KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACADU THIRUVANANTHAPURAM APPEAL NO. 132/04 JUDGMENT DATED.4.4.08 PRESENT JUSTICE SHRI.KR.UDAYABHANU -- PRESIDENT SMT.VALSALA SARANGADHARAN -- MEMBER SHRI.M.K.ABDULLA SONA -- MEMBER The Divisional Manager, New India Assurance Co.Ltd. Divisional Office, -- APPELLANT Thiruvananthapuram. (by Adv.Sreevaraham G.Satheesh) Vs. K.R.Cleetus, Kurisinkal, DBRA-I TC.24/771, Nanthancode, -- RESPONDENT Thiruvananthapuram. (By Adv.S.A.Karim) JUDGMENT JUSTICE SHRI.KR.UDAYABHANU,PRESIDENT The appellant is the opposite party in OP.31/02 in the file of CDRF, Thiruvananthapuram and under orders to pay a sum of Rs.15000/- with interest at 14.5% from the date of the complainant and Rs.3000/- as compensation and Rs.1000/- as costs. 2. The appellant /Insurance Company has called in question the above finding contending that the exclusion clause in the medi-claim policy did not provide for coverage to pre-existing diseases. The case of the complainant is that he had taken a medi-claim policy for himself, his wife and children with coverage of Rs.15000/- each. Subsequently his wife developed fibroid uterus and had to be operated. The hospital expenses amounted to more than Rs.22000/-. The claim was repudiated by the opposite party. 3. The evidence adduced consisted of the proof affidavit for both sides Exts.P1 to P5, D1 and Exts.C1. 4. The forum has held that there is no evidence that the fibroid uterus was detected and informed to the complainant previous to the date of taking the policy. The counsel for the appellant has relied on Clause 4(1) captioned. Exclusions in Ext.P1 policy which runs as follows - that the Company would be excluded from liability for such diseases which have been in existence at the time of proposing the insurance. It further provides that pre-existing condition also means any sickness or its symptoms that existed prior to the effective date of insurance “whether or not the insured person had knowledge that the symptoms were relating to the sickness”. Ext.C1 is the deposition of the Doctor, who was examined on Commission. We find that Doctor has mentioned in no uncertain terms that on 21.4.01 also the patient was suffering the same disease. She has also stated that the disease was detected on 30.6.01. It is her version that for the last 6 months to the date of detection the patient was having stomach pain. We find that the exclusion clause provides that in the case of existence of illness whether the patient was aware of the illness or whether the illness was detected before the date of taking the policy excluded coverage. The very fact of existence of the disease alone would suffice to exclude liability by the Insurance Company. In the instant case the expert testimony of the Gynecologist mentions that the patient was having the particular illness on 24.5.01. The policy was taken on 24.5.01. The patient was admitted for operation on 12.7.01 ie; within 45 days of taking of the policy. In the circumstances and in view of the Clause 4-1 of Ext.P1 we find that the complainant will not be entitled to claim the Insurance benefit. Hence the order of the Forum is set aside. The appeal is allowed. JUSTICE SHRI.KR.UDAYABHANU -- PRESIDENT SMT.VALSALA SARANGADHARAN -- MEMBER SHRI.M.K.ABDULLA SONA -- MEMBER
......................JUSTICE SHRI.K.R.UDAYABHANU
......................SMT.VALSALA SARNGADHARAN
......................SRI.M.A.ABDULLA SONA | | 
