JUDGEMENT By Sri. Pampapathi President:- This is a complaint filed by the complainant Smt. Sunitabai against the Opposite New India Assurance Company Ltd., Raichur U/sec. 12 of Consumer Protection Act for to direct the opposite to pay an amount of Rs. 60,000/- with cost. 2. The brief facts of the complainant case are that, she obtained policy by name Hospitalization and Domiciliary Hospitalization Benefit Policy from opposite bearing Policy N. 671801/3/07/20/00000165 covering the period from 14-08-07 to 13-08-08 and date it was renewed further period from 14-08-08 to 13-08-09. Thereafter she was suffering from white discharge PV, irregular periods, therefore she approached one Dr. N.Nalini Ramesh at Bangalore on 27-08-07 scanning was done by Suman Scans at Bangalore by Dr. Shashikala.N. and report suggests that she was not suffering any disease as on 27-08-07. Thereafter one year pain developed in her stomach, as such she approached Dr. Nalini Ramesh and as per her advised, test conducted in Kanva Diagnostic Services Private Ltd., Rajajinagar Bangalore and histopathology report dt. 12-07-08 shows as she was having histopathological feature which are suggestive of chronic non-specific cervicitis within CIN-1 and regular treatment taken by her, as per the advise of Dr. Nalini Ramesh and as per th certificate issued by Dr. Nalini Ramesh dt. 19-03-09 as she was suffering from discharge from PV, since 2007, however she was diagnosed as chronic cervicitis with CIN-1 only in July 2008. The complainant incurred heavy expenditure for consultation, examination, and treatment, totally she incurred expenditure of Rs. 51,600/- towards medical expenses, further she incurred incidental expenses, as such she claimed an amount of Rs. 60,000/- before the opposite company, but it illegally repudiated her claim and thereby it shows its negligence in reimbursement of the medical bills and thereby opposite found guilty under deficiency in its service, as such she filed this complaint against opposite for the reliefs as prayed in her complaint. 3. Opposite New India Assurance Company Ltd., appeared in this case through its Advocate filed written version by admitting the obtaining the policy by the complainant and it is renewal till 13-08-09. It denied all the allegations of complainant and contended that the complainant was suffering from white discharge PV, since July 2007 and she under gone treatment chronic non-specific cervicitis within CIN-1. This ailment was diagnosed prior to taking the policy it was intentionally suppressed by her while taking the policy from opposite with an intention to get monetary benefit, it rightly repudiated the claim of the complainant as it was breach of one of the conditions of the policy, there was no negligence on its part and no deficiency in service, accordingly it prayed for to dismiss the complaint with exemplary cost of Rs. 500/-. 4. In-view of the pleadings of the parties. Now the points that arise for our consideration and determination are that: 1. Whether the complainant proves that, she obtained Hospitalization and Domiciliary Hospitalization Benefit Policy bearing No. 671801/3/7/20/00000165 for a period from14-08-07 to 13-08-08 from opposite and thereafter she was suffering from white discharge PV, irregular periods, therefore she got treated with Dr. Nalini Ramesh at Bangalore on 27-08-07 thereafter she got diagnosed in Kanva Diagnostic Service histopathology report shows the presence of histopathological features and Dr. Nalini Ramesh issued a certificate to the effect on 19-03-09 for that she incurred medical expenditure to the extent of Rs. 51,600 + 9,000 incidental charges totally Rs. 60,000/- she filed this complaint before the opposite for to reimburse the said medical expenditure but it illegally repudiated her claim on 10-04-09, it shows its negligence and thereby opposite found guilty under deficiency in its services.? 2. Whether complainant is entitled for the reliefs as prayed in her complaint.? 3. What order? 5. Our findings on the above points are as under:- (1) In the affirmative (2) As discussed in the body of this judgement and as noted in the final order. (3) In-view of the findings on Point Nos. 1 & 2, we proceed to pass the final order for the following : REASONS POINT NO.1 & 2:- 6. To prove the facts involved in these two points, affidavit-evidence of complainant was filed, she was noted as PW-1. The documents Ex.P-1 to Ex.P-17 are marked. On the other hand the affidavit-evidence of Divisional Manager of opposite was filed, he was noted as RW.1. The documents Ex.R-1 to Ex.R-3 are marked. 