State Consumer Disputes Redressal Commission
The Manager,The New India Assurance ... vs Ku.Jayashree Kestashi Dama, U/G Ship Of ... on 18 August, 2010
Date of filing :14.09.2006 Date of order :18.08.2010 MAHARASHTRA STATE CONSUMER DISPUTE REDRESSAL COMMISSION,MUMBAI, CIRCUIT BENCH AT AURANGABAD. FIRST APPEAL NO. : 1830 OF 2006 IN COMPLAINT CASE NO.:75 OF 2005 DISTRICT CONSUMER FORUM : AURANGABAD. The Manager, The New India Assurance Co.Ltd., Branch Lakkad Kot, Jalna. APPELLANT (Org.Opp.No.1) VERSUS 1. Ku.Jayashree Kestashi Dama, U/g ship of real father and Ketashi S/o Gokuldas Dama, R/o Saklecha Nagar, Bhokardan Road, Jalna. 2. The Manager, Paramount Health Service Pvt.Ltd., Elite Auto House, 54-A, M.Vasanji Road, Off.Andheri Kurla Road, Andheri(E) Mumbai 400 093. RESPONDENTS (No.1-Org.Complainant, No.2-Org.Opp.No.2) CORAM : Shri.S.G.Deshmukh, Hon`ble Presiding Judicial Member.
Mrs.Uma S.Bora, Hon`ble Member.
Present : Adv.Shri.R.H.Jobanputra for appellant, Adv.Shri.T.G.Gaikwad for respondent No.1, None for respondent No.2.
O R A L O R D E R Per Shri.S.G.Deshmukh, Hon`ble Presiding Judicial Member.
1. The present appeal is filed by The New India Assurance Co.Ltd. against the judgment and order dated 4.08.2006 in complaint case No.75/05 passed by District Consumer Forum,Jalna.
2. Respondent No.1`s/Org.Complainant`s case before the Forum is that, Ketashi had obtained hospitalisation and domiciliary hospitalization benefit policy bearing No. 160501/48/03/00487 from the appellant for himself and his family members for the period 23.10.2003 to 22.10.2004 for sum assured of Rs.35,000/- each. It is contended that complainant Jayashree fell ill and admitted in Kamalnayan Bajaj Hospital for the period 26.04.2004 to 24.07.2004. She was treated there. She incurred expenses for the treatment. It is contended that father of complainant sustained loss in his business during the treatment of his daughter. Thus claim was preferred before the appellant. The claim was repudiated on the ground that the insured has suppressed the material particulars about the health of his daughter at the time of obtaining policy. Thus complainant approached the Forum.
3. Present appellant appeared before the Forum and resisted the claim. It is contended that claim has been made within 8 months of the commencement of the policy. They are not at dispute that Jayashree was admitted in Kamalnayan Bajaj Hospital between 26.6.2004 to 24.7.2004. She was diagnosed to be suffering from collagen disorder vasculites tuber culer with bilateral plured effusion and parecaridial effusion kocha old tuber culom treated query pituitary abcess, query scepticem query varicla. It is contended that discharge summary clearly mentions that old tubler culom treated i.e. patient had space keeping lesion and brain and was actiology as a T.B. Insured had ailment of T.B. In the medical report submitted alongwith the claim remains silent on the issue of tuber culoma. It is contended that treatment of tuber culosis was from last 9 months which would be prior to the commencement of the policy. Tuber culosis is a cronic infection caused by mycobacterium tuber culosis and is of the indiass onset i.e. signs and symptoms may take months to appear after infection as set in. It is contended that tuber culoma existed prior to commencement of the policy.
They have rightly repudiated the claim.
4. The Forum below after hearing both the parties allowed the complaint and directed appellant to pay Rs.35,000/- with the interest @ 9% p.a. from 20.12.2004.
5. Being aggrieved by the said judgment and order passed by the District Forum,Jalna, The New India Assurance Co.Ltd. came in appeal.
6. Notices were issued to the appellant as well as respondent. Learned counsel Shri.R.H.Jobanputra appeared on behalf of appellant whereas learned counsel Shri.T.G.Gaikwad appeared on behalf of respondent. We heard both the counsels at sufficient length.
We perused the papers. It is the contention of appellant that respondent had suppressed the material particulars about his daughter`s health while obtaining policy. According to appellant treatment of T.B. was from last 9 months which should be prior to the commencement of the policy. Discharge summary mentions the old tubler culom treated. In order to discharge onus the insurance company to place material on record to show that complainant suppressed the fact which it was material to disclose. In the instant case no evidence had been adduced by insurance company to substantiate their contention that treatment of T.B. was from last 9 months which would be prior to the commencement of the policy. Forum has rightly considered these aspects and rightly allowed the complaint. We are not inclined to interfere the order passed by the Forum. We pass the following order.
O R D E R
1. Appeal is dismissed.
2. Appellant to pay Rs.1000/-
to the respondent No.1 towards cost in appeal.
3. Pronounced and dictated in the open court.
4. Copies of the judgment be issued to both the parties.
Mrs.Uma S.Bora S.G.Deshmukh Member Presiding Judicial Member.
Mane