V.B. Gupta ORDER
V.B. Gupta, J. (Presiding Member)
1. In this revision petition filed by Petitioner/Opposite Party there is challenge to impugned order dated 24.3.2008, passed by H.P. State Consumer Disputes Redressal Commission, Shimla (for short, 'State Commission') vide which First Appeal No. 365 of 2007 filed by the petitioner was dismissed.
2. Respondent/Complainant got himself insured with the Petitioner Company under 'Videsh Yatra Mitra Policy' dated 25.05.2009 before proceeding on foreign tour of 28 days for U.S.A. U.K. & Europe and paid premium of Rs. 1,754/-. It stated that respondent developed uneasiness suddenly during USA tour and consulted the doctor. Respondent had suffered sudden blockage of veins and had to be operated for the disease and incurred an amount of 2,00,000/- on operation and paid 65,000/- on the spot to Doctor Sen Gabriel Vally Medial Centre, CHW-438. Respondent was again advised for post operative visits, by Dr. Gleen-H Weissman, M.D. who conducted the surgery on 06.07.2009 and advised him not to fly. Petitioner did not admit the claim of the respondent, for release of sum of 2,00,000/-. Hence, consumer complaint was filed before the District Consumer Disputes Redressal Forum, Nahan, H.P. (for short, 'District Forum').
3. Petitioner in its written statement denied, that respondent suddenly developed problem of some easiness. In fact, respondent concealed the ailment and by pleading false facts obtained the policy cover. In view of the concealment of the ailment, respondent is not entitled to take benefit of the policy. Moreover, there was no such disease for which immediate operation was required.
4. District Forum vide order dated 09.04.2007, allowed the complaint and passed following directions;
"The OP-Company to indemnify the complainant to the extent of 2,00,000/- along with interest at the rate of 9% per annum with effect from the date of filing of the complaint, i.e. 05.11.2003 till actual payment is made. The litigation cost is quantified at 1,500/-. These payments shall be made to the complainant by the OP-Company within a period of forty five days from the date of receipt of copy of this order. With these observations, the present complaint stands disposed of."
5. Aggrieved by the order of the District Forum, petitioner filed an appeal before the State Commission, which dismissed the same with cost of 5,000/-.
6. I have heard the learned counsel for parties and gone through the record.
7. It is submitted by learned counsel for the petitioner, that respondent has concealed the material facts and has given wrong information at the time of obtaining the policy cover. Under these circumstances, respondent is not entitled for any insurance claim.
8. On the other hand it is submitted by learned counsel for the respondent, that there has been no concealment of material facts in this case. On the other hand, respondent all of a sudden developed problem of uneasiness and due to that, he had to take treatment and had undergone surgery. Since, there is no concealment, petitioner wrongly repudiated the insurance claim.
9. District Forum in its order held;
"4. The complainant, admittedly, purchased a Videsh Yatra Mitra Policy bearing No. 613895 from the OP-Company on 25.5.2009 and paid a premium of Rs. 1,754/-. The complainant fell ill during the subsistence of the insurance policy. The OP-Company has repudiated the claim of the complainant on the ground that the complainant has not complied with the terms and conditions of the policy.
5. Annexure R-2 is copy of the proposal form submitted by the complainant before obtaining the Videsh Yatra Mitra Policy. On appraisal of the aforesaid from, it is evident that the detail in clause-B has to be filled by a Doctor to find out the health of the insured which may be a circumstance to strengthen the case of the OP-Company to justify the purpose of visit. Such columns of Annexure R-2 are blank and do not bear the signature of any Cardiologist. This goes to show that the OP-Company has failed to bring on record the material to warrant their contention that the complainant just availed the medical facility during foreign trip. Th........