State Consumer Disputes Redressal Commission
Bharatbhai P Patel vs The National Ins Co Ltd on 12 August, 2021
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7. Duration of present disease suffered (i.e. since how long he or she may be suffering from present disease before approaching you): 1 day.
8. Is the present disease suffered connected to previous disease or Diabetes, Hypertension (Blood Pressure), Surgery or other existing disease ? : No.
9. Is disease suffered Acute or Cronic ? : Acute.
(P VFD4 D[0LS, ;l8"lOS[8GL p5ZMST AFATM T5F;TF\ H[ ALDFZLGL ;FZJFZ DF8[ OZLIFNLGF 5ltGG[ CMl:58,DF\ NFB, SZJFDF\ VFJ[,F K[4 T[ ALDFZL V[S lNJ;GL CTL4 T[D ;FALT YFI K[ VG[ T[YL OZLIFNLG\] SYG S[ T[DGL 5ltG AFYZ]DDF\ 50L HJFYL T[DG[ CMl:58,DF\ NFB, SZJFD\F VFJ[,F T[ AFAT 5]ZJFZ YTL CMI T[D ,FU[ K[P JW]DF\ SM,D G\P ( 5|DF6[ T[DGL CF,GL lADFZLG\] SFZ6 0FIFAL8L; S[ CF. AL5L GYL4 T[D :5Q8 NXF"J[, K[ VG[ T[ S|MlGS 56 GYLP VFD4 VF ;J"[ AFATM ;FALT SZ[ K[ S[4 OZLIFNLGL BORICHA A. NO.1585/2014 Page 5 of 9 6 5ltGG[ H[ ALDFZL DF8[ CMl:58,DF\ NFB, SZJFDF\ VFJ[,F CTF4 T[ lADFZL l5|V[ShL:8L\U GYLP )P hFI0; CMl:58, S[ H[DF\ OZLIFNLGF 5ltGG[ tIFZAFN NFB, SZJFD\F VFJ[, CTF4 T[G\] D[0LS, ;l8"lOS[8 56 VF SFD[ 5FG G\P Z!qZZ YL ZH] YI[, K[P T[DF\ SM,D G\P ( DF\ 56 :5Q8 ZLT[ NXF"J[, K[ S[4 CF,GL lADFZL 0FIFAL8L;4 CF. ALP 5LP H[JL ALDFZLG[ SFZ6[ YI[, GYLP !_P hFI0; CMl:58, TYF V5ZF Gl;"\U CMDGF 0L:RFH" ;l8"lOS[8 VF SFD[ ZH] YI[,F K[4 T[ T5F;TF\ H6FI K[ S[4 T[DF\ CF. ALP 5LP VG[ CFI5Z YFIZM.0GL ALDFZL SIFZYL K[ T[ AFAT[ SF\. H6FJ[, GYL TYF :5Q8 H6FJ[, K[ S[4 KFTLDF\ N]oBFJFGL OZLIFN ;FY[ OZLIFNLGF 5ltG NFB, YI[, CTFP !!P ;FDFJF/F JLDF S\5GLGM Z[%I]0LV[XG ,[8Z VF SFD[ ZH] YI[, K[4 T[ 5FG G\P Z* p5Z K[4 T[DF\ GLR[ 5|DF6[ H6FJ[, K[P "We are in receipt of claim papers from you for your hospitalization due to Acute Coronary Syndrome, AFAR, Hypothyroidism and HBP. while going through claim paper it is observed that the policy is 2nd year of operation and you are known case of HBP. The ECG report dated 01.02.2013 is suggestive of HT, Thyroid, CRF, with ascending Aorta Aneurysm to RO Dissection. It means you are having long standing HBP. Physician has also confirmed this fact. Also HBP BORICHA A. NO.1585/2014 Page 6 of 9 7 can lead to Aorta Aneurysm. Considering the disease as Chronic progressive development, The disease is pre existing which is not covered during 2nd year policy as per condition No. 4.1 which states that," Benefits for pre-existing disease will not available for any condition(s) as defined in the policy until 36 months of continuous coverage have elapsed since inception of first policy with us."
!ZP VFD4 JLDF S\5GLV[ OZLIFNLGL 5ltGG[ 5C[,F\YL CF. ALP 5LP CMI4 T[ SFZ6[ CF,GL lADFZL YI[, K[ T[D DFGL S,[.D GFD\H]Z SZ[, K[4 T[ IMuI GYLP ;FZJFZ SZGFZ 0MS8ZGF D[0LS, ;l8"lOS[8 p5ZYL :5Q8 H6FI K[ S[4 T[DG[ CF,GL ALDFZL CF. ALP 5LP G[ SFZ6[ YI[, GYLP GFDNFZ ;]l5|D SM8"[ ;LJL, V5L, G\P 8245 of 2015, (Sulbha prakash Motegaonkar & Ors. Vs. LIFE Insurance Corporation of India.) DF\ GLR[ 5|DF6[ 9ZFJ[, K[P "We are of the opinion that the National Commission was in error in denying to the appellants the insurance claim and accepting the repudiation of the claim by the respondent. The death of the insured due to ischaemic heart disease and myocardial infraction had nothing to do with his lumbar spondylitis with PID with sciatica. In our considered opinion, since the BORICHA A. NO.1585/2014 Page 7 of 9 8 alleged concealment was not of such a nature as would disentitle the deceased from getting his life insured, the repudiation of the claim was incorrect and not justified."
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