Document Fragment View

Matching Fragments

6.      Opposite Parties No.1 and 2, in their joint written version, pleaded that the complaint was liable to be dismissed, on account of concealment of material facts, by the complainant, at the time of obtaining the Policy, in question. It was stated that the complainant was already suffering from the disease, for which he was operated upon, at Singapore, during the period of Policy, much prior to the issuance of the same, and he deliberately concealed the same. It was further stated that, as such, the repudiation of his claim was legal and valid. It was further stated that the discharge summary issued by the Mount Elizabeth Hospital, Singapore, where the complainant was operated upon, showed that he had a bout of similar infection, three weeks earlier, but, at that time, he had refused circumcision. It was further stated that the complainant was suffering from Phymosis (a condition of male genitals), which could be acquired after birth, due to various infections. It was further stated that, however, the most common cause of this condition, was congenital in nature. It was further stated that, as per the terms and conditions of the Policy, any claim resulting directly or indirectly from any internal or external congenital conditions, could not be reimbursed. It was further stated that since the complainant was suffering from the pre-existing disease, referred to above, and concealed this fact, at the time of obtaining the Policy, he was not liable to be indemnified. It was further stated that the contract of insurance is based on utmost good faith, and, as such, due to the concealment of the aforesaid material facts, the same stood vitiated. It was further stated that neither there was any deficiency, in rendering service, on the part of Opposite Parties No.1 and 2, nor they indulged into unfair trade practice. The remaining averments, were denied, being wrong.

14.   We have heard the Counsel for the appellant, respondent no.1, and have gone through the evidence and record of the case, carefully.

15.       Admittedly, the complainant, and his family members obtained Travel Suraksha Family Floater insurance cover, Annexure C-3, valid for the period from 15.06.2011 to 26.06.2011 (mid night), from Opposite Party No.1 (now the appellant), for the period of their travel outside India, as they had planned to go to Singapore, in the month of June, 2011. There is also, no dispute, about the factum, that the complainant, was earlier subscriber to a Family Medicare Policy, and purchased two Insurance Policies, from the United India Insurance Company Limited, regularly, since 2009 (February). It was proved from the evidence, on record, that the complainant suffered an infection, and was admitted in the Mount Elizabeth Hospital, Parkway Hospitals Singapore Pte Ltd., 3 Mount Elizabeth Singapore 228510, in the late hours of 16.06.2011, and remained hospitalized for one day. He was discharged from the hospital on 17.06.2011, as is evident, from Annexure C-4. Alongwith Annexure C-4, copies of record, with regard to his first consultation/case evaluation/post operation notes, are attached. It is evident, from this document, at pages 143 and145, attached with Annexure C-4, that the complainant presented himself, with the symptoms of 1) acute retention of urine and 2) acute balanitis. Under the column relation, if any, of the present illness with past or existing chronic illness, the word none was written. Under the heading is the present ailment related to indulgence in alcohol/tobacco products/narcotic abuse, the word no, was written. The provisional diagnosis/differential diagnosis, which was made by the concerned Doctor, attending on the complainant was balanitis with acute urinary retention. Against the column of treatment initiated, it was written catheterization failed because of swollen/tight foreskin. Hence, admitted for emergency circumcision and catheterization. Under the heading investigations requested/advised it was written as none needed-only emergency surgery. Against the column of proposed history stay, it was written as one day. It is further evident, from the operations notes at page 145/14 of the District Forum file, that it took 30 minutes, for conducting operation. Under the heading surgical procedure, it was written as circumcision + catheterization. Against the column recovery from anesthesia, full was written. It is further evident, from this document, that there was full recovery of the complainant. Under the heading post operation/surgery treatment initiated, following observations were made Catheter removed on 17 June 2011. Able to pass urine. Circumcision wound. No active bleed, minimal pain, for daily dressing until healed. Dr. Chin Chong Min, Consultant Urologist, MBBS FRCS MMED FAMS MCR 041591 signed the operation notes. At page 147/77 there is a letter written by Dr. Chin Chong Min, which reads as under:-

UROLOGY SPECIALIST REPORT OF CHOPRA, YASHAAN DOB 11July 1992, M/18 yrs Period of Admission: 16 to 17 June 2011 Mr. Chopra came to Mt. Elizabeth Hospital as an emergency case because of sudden inability to pass urine due to foreskin infection. On examination, he was in pain, his bladder was distended up to umbilicus, and the foreskin was grossly swollen. Attempts to insert a urinary catheter failed because of the tight and swollen foreskin. As such, he had to be admitted for emergency circumcision and catheterization.
Surgery was performed at 1 am on 17 June under general anesthesia. The swollen foreskin was excised to expose the glans penis, and Foley catheter inserted. One litre of urine was drained from the bladder.
The catheter was removed the next day. He is able to pass urine now. From here on, it is a matter of dressing the circumcision wound daily till it heals. This may take a week or so. To prevent infection, antibolic tablets and cream have been given. Supplies for dressing have also been given because he is travelling. He may need nursing assistance to help with the wound cleaning and dressing.