DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II

U.T.CHANDIGARH

Murlidhar Pillai r/o House No.39, Phase I, Housing Board Colony, Baddi, Distt. Solan (HP), aged about 46 years.

                                    ...Complainant.

Versus

1.           Star Health and Allied Insurance Co. Ltd., K R M Centre, VI Floor, No.2, Harrington Road, Chetpet, Chennai through its General Manager/Managing Director.

2.           State Health and Allied Insurance Co. Ltd., SCO 257, 2^nd

...Opposite Parties.

BEFORE: 

SMT. MADHU MUTNEJA, MEMBER

SHRI JASWINDER SINGH SIDHU, MEMBER

Argued by: 

PER RAJAN DEWAN, PRESIDENT

1.                      

2.                     

3.                    

4.                    

5.                        

“Our medical team has observed from the discharge summary of the above hospital it is clearly mentioned that the insured patient had underwent laparoscopic incisional hernia repair. The present condition of incisional hernia is a complication of hysterectomy undergone prior to inception of medical insurance policy. 

However, surprisingly the opposite parties have neither mentioned the composition of such medical team nor have placed on record their observations, as referred to in their letter of repudiation, on the basis of which the claim of the complainant was repudiated. 

6.                       

7.                     

"Pre-Existing Disease means any ailment or injury or related conditions(s) for which the insured person had signs or symptoms and/or was diagnosed and/or received medical advice/treatment within 48 months prior to insured person's first policy with the Company."

However, as per the documents on record, the first policy was valid from 24.5.2011 to 23.5.2012.    

8.                      

9.                     

i)            To pay Rs.46,537/- being the medical claim of the complainant towards hospitalization of his wife.

ii)          To pay Rs.10,000/- as compensation for mental agony and harassment.

iii)        To pay Rs.7,000/- as costs of litigation.

10.                 

11.                 

Announced

09.12.2013.

Sd/-

(RAJAN DEWAN)

PRESIDENT

Sd/-

 (MADHU MUTNEJA)

MEMBER

Sd/-

(JASWINDER SINGH SIDHU)

MEMBER

hg

DISTRICT CONSUMER FORUM-II

[Consumer Complaint No.318 of 2013]

ORDER

Present:None.