By Smt. Padmini Sudheesh, President: <br /> <br /> The case of the petitioner is as follows:<br /> <br /> On 10.9.98 the petitioner and his two sons were joined in the Jan Arogya Bima Policy of the respondent. The premium was Rs.170/- only. The wife of petitioner joined in the policy on 9.9.99. The premium was Rs.70/- only. The younger son of the petitioner had treated for the disease of ‘Balanoposthitis’ in Kunnamkulam Royal Hospital during the period of 12.3.03 to 13.3.03 and the medical expenses were Rs.2479/-. The claim was submitted on 21.3.04 and 15.9.03, but a reply received stating repudiation of the claim. The policy period was till 6.9.04. so he is entitled for the medical expenses. Hence this complaint. <br /> <br /> 2. The counter in short is as follows: On scrutiny of papers submitted by the complainant it is noted that the complainant’s son had consulted the doctor for the same disease in the year of 2000 and which shows that the son availed the treatment is for a pre-existing disease. As per exclusion No.4.1 and 4.2 of the conditions of the policy, the Company shall not liable. The medical certificate obtained from the treated doctor shows that the first consultation was in the year 2000. The act of the complainant is deceiving, consciously suppressing the diseases at the time of making the application for insurance policy. The amount of compensation claimed is highly excessive. Hence dismiss the complaint.<br /> <br /> 3. The points for consideration are:<br /> <br /> (1) Whether the petitioner is entitled for the insurance claim?<br /> (2) Whether there is deficiency in service?<br /> (3) Reliefs and costs.<br /> <br /> 5. The evidence consists of Exts. P1 to P10 and R1 to R10.<br /> <br /> 6. Point No.1: The younger son of the petitioner had treated for the disease of Balanoposthitis in Kunnamkulam Royal Hospital during the period of 12.3.03 to 13.3.03 and there occurred medical expenses of Rs.2479/-. Since he and his sons are policyholders he had applied for the expenses, but it was rejected stating pre-existing disease and excluded from the purview of the policy. According to the petitioner the policy started from 10.9.98 and the termination period was 6.9.04. The treatment was within the policy coverage. But the respondent company rejected this by stating that he had taken different policies and not continuation of the previous policy. On perusal of records it can be seen that the policies are different. But the petitioner is on the view that he had renewed the policy. But there is no gap in the policy. So even if the first consultation was in the year 2000, it is also covered under the policy. So the complainant is entitled for the insurance claim. The expense stated is Rs.2479/-. He is entitled for that amount.<br /> <br /> 7. Point No.2: Repudiation of genuine claim is a deficiency in service on the part of the respondent Company.<br /> <br /> 8. In the result, the complaint is allowed and the respondent is directed to provide Rs.2479/- (Rupees two thousand four hundred and seventy nine only) to the petitioner with interest at the rate of 12% per annum from 12.3.04 till realisation. He is also entitled for Rs.1000/- (Rupees one thousand only) towards costs. Comply the order within one month. <br /> <br /> Dictated to the Confidential Assistant, transcribed by her, corrected by me and pronounced in the open Forum, this the 28th day of July 2008.<br />