JUDGMENT - Justice G.G. LONEY, President:---In this complaint, the complainant is claiming the compensation of Rs. 1,55,849.15 on account of deficiency in service of the opposite party while rendering the promised service. The complainant alleged that in the year 1987-88 on the basis of proposal and declaration, the opposite party i.e. New India Assurance Co. Ltd. (hereinafter referred to "as Insurance Company") issued a hospitalisation and domiciliary hospitalisation benefit policy for the complainant and his wife for the period of one year commencing from 29-4-1987 to 28-4-1988. The aforesaid policy was there after renewed from time to time for the year 1988-1989 and 1989-90. The complainant alleged that during the renewal of aforesaid policy for the year 1990-91, he paid the premium on 8-5-1990 by a cheque which was received by the opposite party on 11-5-1990 and the similar policy was issued to him on 6-6-1990 for the period from 11-5-1990 to 10-5-1991. A copy of that policy is placed on record as annexure "C" with identical terms and conditions of his earlier policy issued by the Insurance Company. The complainant also submitted that for the aforesaid policy for the year 1990-91 no fresh proposal was obtained from him by the opposite party. The complainant lodged his claim on 22-5-1990 for Rs. 72,773.15. It is further contended that the complainant paid the premium towards renewal of policy for the period 11-5-1991 to 10-5-1992 which is also accepted by the opposite party. The complainant alleged that on 13-6-1991, he was again hospitalised and undergone re-surgery of which notice of claim was also given to the opposite party on 18-6-1991. Thereafter on 15-7-1991 a renewal policy was issued to the complainant by the opposite party for the period 11-5-1991 to 10-5-1992 which is at annexure "D". The complainant alleged that in the renewal policy at annexure "D" new clause being Clause 2-1-14 and separate endorsement/attachment were included in the policy for the first time without notice to the complainant. The complainant alleged that his claims are rejected by the opposite party on the ground of pre-existing illness. The complainant alleged that his two claims for Rs. 72,773.50 for the year 1991 and another for Rs. 83,075.65 for the year 1991-92 had been wrongly rejected, by the opposite party. Complainant therefore, claimed total amount of Rs. 1,55,849.15 towards compensation towards settlement of his claim under the two policies. The complainant alleged that his two claims for Rs. 72,773.50 for the year 1991 and another for Rs. 83,075.65 for the year 1991-92 had been wrongly rejected, by the opposite party. Complainant therefore, claimed total amount of Rs. 1,55,849.15 towards compensation towards settlement of his claim under the two policies. The complainant alleged that the services of the opposite party were deficient in as much as promised services were not rendered to him and therefore he sustained loss due to negligence on the part of opposite party. The opposite party filed its written statement/version dated 26-2-1993 and has opposed the complainants' claim mainly on the following two grounds : i) The complainant was suffering from Myocardial Infraction attack in 1980 and Angina for 2 months, Hypertention for 240 months and was under medication. ii) In respect of policy issued for the period 18-5-90- to 10-5-91, the complainant was hospitalised within 30 days from the issue of policy and therefore falls within exclusion of No. 1 of the policy. 2. We have perused the allegations contained in the complaint along with documents and also written statement/version of the opposite party dated 26-2-93 and heard Shri Subramanium, Advocate for the complainant and Shri Mokashi, Advocate for the opposite party. 3. As regards grant of hospitalisation and domiciliary hospitalisation benefit policies to the complainant and his wife for the year 1957 to 1991 facts are not in dispute. The only disputed point is that the complainant did not disclose to the opposite party that he was suffering from Myocardial Infraction Attack in 1980 and Angine for 2 months and also Hypertention for 240 months. The opposite party except raising such contentions in the written version, did not substantiate its allegation by filing any documentary evidence on record. Although it has been mentioned by the opposite party in para 8 of its written version, that the panel doctors opined that the complainant was aware of pre-existing illness the said opinion of the panel doctor is not tendered before this commission. It is also found that the opposite party by a letter dated 3-7-91 had informed the complainant with regard to applicability of exclusion Clause No. 1 of the mediclaim policy and stated that the complainants' claim has been referred to the panel doctor for his opinion and the claim could be settled subject to the opinion of panel doctor. It is also found that the opposite party by a letter dated 3-7-91 had informed the complainant with regard to applicability of exclusion Clause No. 1 of the mediclaim policy and stated that the complainants' claim has been referred to the panel doctor for his opinion and the claim could be settled subject to the opinion of panel doctor. However, according to complainant he was not communicated or supplied with any opinion of the panel doctor nor the opposite party has placed on record any such opinion to support its contention. On the contrary, the complainant has submitted that the rejection of complainants' claim on the ground of pre-existing illness is untenable and that the opposite party erred in holding the existence of pre-existing illness without material on record. It is also submitted by the complainant that there is no nexus between the so called "pre-existing illness and the complainants' treatment stated in the complaint". It is also alleged that the policy does not include the disease which are alleged to be pre-existing. At any rate, we are satisfied that the opposite party which opposed the complainants' claim has totally failed to place on record any material to substantiate its stand. The burden lies on the opposite party to substantiate its allegations of pre-existing illness and medication received by the complainant. This commission in the case of (Ramesh Jadhav in Original Complaint No. 87 of 1990 decided on 3-7- 1991 against the Oriental Insurance Co. Ltd.)1, has taken the view that the burden lies on the Insurance Company to substantiate its allegations when the claim of insured is rejected on the ground of the insurance policy. The aforesaid view of this commission has been upheld by the National Commission in First Appeal No. 240 of 1991 dated 18-5-1993. In view of the facts and circumstances of this case, we hold that the opposite party has completely failed to prove that complainant was having pre-existing illness and received medication before the grant of insurance policy. This contention of the opposite party alleging suppression of material substance thus is liable to be rejected. 