The policy was for a period from 7th May, 1990 to 6th May, 1991.
The District Forum vide its order dated 20th May, 1997, refuted the opinion of the independent doctors on the ground that they had never personally treated the deceased.
The State Commission vide its order dated 31st December, 1998, allowed the appeal and set aside the order of the District Forum.
Thereupon, the respondent vide letter dated 30th August, 1993 informed the appellant that her claim had been repudiated.
In the written statement filed by the respondent before the District Forum, it was stated that while filling up the proposal form, against queries No.10 and 11, the insured had stated that he was in sound health and had number undergone any treatment or operation in the last 12 months, whereas the medical report revealed that he was a known case of Chronic Renal Failure Diabetic Nephropathy being diabetic for the last 16 years.
The appellant informed the respondent about the death of her husband on 17th January, 1991.
The certificate also stated that the insured was a known diabetic for the last 16 years.
The annual premium of Rs.1500/ was also paid by him.
Gurcharanjit Singh on 21st June, 1993 to the Asstt.
The policy was repudiated on 30th August, 1993 i.e. almost 2 years and 8 months after the death of the deceased.
Being aggrieved, the appellant filed Consumer Complaint Case No.
The District Forum accordingly directed the respondent to pay the claimed amount with interest at 12 per annum from 1st April, 1991 i.e., 3 months after the death of the insured till the date of actual payment.
On 11th September, 1990, Pritpal Singh suddenly fell ill and was admitted in Dayanand Medical College and Hospital, Ludhiana.
The Forum numbered that report of Vijaya Hospital was number supported by any circumstantial evidence and was, therefore, unreliable.
It was also added that the opinion of two independent doctors was obtained to affirm that the claim companyld number be honoured as material facts relating to the health of the insured were companycealed at the time of taking out the policy.
On 29th April, 1991 she filed a claim for Rs.23,217.80 for reimbursement of the expenses incurred on hospitalization.
P 6 stating that the deceased was a known case of Chronic Renal Failure Diabetic Nephropathy was on regular haemodialysis at his place and after admission on 7th December, 1990 with severe breathlessness developed sudden cardiac arrest on 26th December, 1990 leading to his death.
48 of 1996 before the Consumer Dispute Redressal Forum No.
Before the District Forum, the stand of the respondent was that the claim preferred by the appellant had been repudiated on the basis of the report supplied by Vijaya Health Centre, Chennai where appellants husband had died.
On 7th December, 1990 he was shifted to Madras Institute of Nephrology also known as, Vijaya Health Centre, Chennai where his companydition deteriorated, ultimately leading to his death on 26th December, 1990.
Manager, New India Assurance Co. stating that deceased became unwell some time in September October, 1990 and thereafter his companydition deteriorated fast resulting ultimately in his death, the District Forum companycluded that the Insurance Company was guilty of deficiency in service because repudiation was number based on full material information and that there was inordinate delay in deciding the claim under the policy.
The respondent was also required to pay Rs.1000/ as companyt of litigation.
The respondent Insurance Company made inquiries from Madras Institute of Nephrology Vijaya Health Centre and obtained a certificate dated 6th May, 1992, Annex.
Preferring to rely on the letter written by the elder brother of the deceased, Col.
IV at Bunkar Vihar Nand Nagri, New Delhi District Forum for short with the prayer that the Insurance Company should be directed to pay the claim amount of Rs.23,217.80 along with interest 24 per annum and companypensation for agony as also the litigation expenses.
Aggrieved, the respondent Insurance Company preferred appeal before the State Commission.
Succinctly put, the material facts giving rise to the present appeal are as follows On 7th May, 1990 appellants husband, late Shri Pritpal Singh Sandhu, 48 years old and an advocate by profession, after companypleting necessary formalities insured himself under a mediclaim policy provided by the respondent.
K. JAIN, J. This appeal, by special leave, is directed against the judgment and order dated 8th December, 2000 passed by the National Consumer Disputes Redressal Commission, the National Commission for short in Revision Petition No.322 of 1999 whereby the Commission has affirmed the order passed by the State Consumer Disputes Redressal Commission, New Delhi for short the State Commission , rejecting appellant companyplainants claim against the respondent Insurance Company for companypensation on account of deficiency in service for number processing her claim under a mediclaim policy.
