PER SHRI. S.M. RATNAKAR – HON’BLE 

1)         

2)         .1 of the policy as the disease of hypertension which was the proximate cause for Coronary Artery Disease (referred to as CAD) which was pre-existing as revealed from the indoor case papers. The Complainant thereafter, made various correspondences with the Opposite Parties and also furnished the certificate of treating Doctor - Ajit Menon dtd.14/10/06, wherein it was stated that the Complainant had no past history of hypertension. The Opposite Party No.2 did not accept the said certificate on the grounds that the Complainant as per the hospital records was a known case of hypertension (referred to as HTN) since last 15 years. .1 and thus, the claims filed by the Complainant were held as non tenable. The Complainant thereafter, approached the Ombudsman. The Ombudsman disposed off the complaint filed by the Complainant with liberty to the Complainant to approach appropriate Consumer Forum/Civil Court.    The Complainant has relied various documents placed on record at Exh.‘A’ to ‘Q’. 

3)       written statement   .7 which is pertaining to fraud. .   

4)       written statement  written arguments.  

5)           

6)          He has specifically opined that from the discharge card of the Lilavati Hospital submitted by the Complainant, it revealed that he was suffering from IHD and was admitted for the treatment of the same.                      .1 & 5.7 of the mediclaim policy issued by the Opposite Party No.1.  Complainant 

O R D E R

i.                   Complaint No.277/2008 is dismissed with no order as to cost.

ii.                Certified copies of this order be furnished to the parties.