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Judgment
HEARD the learned Advocates for admission of the appeal. Perused the material available before us including the impugned order being dated 3.1.2001 passed by the District Forum, Nasik in Complaint No. 391/1998 dismissing the complaint of the complainant/appellant herein.
ON hearing the learned Advocates and on perusal of the order impugned in this appeal, prima facie the basic issue for consideration was as to whether when the complainant/appellant increased the coverage of the Mediclaim Policy obtained from the respondents herein, was having any problem connected to the heart. The respondent/Insurance Company contended that just prior to submission of the proposal for increase of the amount of coverage, the appellant/complainant had undergone Angiography in Bombay Hospital. Discharge Certificate of the complainant is at page No. 39 of the appeal paper book. It was contended by the Insurance Company that when the appellant got the coverage limit increased, he did not disclose the fact of his heart disease. The certificate issued by concerned doctor of Bombay Hospital Dr. B.K. Goyal being dated 11.7.2001 clearly states the said fact and the District Forum in its impugned judgment has reproduced the text of the said letter which reads as under : TO WHOMSOEVER IT MAY CONCERN "This is to certify that Mr. Sivraj Chudamani Salaskar was admitted under me in Bombay Hospital and he was suffering from Ischaemic Heart Disease. He was admitted on 21.1.1997 and underwent Angiography and was discharged on 24.1.1997."
District Forum relied upon the said certificate issued by above mentioned heart Surgeon Mr. V.K. Goyal and in our view rightly held that there was suppression of material fact by the complainant/appellant.
IT is to be stated that insurance is a contract essentially based on mutual trust and confidence and it is the duty of the insured to be sincere and honest to disclose all the facts in the nature of policy as obtained in the matter herein. The District Forum in its impugned order has also noted the case, which was presented by and on behalf of the respondent/Insurance Company and the reason assigned by them for repudiation of claim of the complainant. In our view the fact of nature which was just little before the fresh proposal was certainly known to the complainant and it was necessary for him to disclose the same. Having not done so, the same as held by the District Forum certainly amounts to suppression of material fact.
IN view of this, we do not wish to interfere with the order of the District Forum. No merits. Appeal stands dismissed. Appeal dismissed.