4. The next contention raised by the opposite party in relation to Policy No. 48111400 issued on 6-6-1990 is concerned the objection of the opposite party is that the exclusion Clause No. 1 is attracted since the complainant was hospitalised within 30 days from the issue of policy. 4. The next contention raised by the opposite party in relation to Policy No. 48111400 issued on 6-6-1990 is concerned the objection of the opposite party is that the exclusion Clause No. 1 is attracted since the complainant was hospitalised within 30 days from the issue of policy. It is the contention of the opposite party that the complainants' previous policy expired on 29-4-1990. It was renewed by the subsequent policy issued for the period 11-5-1990 to 10-5-1991. According to opposite party the complainant was hospitalised on 30-5-1990 and therefore his claim is hit under the exclusion Clause No. 1 of the policy. The exclusion clause reads "any disease suffered by the insured person during the first 30 days from the commencement date of policy this exclusion clause shall however apply. In such case they shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by any insured person". According to complainant, he was out of Bombay and therefore, he paid renewal premium on 8-5-1990 by a Cheque No. 270289 and it was collected by the opposite party on 11-5-1990. The complainant has filed receipt No. 571855 at annexure "B". The complainant further alleged that similar policy came to be issued on 6-6-1990 for the period May, 1990 to 10-5-1991 which is at annexure "C". According to complainant, the policy at annexure "B "C" are identical as regards the terms and conditions. It is the case of complainant that the policy in question was not issued to the complainant on the basis of fresh proposal but it was granted as renewal of previous policy. The complainant submits that he was required to undergo bypass surgery on 30-5-1990 involving the hospitalisation and domiciliary hospitalisation and therefore on 22-5-1990 he submitted his claim for Rs. 72,773.50. The complainant further submits that on 10-5-1991, the complainant again paid premium towards renewal of policy in question for the period 11-5-1991 to 10-5-1992 which was accepted by the opposite party. The complainant was required to undergo bypass resurgery on 13-6-1991. The complainant received the renewal policy on 15-7-1991 for the period 11-5-1991 to 10-5-1992 which is at annexure "D". The complainant therefore contended that the policy at annexure "D" includes clause being Clause 2-1-14 and separate endorsement/attachment were included for the first time without notice to the complainant. The complainant was required to undergo bypass resurgery on 13-6-1991. The complainant received the renewal policy on 15-7-1991 for the period 11-5-1991 to 10-5-1992 which is at annexure "D". The complainant therefore contended that the policy at annexure "D" includes clause being Clause 2-1-14 and separate endorsement/attachment were included for the first time without notice to the complainant. In view of the aforesaid policy it is alleged by the complainant that the policy in question is not a fresh policy but is a renewal of earlier policy as granted to him by the opposite party without fresh proposal form. According to complainant in view of this circumstances, the complainants' claim for Rs. 83,075.65 cannot be rejected on the ground that he was required to undergo medical treatment within 30 days from the date of issue of policy. According to complainant, the new clause added was intentionally inserted without notice to him and therefore exclusion Clause - 1 does not apply in this case. We find that the complainant is right in claiming the benefit under the policy since the complainant has been granted the policy on his proposal submitted in the year 1987. We also hold that there is no suppression of material facts as alleged by the complainant, in absence of evidence on record. Under these circumstances, we hold that the rejection of complainants' both claims for Rs. 72,773.50 and Rs. 83,075.65 are without any substance. We also find that there has been unreasonable and unjustified delay on the part of opposite party to settle the complainants' justified claims and therefore it amounts to negligence in service of opposite party. The National Commission in the case of (M/s. Uniplas India Ltd. in Original Petition No. 42 of 1991 decided on 30-1-1992) has held that reduction of the amount payable under the insurance policy arbitarily, unfairly and has not settled the claim with reasonable expedition has been held guilty of deficiency in service towards the insured. Hence, we hold that the service of the opposite party has been deficient as a result of which the complainant has suffered a loss and therefore he is entitled to receive the justified claim and compensation also. We therefore pass the following order : ORDER The complaint is allowed. The opposite party is directed to settle the complainants' both claims totalling to Rs. We therefore pass the following order : ORDER The complaint is allowed. The opposite party is directed to settle the complainants' both claims totalling to Rs. 1,55,849.15 within 30 days from the receipt of this order and also be paid to the complainant Rs. 10,000/- as compensation. If the opposite party fails to settle the complainants claim by making payment accordingly of his claim and compensation both, the amount shall carry interest at the rate of 18% p.a. till realisation. Complaint allowed. *****