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2004 DIGILAW 50 (UTT)

Oriental Insurance Co. Ltd. v. Ratinderbir Singh

2004-05-11

K.D.SHAHI, LUXMI SINGH

body2004
JUDGMENT This is an appeal by Oriental Insurance Co. Ltd against the order dated 05.12.2003 passed by the District Forum. Nainital whereby the complaint of the complainant was allowed for recovery of medic aim amount of Rs. 1,83 ,156/- (Rupees One Lac Eighty Three Thousand One Hundred Fifty Six) along with interest @ 9% and cost of litigation of Rs. 1,500/- (Rupees One Thou. sand Five Hundred). 2. The brief facts of the case are that the complainant filed a complaint with the allegations that he had taken a medic aim insurance policy from the opposite party for himself and his wife Smt. Surender Kaur on 16.05.2000. The complainant was insured for Rs.300.000/- (Rupees Three Lacs) whereas his wife was insured for Rs. 1,00,000/(Rupees One Lac). He had paid premium on 16.05.2000 at Nainital The proposal form was filled in by the complainant at the instance of the agent of the insurance company Sh. Surendra Pal Singh Bindra, opposite party No.2 to the complaint. The complainant furnished all the information as required by the agent and the company. The complainant had got diabetes, which he reflected in the proposal form with full details showing all his bonafides. All other columns, which were left blank, were to be filled in by the agent. The policy' was effective from 16.05.2000 to 15.05.2001 and at the time of the proposal or issuance of the policy, the complainant had got no other disease except diabetes, which he disclosed' in the proposal form. On 03.12.2000, the complainant all of a sudden felt breathlessness, which persisted for two days. He had got no such breathlessness earlier, The complainant reached Krishna Nursing Home, Haldwani where he was examined by Dr. D.C. Pant and he referred him to higher centre for coronary angiography. On the advise of Dr. D.C. Pant, the complainant went to New Delhi where comprehensive tests like T.M.T. X-ray, E.C.G. etc were conducted on 20.12.2000 at Escorts Heart Institute and Research Centre, 'New Delhi. He was advised to undergo coronary angiography. Accordingly the angiography was done on 24.01.2001. The complainant after arranging funds got himself operated at Batra Hospital- and Medical Research Centre, New Delhi on 14,02.2001. He was advised to undergo coronary angiography. Accordingly the angiography was done on 24.01.2001. The complainant after arranging funds got himself operated at Batra Hospital- and Medical Research Centre, New Delhi on 14,02.2001. He informed, this fact to the insurance company and submitted the bills of the expenses incurred by him, which certify that a sum of Rs.1,83,156,21/- (Rupees One Lac Eighty Three Thousand One Hundred Fifty Six and Twent; One Paise) was spent by the complainant. But by their letter dated 30.03.2001, the insurance company arbitrarily (ejected the claim. Therefore the complaint was filed. 3. The opposite party contested the complaint merely on the ground that the complainant was suffering from heart disease from before taking the policy and submitting the proposal form. He has suppressed this material fact, therefore his claim has rightly, been repudiated, No other plea was pressed before us. 4. Now the only question to be seen is whether the complainant was suffering from heart disease before furnishing the proposal form or not? And. if so whether it has been suppressed by the complainant in the proposal form or not? 5. The complainant has vehemently denied that he was suffering from any disease as such and he has alleged that for the first time on 03.12.2000, he felt breathlessness. The proposal form was filled in on 16.05.2000. It is said that after 7 months for the first time the complainant could know about this disease and all the proceedings took thereafter only. The plea of the opposite party is that such a disease will not come into light overnight and it will take long time to mature. The question is not of the hidden disease but the' question is whether the complainant knew that he was suffering from heart disease earlier or not? 6. There are cases when a man suffers heart attack and immediately he dies. He had never been diagnosted of heart attack. There are cases where cancer is detected at the last stage. There should be definite evidence by the insurance company that the complainant knew about this disease earlier and has knowingly suppressed it. For this there is only a report of the panel of doctors appointed by the insurance company itself who have reported that such a disease will not develop only in 7 months, therefore in their opinion the disease was preexisting before 16.05.2000. Out of this penal, Dr. For this there is only a report of the panel of doctors appointed by the insurance company itself who have reported that such a disease will not develop only in 7 months, therefore in their opinion the disease was preexisting before 16.05.2000. Out of this penal, Dr. M.K. Rastogi, who is M.B.B.S, M.D (Modicine) D. Card, (Cardiology) has himself reported that however the complainant may not be aware of his heart problem earlier. Even if the disease was pre-existing and the complainant did not know it, he cannot• be blamed of deliberate suppression. What was necessary for the insurance' company was that it should have inquired from Dr. D.C. Pant or the doctors of Escorts Heart Institute and Research Centre, New Delhi who conducted the T.M.T. etc or .the doctors of Batra Hospital and Medical Research Centre, New Delhi, who conducted the operation. 7. The Learned Counsel for the insurance company argued that the evidence should be giver by the complainant himself. The complainant will not give evidence in the negative. The insurance company has got its own investigators, surveyors who are fully authorized and competent enough to record the statement of the doctors and to collect evidence in support of their allegations. There is no averment at all that the doctors of Batra Hospital or doctors of Escorts Heart Institute or Dr. D.C. Pant did not co-operate with the insurance company when the officer of the insurance company went to record their statement or to take their 'opinion but they refuse to do so. There is absolutely no evidence that the complainant was suffering from such a disease earlier before the submission of the proposal form. The complainant in his all bonafide has mentioned the disease of diabetes. Had he got heart problem and had he been in the knowledge of such a problem, he could have definitely shown this problem in the proposal form as well. No malafide can be atributed on the complainant. 8. The net result is that we do not find any force in this appeal and the appeal is liable to be dismissed. ORDER The appeal is hereby dismissed. However, in the circumstances of the case, cost of this appeal shall be easy.