Punjab-Haryana High Court
United India Insurance Company vs Smt. Suman Kawatra And Others on 7 October, 2009
Author: Sabina
Bench: Sabina
R.S.A. No. 3574 of 2009(O&M) -1-
In the High Court of Punjab and Haryana at Chandigarh
R.S.A. No. 3574 of 2009(O&M)
Date of Decision:October 07, 2009
United India Insurance Company
---Appellant
versus
Smt. Suman Kawatra and others
---Respondents
Coram: HON'BLE MRS. JUSTICE SABINA
***
Present: Mr. Munish Goel, Advocate,
for the appellant
***
SABINA, J.
Plaintiff - Janki Nath Kawatra had filed a suit for recovery of Rs. 2,52,560/-. Civil Judge (Jr. Division), Batala vide judgment and decree dated 5.11.2005 decreed the suit of the plaintiff. Aggrieved by the same, defendants preferred an appeal and the same was dismissed by Additional District Judge (Ad hoc) Fast Track Court, Gurdaspur, vide judgment and decree dated 13.3.2009. Hence, the present appeal by defendant No. 3.
The facts of the case as noticed by the learned Additional District Judge(Ad Hoc) Fast Track Court, in paras 2 and 3 of its judgment are as under:-
"Brief facts of the case are that plaintiff-Janki Nath Kawatra R.S.A. No. 3574 of 2009(O&M) -2- filed suit for recovery of 'Rs. 2,52,560/- against the defendants on the grounds inter alia that the plaintiff took a mediclaim Insurance Policy on 19.3.1993 from the defendants with its Branch Office at Batala vide cover note no. 125667 dated 19.3.1993 R/C Note No. 84`910 dated 28.02.1992 for the period from 19.03-1993 to 18.03.1994 and paid the annual premium and prior to the said Insurance Policy, he had taken the similar policy vide cover note No. 20406 dated 26.2.1991 for the period from 26.2.1991 to 25.2.1992, over note no. 84910 dated 28.2.1992 for the period from 28.2.1992 to 27.2.1993 and before taking up the said policies, he completed all the formalities of the defendants and he was even medically examined by the doctor on the penal of Medical Practioners of the defendants and during the continuance of the said policy, the plaintiff fell ill on 11.4.1993 and got treatment from Dr. R.S.Kalsi, MBBS, M.D, G.T.Road, Simble Batala who advised bed rest for 10 days and the plaitiff again consulted the said doctor on 23.4.1993 and 29.3.1993 and had the medicines and treatment as prescribed by him. On 10.5.1993, the plaintiff felt some pain in the chest and on the recommendation of Dr. Kalsi and in order to be sure of the desease he was suffering and for better treatment, he got himself medically examined from the Exports Heart Institute and Research Centre, Okhla Road New Delhi and the doctor who diagnosed him opined that he was suffering from trouble and that he will be operated for coronary bypass surgery and he was operated upon for the said R.S.A. No. 3574 of 2009(O&M) -3- disease in the said Institute and the original of various tests, admission and discharge slips, treatment conducted and the hospital bills etc. of the said hospital and that of Dr. R.S. Kalsi were sent to the defendants and vide letter dated 15.4.1993, the plaintiff requested the defendants for registration of the claim and after completing the claim for Rs. 1,64,000/-, the amount spent by him for the said treat and requested them to make the payment of the said amount, but the defendants vide their letter dated 22.4.1994 repudiated the claim without assigning any reason and by violating the terms and conditions of the said poli9cy which theywere liable to pay as he was quite hale nd hearty at the time of taking the aforesaid insurance policy. The plaintiff was also entitled to interest at the rate of 18% per annum on the said amount of Rs. 1,64,000/- from 22.4.1994 to 21.4.1997, because the defendants had deprived the plaintiff from the use of the said mediclaim and as such, suit amount was due and payable by the defendants which they had refused to pay despite repeated requests and demands and as such, suit was filed out of which this appeal has arisen.
3. The defendants by filing written statement alleged that the said cover notes/policies/coverage of any risk etc. under them was absolutely null and void, abinitio for the reason that a contract of insurance was a contract or utmost faith. The insured was guilty of breach of faith as he had suppressed material facts as he was an old case of Angine and as per his medical reports, the plaintiff had a positive family history of R.S.A. No. 3574 of 2009(O&M) -4- Ishcaemc heart disease and he had an episode of Agnine on exertion in 1988 and since them he was an Antianginalo therapy and as per the said report, there was also a positive history of post prandial Angine and this vital information intentionally, willfully and fraudulently kept concealed by the plaintiff from defendants and their consent was obtained for covering the risk by suppression and concealment of facts. The plaintiff was not liable to be reimbursed for any such expenses and the defendants specifically denied the correctness, genuineness and validity of the alleged hospital record i.e. Tests admission and discharge slips, treatment and bills etc. It was further alleged that the plaintiff was not entitled to claim and the defendants were not liable to pay any such amount ad the repudiation of the claim of the plaintiff was neither illegal nor false, nor mala fide or against law. The claim was highly exaggerated. The defendants were not liable to pay the suit amount. The plaintiff had got no cause of action and the suit was not within time. All other averments were denied and dismissal of the suit was prayed.
On the pleadings of the parties, following issues were framed by the learned trial court:-
1. Whether the plaintiff is entitled to recover the suit amount along with interest?OPP
2. Relief After hearing learned counsel for the appellant, I am of the opinion that the present appeal is devoid of any merit. R.S.A. No. 3574 of 2009(O&M) -5-
Plaintiff had taken insurance policy on 19.3.1993. Plaintiff also paid the annual premium in pursuance to the policy. The case of the insurance company was that the plaintiff had taken the policy by playing fraud upon the company. Learned Additional District Judge in its judgment has observed that the plaintiff had also taken policies for the period from 26.2.1991 to 25.2.1992( Ex. P-2), from 28.2.1992 to 27.2.1993 (Ex. P-3). Plaintiff had also taken policy Ex. P-5 for the period from 19.3.1993 to 18.3.1994 and also taken policy for the period from 19.3.1993 to 18.3.1994 and for the period from 1994 to 1995. Thus, the plaintiff had been regularly getting himself medically insured had been paying the premium. In case. In case, during the said previous years, there was any chronic disease from which the plaintiff was suffering, then it should have been detected by the company at the time of issuance of the policy. Since the plaintiff was being issued policy from time to time after due medical examination, Courts below had rightly held that it could not be said that the plaintiff had obtained policies by playing fraud upon the company. During the subsistence of the policies(Ex. P-1 to Ex. P-6), plaintiff suffered heart ailment on 11.4.1993 and got himself medically treated from Escorts Heart Institute, New Delhi and spent a sum of Rs. 2,52,560/-. The courts below, thus, in these circumstances have rightly decreed the suit of the plaintiff. Plaintiff had examined the doctor who had given him treatment, as PW-2. He had proved the prescription slips, the amount mentioned in the receipts (Ex. P-38 to P-43) which had been duly deposited by the plaintiff with the hospital. The claim made by the plaintiff was to the extent on Rs. 1,64, 000/- whereas the trial court had decreed the suit for recovery of Rs. 83000/- only.
R.S.A. No. 3574 of 2009(O&M) -6-
No substantial question of law arises in this appeal for consideration. Accordingly, this appeal is dismissed.
(SABINA) JUDGE October 07, 2009 PARAMJIT