KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM.

APPEAL  NO: 52/2008

 JUDGMENT DATED:  07-01-2011

PRESENT

JUSTICE SHRI. K.R. UDAYABHANU                :  PRESIDENT

SHRI. S. CHANDRAMOHAN NAIR                     : MEMBER

Shobin.K.Jose,

Kollakombil House, Kolayad.P.O,

Chittariparambu-670 650,

Re. by his power of attorney holder-

K.U.Joseph.

(By Adv: Sri.Sajeev.P)

            Vs.

1.         Branch Manager,

New India Assurance Co. Ltd.,

Branch Office, Aristo Complex,

Near Post Office, Mahe-673 310.

                                                                        : REPONDENTS

2.         M/s New India Assurance Co. Ltd.,

Regd. & Head Office, 87,

Mahatma Gandhi road,

Fort, Mumbai-400 001.

(By Adv.Sri. Sreevaraham.G.Satheesh)

       JUDGMENT

JUSTICE SHRI. K.R. UDAYABHANU:  PRESIDENT

Appellant is the complainant in OP.139/03 in the file of CDRF, Kannur.  The complaint filed stands dismissed on the ground that the complainant was having pre-existing illness and that the same was suppressed when the medi claim policy was availed.

2. It is the case of the complainant that while studying at Alappuzha he used to take river bath and consequently he developed slight ear pain and slight ear hearing loss.  Consequently he consulted the doctor and underwent surgery in the left ear on 8/7/2002 and got discharged on 14/7/2002.  He is having the medi claim policy of the opposite party from 26/12/2000.   The claim amount is Rs.17,490/- and compensation of Rs.25,000/-.

3. The opposite parties have repudiated the claim on the ground that the complainant had a past history of Otorrhea during childhood.  According to the opposite parties the same was suppressed.

4. The evidence adduced consisted of PW1, DW1, Exts.A1 to A10 and B1 to B7.

5. On a perusal of the evidence adduced we find that the only evidence relied on by the opposite party is the reference in the discharge summary in the column regarding clinical history wherein Otorrhea during childhood is noted.  There is no evidence as to whether the complainant was having discharge from ear or hearing loss prior to the date of taking of the policy or in the proximate past.  There is no case that the condition was a continuing one from childhood.  In the circumstances we find that the opposite party ought not to have stressed the above observation in the discharge summary to disclaim liability.

In the circumstances the order of the Forum is setaside.  The appeal is allowed.  The opposite parties/respondents are directed to pay a sum of Rs.17,490/- with interest at 9% per annum from the date of complaint ie on 8/4/2003 and cost of Rs.5000/-.  The amounts are to be paid within 3 months from the date of receipt of this order failing which the complainant will be entitled to interest at 15% from 11/1/2011, the date of this order.

JUSTICE K.R. UDAYABHANU:  PRESIDENT

S. CHANDRAMOHAN NAIR: MEMBER

VL.