United India Insurance Company Ltd. v. Jaswant Singh
2003-03-03
K.D.SHAHI, LUXMI SINGH, SURENDER KUMAR
body2003
DigiLaw.ai
JUDGMENT 1. This appeal has been filed by the Insurance Company against the order of the District Forum, Udham Singh Nagar whereby the Forum has directed the appellant to pay a sum of Rs. 2,00,000/- to the complainant. 2. The brief facts of the case are that the complainant Shri Jaswant Singh took a Medi-care policy for a sum of Rs. 3,00,000/- which was effective from 21.5.98 to 20.5.99. He again got it renewed to Rs. 2 lacs irom 8.7.99 to 7.7.2000. On 1.10.99 he suffered a heart attack due to chest pain. He got himself admitted in the nursing home of Dr. Narender who referred him for the Medical Institute, New Delhi for the change of valve in the heart. On 20.10.99 the valve was changed in Apolo Hospital. He was discharged on 30.10.99. He claimed the reimbursement of the medical charges. He has alleged that he has spent a sum of Rs. 3,25,000/- but the renewed policy was Rs. 2,00,000/-. The learned Forum.has awarded compensation of this amount only. 3. The complaint was contested on the ground that the claimant was suffering from heart disease from before the insurance and since he has suppressed the disease therefore, he is not entitled to any compensation. The claim of the claimant was also repudiated on this ground by the Insurance Company. However, on evidence the District Forum allowed the claim, therefore, this appeal by the Insurance Company. 4. We have heard the learned counsel for the parties at length and gone through the records. Although arguments were advanced in great details but the point of dispute is very limited and that is whether the claimant has suppressed a pre-existing illness at the time of the proposal. Although, no such case was taken before the District Forum but at the appellate stage, it was also argued that the claimant himself was impersonated, his brother Guru Bux Singh is a practicing lawyer and it is who, who has filled the proposal form and signed on behalf of Shri Jaswant singh. Shri Jaswant Singh is a highly educated person. He knows Hindi as well as English. Merely because somewhere he has signed in English and somewhere he has signed in Hindi, it cannot be said that he has not signed the proposal form.
Shri Jaswant Singh is a highly educated person. He knows Hindi as well as English. Merely because somewhere he has signed in English and somewhere he has signed in Hindi, it cannot be said that he has not signed the proposal form. It was the duty of the appellant to have proved this allegation but it has utterly failed in proving this allegation. 5. As regards the suppression of the alleged illness, the complainant has alleged that for the first time on 1.10.99 it was revealed that he was suffering from the disease in the heart. He did not know of any illness earlier. The burden of proof was squarely on the appellant to have proved but in this regard, too, the appellant has failed. 6. The copy of the report of Shri Chandra Pal Singh Tomar, Surveyor has been filed but it ha5 not been proved on his affidavit. It is a new proposition of law, as propounded by the appellant that survey has been made by Mr. Tomar and it is going to be proved by the Divisional Manager in his affidavit. The report could have been proved only on the affidavit of the Surveyor and not through the affidavit of the Divisional• Manager Shri S. S. Saxena. However, even of this report is read in evidence, this report also shows that the surveyor did nothing except finding fault with the claim of the claimant. He visited the Narender Heart Centre and there the doctor told that he does not poosess any record of any patient.. He tears but the prescriptions and the record, if any, will be with the patient. The doctor did not tell the surveyor that he has examined the patient earlier than 1.10.99. However, on the basis of the examination dated 1.10.99, the doctor had told that the disease could have been several years old because the valve is not affected within a day or two. The doctor stated that there is no suspicion that the disease was old and the claimant must have got himself treated some where. This type of the statement based on conjestures and surmises cannot be relied upon. The statement of doctor was recorded on 8.3.2000. The claimant has met him on 1.3.99. The doctor does not keep any record.
The doctor stated that there is no suspicion that the disease was old and the claimant must have got himself treated some where. This type of the statement based on conjestures and surmises cannot be relied upon. The statement of doctor was recorded on 8.3.2000. The claimant has met him on 1.3.99. The doctor does not keep any record. If he is a busy doctor, he should not be presumed to keep memory of each and every patient whom he has examined before the 12 months. The surveyor did not record the statement of the doctors at Apollo Hospital where the operation was done. He also did not care to examine the claimant. 7. The surveyor has reached Gupta Heart Centre as well but he could not get any information thereat. Then he has recorded the statement of Guru Bux Singh, the brother of the claimant. He has definitely stated that his brother Jaswant Singh was not having any heart illness from before. Then all of a sudden the surveyor came to the conclusion that the illness of the claimant was from before 1998. Such type of report of a surveyor cannot be believed. Then there is an additional report Paper No. One dated 20.3.2000 where the surveyor has reported that the claimant has illness from the last one year. It was not clear to the appellant to say that the claimant was suffering for the last one year or for 5 years or for a number of years. There is no concrete evidence, paper, prescription, diagnosis report, ECG, any report of any doctor who has actually examined the patient to prove all these allegations. It has become a general fashion with the Insurance Company to say that the patient has suppressed his fact of his illness which he was having for the last number of years merely on the basis of the report of surveyors who are merely interested in the settlement of their bills and their palms being greezed by the claimants. These are simple inferences from the report of the surveyors like this wherein without any evidence it has been reported that the claimant was suffering from heart disease for a last number of years. There is no force in this appeal and the appeal deserves to be dismissed however in the circumstances of the case, cost shall be easy. ORDER 8. The appeal is hereby dismissed.
There is no force in this appeal and the appeal deserves to be dismissed however in the circumstances of the case, cost shall be easy. ORDER 8. The appeal is hereby dismissed. However, in the circumstances of the case, cost shall be easy.