Dtd.24.03.2023                                            A/453/2023

O R D E R

        HON’BLE Mr.JUSTICE HULUVADI G RAMESH : PRESIDENT

1.    This is an appeal filed U/s.41 of CPA 2019 by OP.1/Appellant aggrieved by the order dtd.22.12.2022 passed in CC/1530/2017 on the file of 3^rd Addl., Bengaluru District Commission.   
2. The Commission examined grounds of appeal, impugned order, appeal papers and heard. Accordingly found satisfied to dispense with issuance of appeal notice.
3. It is not in dispute that Complainant is a senior citizen and had obtained Senior Citizen Red Carpet insurance policy from OP.1 by paying prescribed premium on 03.09.2014. It is also not in dispute that he had submitted medical bills in the month of July 2015 claiming the expenses incurred in the hospital towards his treatment of Rs.3,89,877/- and the same was rejected on the reason that the Complainant did not disclose pre-existing diseases at the time of taking the policy.  However, since he had also obtained a group insurance policy, he was paid only Rs.2,25,000/-, thereby claims remaining amount of Rs.1,59,448/- along with interest and other reliefs. In this regard, we examined the impugned order, wherein the Commission below observed in para 13 of the order that, “In the repudiation letter, vide Ex.C10 dt.11.08.2015 it is stated that at the time of inception of the policy which was from 03.09.2014 to 02.09.2015, the complainant did not disclose the past medical history/health details in the proposal form which amounts to misrepresentation, thereby the opposite party no.1 had repudiated the claim as per condition No.7 of the policy.  On perusal of Ex.C5 and Ex.C7 with regard to the course in the hospital it appears that the patient was aged 75 years, it cannot be said that the patient had previous knowledge about the previous disease mentioned in Ex.C5 past history of the diseased.    If the complainant had knowledge about the disease mentioned in Ex.C5 and Ex.C7, he would have obtained treatment, and he came to know the names of the disease mentioned in the discharge summary only on the admission to the hospital.  For mere, on the basis of the entry made in the discharge summary about the past history of the diseased, it cannot be said that the patient had knowledge about the said disease prior to admission to the hospital.  It is not the case of the opposite party no.1 that the complainant got treated to the said disease in the hospital prior to his admission to Sagar Hospital as per Ex.C5 and Ex.C7.  Therefore, I feel the ground stated by opposite party no.1 in the letter of repudiation of claim vide Ex.C10 is not sustainable” which in our view sounds well for the reasons stated therein and does not call for any interference of this Commission. However, if the rate of interest awarded is reduced, would meet the ends of justice. Accordingly we proceed to dispose of the appeal, reducing the rate of interest from 9% p.a. to 6% p.a. and rest of the award under order shall remain unchanged.
4. The amount in deposit is directed to be transferred to the District Commission for needful.
5. Notify copy of this Order to the District Commission and parties.

Lady Member             Judicial Member              President      

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