable under the policy of Mediclaim insurance besides interest from 1st October, 1989 till payment and cost of Rs. 500/-. She had lodged a claim for Rs. 1,29,752/- under the Mediclaim insurance policy and in appeal has submitted that the rejection of the full claim and limiting it to Rs. 28,250/- by the State Commission is wrong; it has also wrongly rejected the claim for Rs. 14,100/- for post hospitalisation and that the said Commission has failed to award to her compensation including penal damages and that the said State Commission has awarded inadequate interest and costs.

(2.) The facts of the case briefly are that the Appellant had taken a Mediclaim insurance policy from the Respondent covering risks of expenses incurred for hospitalisation and domiciliary hospitalisation for the period from 12th January, 1989 to 11th January, 1990. On 30th of March, 1989 the appellant's husband Mr. Shyam Sunder Chaudhari felt chest discomfort for the first time and was advised to undergo bye-pass surgery. He underwent bye-pass surgery at Appolo Hospital, Madras in May, 1989. The Respondent Insurer repudiated the Mediclaim on the ground that Mr. Chaudhari had been suffering from chest discomfort since ten years and this fact had not been disclosed in the proposal form.

(3.) The repudiation of the insurance claim by the insurer-Respondent was primarily based on the 'history' of the patient as recorded in the Hospital Discharge Card of the 28th April, 1989 wherein it had been stated that Shri Shyam Sunder Chaudhari had "..chest discomfort since ten years..". In addition the Insurer also cited a certificate issued by one Dr. Bharat Patel dated the 24th August, 1989 stating that Shri Shyam Sunder Chaudhari had been seen by Dr. Patel earlier 11/4 years before for pain in chest, and that the patient was referred by him to the Cardiologist Dr. Om Prakash Modi on whose advise the patient had undergone bye-pass heart surgery at Madras. Mr. Chaudhari had, however, maintained that he had no history of chest discomfort prior to 30th of March, 1989 and that there was an error in the hospital record and this he supported by a letter from Dr. Mathew of the Appolo Hospital. Dr. Mathew has stated as under: