The Consumer Disputes Redressal Commission (CDRC) bench, comprising of president Justice MS Parikh and member MK Joshi, while partly allowing the insurance company's appeal against the 1998 order of the District Consumer Disputes Redressal Forum, Valsad, to pay original complainant and policy-holder Prakash Balkrishna Shethji Rs 1,41,654 as reimbursement claim towards the expenses of his by-pass surgery, modified the judgment on Saturday.

The CDRC order read, "The opponent insurance company has given the detailed working, showing entitlement of the applicant to the extent of Rs 64,279. It has been fairly conceded that the applicant would be entitled to 15 per cent bonus. Since the claim was repudiated on grounds with regard to which even the opponent insurance company was not certain, it will have to pay interest at the rate of 12 per cent, working out of bonus at 15 per cent which comes to Rs 9,641. The insurance company is hereby directed to pay to the applicant Rs 73,920 at 12 per cent interest rate since July 1997, and cost directed by the District Forum, Valsad, within six weeks from the date of receipt of copy of this order. It is clear that the applicant himself has lodged claim with regard to expenses of angiography, as also by-pass surgery ,and in its natural course the documents must have been passed over by the applicant to the opponent insurance company," the order said.

"If the applicant had any evil intention of suppressing any fact, he would have withheld this document, the order said."

"Be that it may," it continued to say, "what should be noted is that on the day when first insurance was taken by the applicant, he clearly did not have knowledge about any ailment regarding hypertension or diabetes."