ICICI LOMBARD GENERAL INSURANCE COMPANY LTD., THROUGH ITS MANAGER (LEGAL) Vs. JASBIR SINGH

JUDGEMENT

(1.) This appeal, under Section 15 of the Consumer Protection Act, 1986, is directed against the order dated 08.05.2013, of learned District Consumer Disputes Redressal Forum, Mandi, whereby a complaint, under Section 12 of the Consumer Protection Act, 1986, filed by respondent -Jasbir Singh against the present appellant, has been allowed and a direction is given to the appellant to pay a sum of Rs.2,37,830/ - on account of insurance money, with interest at the rate of 9% per annum, from the date of filing of the complaint, to the date of its payment and also to pay Rs.3,000/ - on account of compensation and Rs.2,500/ - as litigation expenses.

(2.) Admitted facts are that respondent -Jasbir Singh purchased a health policy from the appellant for his parents, for the period from 20.12.2010 to 19.12.2011. The policy was renewed from 20.12.2011 to 19.12.2012. After the purchase of the policy, father of respondent had some medical problem. He was got medically checked up and it was found that he had heart coronary disease. He was operated upon at National Heart Institute, New Delhi on 15.12.2011. A sum of Rs.2,24,330/ - was spent on the treatment at National Heart Institute and another sum of Rs.13,500/ - was spent on Angiography at Metro Hospital and Heart Institute, New Delhi. Claim was lodged with the appellant for reimbursement of the expenses incurred on the treatment and Angiography, as per terms and conditions of the policy. Appellant initially sanctioned a sum of Rs.1.50 lacs, but later on refused to pay even the said amount of money and repudiated the claim on the ground that father of the appellant had been suffering from Hypertension for the last seven years, which fact he had suppressed while submitting the proposal form. It was stated that suppression of this fact disentitled the respondent to reimbursement in view of clause -1 of Part -III of the Schedule to the policy, as also exclusion clause 3.1 of the Schedule.

(3.) Appellant then filed a complaint, under Section 12 of the Consumer Protection Act, 1986, seeking a direction to the appellant to pay the insurance money with interest and also to pay compensation and litigation expenses.