SRI.K. VIJAYAKUMARAN, PRESIDENT. Complainant filed this complaint for realization of insurance claim. The averments in the complaint can be briefly summarized as follows: The complainant is running a Beauty Parlour in the name and style Charmes Beauty Parlour at Kollam. The complainant is a policy holder of Mediclaim with Oriental Insurance Co. Ltd., Kollam. She had a valid policy bearing No.4441400/2003/1086 and it is valid for the period from 28.2.2003 to 27.2.2004. During 2003 the complainant had pain and bulging in her stomach . So she consulted doctors in Amritha Institute of Medical Science, Ernakulam on 7.8.03 and under gone many medical examinations and she finally undergone surgery for incisional Hernia . She was admitted as in patient on 8.9.03 undergone treatment upto 19.9.2003 and she had incurred an expenditure of Rs.60,000/- in connection with the hospitalization and treatment. Though she made a claim for the amount the opp.party has repudiated the claim and hence the complaint. The opp.party filed version contending interalia that the complaint is not maintainable either in law or on facts. The complainant is not a consumer within the meaning of Section 2[1] [d] of the Consumer Protection Act. The complaint is bad for non-joinder of necessary party. The complainant had not impleaded M/s. T.T.K. Health Care Service, Bangalore who is authorized to decide the genuiness and admissibility of the claim is not made a party. The complainant approached the Forum with unclean hands . It is submitted that the opp.party has issued a medi claim policy for Rs.35,000/- to the complainant for a period from 28.2.2003 to 27.2.2004. The complainant is liable to comply with the policy conditions in order to got indemnity the claim. It is mandatory that the complainant shall give immediate notice of claim with particulars relating to the policy the medical practitioner, hospital etc. It is also obligatory on the part of the complainant insured to submit the final claim along with the receipts and bills to the opp.party within 7 days from the discharge from the hospital. The above mandatory conditions have been violated by the complainant. The opp.party in fact got knowledge about the claim of amount only on receipt of the advocate notice. The opp.party had no opportunity to examine the genuiness or admissibility of the claim preferred by the complainant before the Advocate notice. Therefore the complainant had willfully violated the policy condition. The complainant has not submitted any of the documents before this opp.party and thereby violated the policy conditions. The opp.party has not liable to consider an admissibility of the claim as it is belated.. There is no deficiency in service on the part of this opp.party . This opp.party filed an addition version. The 3rd opp.party who was impleaded subsequently has repudiated the claim of the complainant as early as on 23.11.2003 stating specific reason for the same. The complainant was suffering from complaints of incisional hernia before the inception of her first policy which was commencing from 28.2.2000 The complainant had produced the discharge summary issued from the hospital which shows that the complainant was suffering from the disease of incisional Hernia since 4years prior to her admission in the hospital on 7.8.2003. It is further stated in the discharge summary that the complainant had undergone surgery for hysterectomy in 1997. The claim preferred by the complainant being one for a disease which was pre-existing prior to inception of the policy, the claim preferred by the complainant is not covered by the exclusion clause 4.1. Under exclusion clause 4.3 also the disease of the complainant is not covered The complainant has willfully suppressed existence of the above disease at the time of submitting the proposal form for the insurance.. Hence the opp.party prays to dismiss the complaint with compensatory costs. Points that would arise for consideration are: 1. Whether there is deficiency in service on the part of the opp.party 2. Whether the claim preferred by the complainant is hit by policy condition NO.4 3. Reliefs and costs. For the complainant PW.1 is examined. Ext. P1 to P8 are marked. For the opp.party DW.1is examined.. Ext. D1 to D4 are marked. As a matter of fact the policy is not disputed. The contention of the complainant is that despite the fact that she was having a valid insurance policy her claim for re-imbursement of the medical expenses incurred by her in connection with her treatment at the Amritha Hospital, Ernakulam was repudiated which is illegal. It is the contention of the opp.party that the claim preferred by the complainant is in respect of a pre-existing disease and therefore the claim is not covered under the policy. Policy Condition No.4.1 and 4.3 of Ext.P1`. It is further contended that even at the inception of the policy the complainant was suffering from incisional hernia and the policy was taken suppressing this aspect.. Ext.P7 is the discharge summary issued from the Amritha Hospital to the complainant. Ext.D2 is also the copy of the discharge summary in respect of the complainant produced by the opp.party . Ext. P7 and D2 shows that the illness for which the complainant had under gone treatment and surgery is for incisional hernia. In the discharge summary against history and physical findings the treated doctor has stated that the patient has given history of swelling in the infraumbilical region since four years prior to her admission in hospital and that it slowly increased in size and attained the present size. It is argued by the learned counsel for the opp.party that the insurance policy in this case was taken by the complainant on 28.2.2000 and the same was being renewed periodically. The complainant was admitted in hospital on 8.9.03 , From the statement of the complainant to the treated doctor that she was having incision or hernia for the last four years it is obvious that she was suffering from the disease from 1999 onwards which means that the disease was a pre-existing one at the inception of the policy on 28.2.2000. Under the exclusion clause 4[1] a pre -existing disease is not cover by the policy. It is to be noted that PW.1 herself has stated to the doctor who treated her that she was having incisional hernia 4 years prior to her admission in the Amritha Hospital on 8.9.03 . The complainant has no case that the period of 4 years was stated to the doctor due to any inadvertence or slip of tongue. There is not even suggestion to that effect of PW.1, when she was in the box. When the complainant herself states that she was having incisional hernia even prior to the inception of the policy the repudiation of the claim cannot be said to be not proper and we feel that we shall not be justified in interfering with the repudiation of the claim of the complainant. There no deficiency in service as alleged. Point found accordingly. In the result the complaint fails and the same is hereby dismissed. No costs. Dated this the day of October, 2009. I N D E X List of witnesses for the complainant PW.1.- Shyla List of documents for the complainant P1. – Policy certificate P2. –Registration card of Amritha Hospital P3. – Registration Certificate of Amritha Hospital P4. – Advocate notice to the 2nd opp.party P5. – Acknowledgement card P6. – Farmacy bill of Amritha Hospital P7. – Discharge summary P8. – Repudiation letter of 2nd opp.party List of witnesses for the opp.party DW.1. – Raju.N. DW.2. - R. Ashok Kumar List of documents for the opp.party D1. – Policy conditions D2. – Discharge summary of complainant D3. - Treated Doctors Certificate D4. – Intimation Letter from TTK | 