7. In the instant case, we can ascertain the fact that the subscription of hospitalization and domiciliary Hospitalization Benefit Policy obtained by the complainant from opposite company was of the period from 14-08-07 to 13-08-09. As per the case of the complainant she got tested o 27-08-07 with Dr. Shashikala of Suman Scan at Bangalore, as per the advise of Dr. N.Nalini Ramesh of Bangalore, as per the diagnostic abdominal scan report Ex.P-1 issued by Dr. Shashikala.N. Sonologist, it was an impression of Polycystic overies. otherwise normal study of abdominal and pelvic organs. This is sufficient for us to note the nature of the disease suffered by the complainant as on 27-08-07. The second document Ex.P-2 histopathology report of Kanva Diagnostic Services Private Ltd., dt. 12-07-08 shows as histopathological features are chronic non-specific cervicitis within CIN-1. Now we have to examine the document Ex.R-3 on which this opposite made its ground for repudiate the claim of complainant, it is a report issued by Chord Road Hospital Private, Ltd., Bangalore, In the said report the presence of CIN-1 from July 2007 was noted, in the light of the above medical literatures Ex.P-1, Ex.P-2 and Ex.R-3, we have to see as to whether the complainant had the knowledge of suffering from cancer in the month of July 2007 i.e prior to the date of taking the policy. 8. The policy taken by the complainant for a period starting from 14-08-07, medical report Ex.P-1 is dt. 27-08-07 i.e, (10) days after the date of commencement of the policy. Ex.P-2 is a report dt. 12-07-08 that means more or less one year after the commencement of the said policy. Ex.R-3 is un-dated, however one date was shown as 20-02-09 as it was a date of examination of the complainant in Chord Road Hospital Private Ltd., Bangalore, then how the said hospital authorities came to a conclusion that she was suffering from CIN-1 since July 2007 without supportive diagnostic report, what is the base for this doctor to form his opinion that complainant was suffering from that disease since July-2007, even though he might have examined her at later. There are no sufficient evidences to corroborate this document Ex.R-3, under the said circumstances and in the absence of other acceptable evidence, we are of the view that the opposite Assurance company failed in proving the fact that the complainant intentionally suppressed the disease of CIN-1 prior to subscribing the policy only to get monetary benefit from it, as such we are of the view that rejecting the claim of complainant is amounting to deficiency in service on the part of opposite company, accordingly we answered in Point No.1 affirmative. 9. As regards to the claim of the complainant, in respect of medical expenses incurred by her for getting treatment she produced some bills among them. Ex.P-11 a Invoice issued by Chord Road Hospital Private Ltd., Bangalore which was to the extent of Rs. 45,900/-. Ex.P-12(a) is a bill which is not readable. Ex.P-12(b) is also not readable. But another bills in Ex.P-12(b) is to the extent of Rs. 375.65/- Ex.P-12(c) is a bill to the extent of Rs. 120/-. Ex.P-12(d) is a bill to the extent of Rs. 761.03/-. Ex.P-12(e) is a bill for Rs. 715.54/-. Ex.P-12(f) is a bill for Rs. 629.73/-. Ex.P-12(g) is not readable, as such the complainant is entitled to get an amount of Rs. 48,501.95/- towards her medical expenditure. 10. We have noticed deficiency in service on the part of this opposite, towards its customer complainant for repudiating the genuine claim of her on flimsy ground, as such the complainant is entitled to get lump sum amount of Rs. 3,000/- under this head. 11. The complainant is also entitled to get lump sum amount of Rs. 2,000/- from the opposite towards cost of this litigation, accordingly the complainant is entitled to recover total amount of Rs. 53,501.95 Ps./- from opposite which is rounded to Rs. 53,500/- and thereby we answered Point No.1 & 2 accordingly. POINT NO.3:- 12. In view of our findings on Point Nos-1 & 2, we proceed to pass the following order: ORDER The complaint filed by the complainant is partly allowed with cost. The complainant is entitled to recover a total amount of Rs. 53,500/- from the opposite. The opposite company is given one month time to make payment of the above said sum to the complainant. Intimate the parties accordingly. (Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 09-12-09) Sd/- Sri. Pampapathi, President, District Forum-Raichur. Sd/- Sri. Gururaj, Member, District Forum-Raichur. Sd/- Smt.Pratibha Rani Hiremath, Member. District Forum-Raichur.
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