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Showing contexts for: copd in The Oriental Insurance Company Ltd. vs Ramesh Kumar on 8 May, 2018Matching Fragments
3. Upon notice, Op appeared and filed the written version stating that the liability under the policy is strictly according to the terms and conditions of the policy; the complainant has not approached the Forum with clean hands and concealed the material facts. On scrutiny of the claim document, it was found that as per discharge summary, the insured was admitted for treatment of Chronic Obstructive Pulmonary Disease - COPD, CO2 retention with bilateral pneumonia with a history of Obstructive Pulmonary Disease - COPD since 2 years, therefore, the diagnose ailment is a complication developed due to pre-existing disease, which was existing at the time of booking the policy, therefore, the claim is not payable. As per exclusion clause No. 4.1 of the policy terms and conditions as the policy was running only in the 2nd year, therefore, the claim of the complainant was repudiated vide letter dated 9.3.2017 being not payable. No deficiency in services on the part of Op. Complaint is without merit, it be dismissed.
12. He has further referred to discharge summary of Fortis Escort Hospital, Amritsar having the past history. It has been stated that the patient was known case of hyper tension, Type II DM and COPD for the last 2 years. With regard to hypertension and DM, no period has been given. With regard to COPD, counsel for the appellant/Op has not referred any document that before taking the policy, the complainant was having the knowledge of this disease and was taking the treatment. In case it is not so then mere reference in the discharge summary is not sufficient and the Op was required to lead any independent evidence to prove this fact. Hon'ble National Commission in Revision Petition No. 200 of 2007 "Mr. Satinder Singh versus National Insurance Co. Ltd." decided on 24.1.2011 wherein it has been observed that "recording of history of patient in the above stated manner does not become a substantiate piece of evidence and convincing evidence be brought on record that complainant was aware of pre- existing disease for which he had taken the treatment of disease." Counsel for the complainant has referred that in case the complainant was not aware of the disease even if there was some problem that cannot be categorized as pre-existing disease. In this regard, he has made a reference to III 2014 CPJ 340 (NC) "New India Assurance Company Limited through its duly Constituted Attorney, Manager versus Rakesh Kumar" that people can live months/years without knowing the disease and it is diagnosed accidentally after routine check up and on that ground repudiation is not justified. Further no Doctor of Fortis Escort Hospital, Amritsar has been examined on what basis he has written that complainant was suffering from COPD for the last 2 years. It has been observed by the Hon'ble National Commission in its judgment IV (2008) CPJ 89 (NC) "Life Insurance Corporation of India & Ors. Versus Kunari Devi" that history recorded in the hospital bed head ticket is not to be taken as evidence as Doctor recording history not examined and suppression of disease not proved. Therefore, we do not agree with the plea raised by the counsel for the appellant/Op that the claim is not payable on the basis of pre-existing disease. We are of the opinion that the District Forum has rightly appreciated the evidence on the record and has rightly come to the conclusion that the claim was wrongly rejected.