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2003 DIGILAW 30 (UTT)

National Insurance Co. Ltd v. Jagdish Rai

2003-03-19

K.D.SHAHI, LUXMI SINGH, SURENDRA KUMAR

body2003
JUDGMENT K.D. Shahi, Chairman - This is an appeal against the Judgment and order dated 19-7-2001 passed by the District Forum. Udham Singh Nagar allowing the complaint of Sh. Jagdish Rai for Medi-claim for recovery of Rs.70,831/- as medi-claim of his wife. 2. The brief facts of the case are that the claimant got a Medi-Claim policy of his wife on 2-8-1996 elective till 1-8-1997. It was renewed from 2-8-1997 to 1-8-1998 and again from 4-8-1998 to 3-8-1999. In June 1998 the wife of the complainant fell ill and on examination she was found to have breast cancer. The investigation was made from Keshlata Hospital. Bareilly, Again on 25-6-1998, he got her admitted in Rajiv Gandhi Cancer Institute. Delhi where she was treated, She was discharged on 29-6-1998. Again Radio-Therapy was done from 27-7-1998 to 21-8-1998. Smt. Jamuna Devi, wife of the complainant was under treatment. It is specifically alleged that before June 1998, the complainant or his wife never knew about this illness. He has spent and sent a bill of Rs.72,408/ - but it was repudiated. Hence, this complaint was filed. 3. The opposite party filed the written statement that on the basis of the report of the surveyor which was based on the report of Dr. P.N. Singh of Sushila Tewari Memorial Hospital, Haldwani. The victim was having cancer for the last more than 4 years and this fact was not disclosed at the time of taking the policy. Therefore, the claim was-repudiated. 4. We have heard the learned counsel for the parties and gone through the records. The moot question is when for the first time the cancer in the breast of the complainant's wife was detected. According to the complainant, it was detected First time in June when his wife got examined in Bareilly Hospital and then immediately he shifted to Rajiv Gandhi Institute. New Delhi. Whereas, the case of the appellant is that the victim was having cancer for more than 4 years. The burden of proof was only the insured. The Insurance Company had not examined the victim ever. He did not apply that the victim be put up for examination by any expert to work out from when she was having the cancer. The Insurance Company has adopted a very novel method to give its opinion on the report of Shri A.S. Rathore. The Insurance Company had not examined the victim ever. He did not apply that the victim be put up for examination by any expert to work out from when she was having the cancer. The Insurance Company has adopted a very novel method to give its opinion on the report of Shri A.S. Rathore. Surveyor who has in turn based a report on the report of Dr. P.N. Singh. Now let us see what is the report of Dr. P.N. Singh. It is to be clear that Dr. P.N. Singh also did not examine the victim and he has given an expert opinion only after perusal of papers which appears to have been produced before him by the Insurance Company. His report is that Jamuna Devi first got medically examined on 17-6-1998 by Dr. S.K. Gupta. Dr. P.N. Singh appears to be a M.D. and in service of hospital at Nainital but there is nothing to show that he is an expert in all these matters. Merely on the basis of his examination of papers and the size of the cancer, etc. he has given such a report. He did not prefer to have gone to the victim along, with the surveyor to examine the victim. Not only this the surveyor also did not care to examine Dr. S.K. Gupta, any doctor of the Bareilly Hospital or any doctor of the Rajiv Gandhi Memorial Institute. To the Surveyor the victim has specifically stated that it was for the first time known in June 1998 that she was suffering from such a disease. In the report of the surveyor also, it is specifically written that the surgery of cancer of breast should be done as early as possible. The complainant appears to be a literate person. Atleast he is fully vigilant that he should have Insurance for the purpose of medical treatment. Only few mentally enlightened people in the society take such a policy. We mean to say that such a vigilant man should have immediately rushed up to a doctor for treatment, for operation if he would have known about the disease earlier. He could not have slept for three consecutive years, to watch that let Insurance policy become old and then to claim. He has not lodged any claim in the previous two years although the policy was effective in those years as well. He could not have slept for three consecutive years, to watch that let Insurance policy become old and then to claim. He has not lodged any claim in the previous two years although the policy was effective in those years as well. This specifically shows that he has not taken a policy merely to claim but he has taken a policy to be indemnified in case there is illness. There doesn't appear any reason for hiding this disease if the complainant would have known it earlier. There is absolutely no evidence that the victim was examined, investigated or treated anywhere of any disease earlier to June 1998. The appellant did not produce any such evidence in this regard. 5. Such a plea has been taken only to defeat the claim otherwise there is no substance in the objection. In the way, in which the false objection has been raised and instead of having any sympathetic, attitude, the appellant filed a false objection and this appeal. It is just that the appellant should pay cost of this appeal as well to the respondent. 6. The complaint has rightly been allowed by the learned Forum. This appeal has got no force, and is to be dismissed, with costs. ORDER 7. The appeal is hereby dismissed. The opposite party shall get a cost of Rs.5000/- from the appellant. Appeal dismissed.