O R D E R<br /> Sri. Santhosh Kesavanath P., President.<br /> Case of the petitioner's is as follows:<br /> The first petitioner is a retired Homoeo Doctor from Government Service. The second petitioner is the wife of the first petitioner. The petitioners taken an insurance policy named “Good Health Insurance Policy” with vide policy No. 766/06. The said policy is valid from 16..6..2005 to 15..6..2006. Petitioners remitted premium amounting Rs. 2621.The sum insured for each was for Rs. 1,00,000/- According to the petitioner during the second week of October 2005, ie. during period of insurance, the first petitioner felt some Auditory impairment on the right side and some difficulty in winking right eye. On 22..10..2005 the first petitioner consulted Dr. Madhusudhanan, who was then <br /> -2-<br /> Professor and Head of Neurology, Medical College, Kottayam. He directed the first petitioner to take C.T Scan and CT Brain which was done on 24..10..2001. The scan report showed right C.P angle lesson with very minimal enchancement. The Neuro surgeon advised to take surgeory. According to the petitioner as per the advise of his son, first petitioner consulted Dr. R.G Varma, Neuro Surgeon in M.s Ramaiah Memorial Hospital, Bangalore.The doctor diagnosed that the petitioner was suffering from “Right Acoustic Neuroma'. The petitioner was admitted in M.S Ramaiah Memorial Hospital on 2..11..2005, surgeory was done, and was discharged on 10..11..2006. The total medical expenses in the hospital was Rs. 1,01,910.29. Total expenses incured to the petitioner including expenses for the various examination done by the petitioner is Rs. 1,12,810/-. The first petitioner after returning from Bangalore preferred claim to the opposite party for reimbursement of the expenses incurred by him for his treatment. On 15..2..2006 the opposite party sent a letter to the petitioner alleging that the petitioner was hypertensive patient and was undergoing treatment so long. The first petitioner sent a reply to the letter dated 15..2..2006 stating that he started treatment of hypertension only from 15..2..2005. According to the petitioner he submitted all the document demanded by the opposite party. The petitioner was informed by a letter Dtd: 26..4..2006 by the second opposite party stating that the claim of the petitioner was repudiated on the ground that the petitioner is having a history of loss of hearing on right side since 1 ½ years and also he was a known hypertensive. According to the petitioner the claim is repudiated without valid and sufficient reason. The petitioner states that he was not suffered from any diseased like loss of hearing on the right side or hypertension for the last 1 ½ years or before. The petitioner states that repudiation of the claim of the petitioner by the <br /> -3-<br /> opposite party, is without any valid reason, and is a clear deficiency of service . So he prays for direction to the opposite parties to pay an amount of Rs. 1,12,810/- together with 12% interest from 28..11..2005. He also prays for a compensation in the tune of Rs. 30,000/- and cost of the proceedings.<br /> The first and second opposite parties entered appearance and filed joint version contenting that the petition is not maintainable. According to the opposite party the first petitioner was suffering from hearing loss on right side from 2..11..2005. The opposite party contented that first petitioner is a chronic hypertensive patient and has problems on his ear, petitioner was undergoing treatment before taking the policy. They contented that reason for repudiation is true and correct. They contented that they opposite party appointed N.B Associates for a private investigation regarding the matter. They produced the photo copy of the case sheet from Ramaiah Memorial Hospital, Bangalore. Since and the report was only on 11..4..2006 their happened a delay in the processing the claim and was not due to any latches or negligence on the part of the opposite party. The opposite party contented that the claim of the petitioner is repudiated on valid and sufficient reason. According to the petitioner he is suffering from hearing problems and hypertension for the last 1 ½ years. The disease of the petitioner is 'Acoustic Neusoma' which has nexus with hearing problems and the petitioner purposefully conceled this fact from the opposite party. Since the petitioner entered the contract without utmost good faith and the claim was repudiated on the basis of pre-existing disease to the petitioner. So, the opposite party contented that there is no deficiency in service on their part and they pray dismissed of the the petition with their costs.<br /> <br /> -4-<br /> Points for determinations are:<br /> i) Whether there is deficiency in service on the part of the opposite party?<br /> ii) Reliefs and costs.<br /> Evidence in this case consists of affidavit filed by both parties Ext. A1 to A11 documents on the side of the petitioner and Ext. B1 document on the side of the opposite party and Court Exhibits C1.<br /> Point No. 1<br /> The petitioner produced repudiation letter dtd:26..4..2006 and the said document is marked as Ext. A1. In Ext. A1 it is stated that since the petitioner is having a history of loss of hearing on right side since 1 ½ years and the petitioner is hypertensive and is on medication and this aspect has not revealed by the petitioner while submitting the proposal form for claim. The main question to be decided in this case is whether the petitioner have a history of pre-existing disease of loss of hearing at the time of entering into the contract of insurance or whether the repudiation of the claim of the petitioner on the ground that he was suffering from hypertension is valid. The petitioner filed a petition to issue a questionaire to the doctor who examined the petitioner at Ramaiah memorial Hospital, Bangalore. Reply dt: 13..4..2007 to the questionaire was received to the Forum and said document is marked as Ext. C1. In Ext. C1 consulstant Neuro Surgeon stated that since the case sheet is usually written by the medical student. He take the responsibility for the mistake made by them in confusing 1 ½ years. He further, stated that the mistake may be due to language problem or over sight during documentation. He further, stated that the decreased hearing in the right ear of the first petitioner was for about 1 ½ week duration. According to the Neuro Surgeon there is no <br /> -5-<br /> causivite or implicative connection between hypertension and acoustic neuroma. The counsel for the petitioner argued that since the doctor, who examined the petitioner stated that mentioning of the history of the disease as 1 ½ years is due to mistake. Repudiation is the claim of not proper. In the light of C1 reply we are of the opinion that repudiation of the claim is the petitioner is not proper and there is deficiency of service on the part of the opposite party in repudiating the claim. Further more hypertension, diabetic etc. are normal ways of life ad are controlable. Pre-existing disease, in our view is one for which insured should have been undergone hospitalisation or undergone long treatment or operation. Otherwise for a layman, this day-to-day normal problems are not to be disclosed as even otherwise medical terminology of such problem is difficult to understand and know. So, we are of the opinion that repudiation of the claim of the petitioner on the ground that the petitioner is hypertensive is not sustainable and is as clear deficiency on service on the part of opposite party. So, point No. 1 is found accordingly.<br /> Point No. 2<br /> In view of findging in point No. 1 petition is to be allowed. The petitioner is entitled to relief sought for.<br /> In the result opposite party is ordered to pay the petitioner an amount of Rs. 1,12,810. Since their was long delay in processing the claim defemotly that had happened caused much loss and sufferings to the petitioner. So we allow Rs. 5000/- as compensation to the petitioner. Opposite party is also ordered to pay Rs. 2000/- as cost<br /> <br /> <br /> -6-<br /> of proceedings. The opposite party is ordered to comply the order with within 30 days of receipt of the order. <br /> Dictated by me transcribed by the Confidential Assistant corrected by me and pronounced in the Open Forum on this the 29th day of September, 2008.