I Date of filing : 01-03-2007 Date of order : 28-10-2009 N THE CONSUMER DISPUTES REDRESSAL FORUM, KASARAGOD C.C. 24/07 Dated this, the 28th day of October 2009. PRESENT SRI.K.T.SIDHIQ : PRESIDENT SMT.P.RAMADEVI : MEMBER SMT.P.P.SHYMALADEVI : MEMBER Sahina, W/o.Abdul Rahiman, Siraj Manzil, Mannakuzhi, } Complainant Po.Uppala. (In person) 1. The Branch Manager, } Opposite parties National Insurance Company, Opp. Central Market, Mangalore. 575 001. 2. The Branch Manager, National Insurance Company, Opp. Central Market, Mangalore.575001 (Adv. M. Balagopal, Kasaragod) O R D E R SRI.K.T.SIDHIQ, PRESIDENT Tersely stated, The case of the complainant Sahina is that the medical insurance claim pertaining to the treatment of her mother-in-law was repudiated by the opposite party on the ground of pre-existing disease. According to complainant she herself, her husband, their childrens Afnan, Adnan, Rayyan & Beefathumma were covered as per Sampoorna Surakehsa Bima Policy. During the validity of policy Beefatumma treated for acute renal disease from 2-7-06 to 21-7-06 at High Land Hospital, Mangalore. During hospitalization humo dialysis was conducted and they spend nearly Rs.70,000/-for medical expense and treatment. But the claim preferred for indemnification was repudiated on the ground that the insured Beefathumma was suffering from Diabetes Mellitus for quite long time and hence the disease was a pre-existing one. According to complainant the insurer in an earlier occasion settled the claim of Beefathumma. Hence they are estopped from taking a different stand that of the earlier one. 2. Opposite party defended the claim of the complainant. According to opposite party Smt. Beefathumma was suffering from Diabetes Mellitus for a quite long time. This disease is pre-existing to the policy and it was suppressed in the proposal. Therefore the claim is repudiated. The opposite party had already taken steps for the recovery of the settled amount paid under mistake in the earlier claim. The principle of estoppel has no application since the previous settlement of claim was originated from suppression of facts. Hence the complaint is liable to be dismissed. 3. Complainant filed affidavit as PW1 and Exts A1 to A4 marked. For opposite party Dr. B.H. Krishna Moorthy was examined as DW1. Exts B1 & B2 and Ext.X-1 marked. Both sides heard. 4. DW1. Dr. B.H. Krishna Moorthy consultant physician of High Land Hospital, Mangalore who treated Smt. Beefathumma has deposed that the disease of Smt. Beefathumma was due to the long standing diabetes. During hospitalization Beefatumma was consuming diabetic diet and was under insulin. During July 2006 the patient came to hospital due to leg ulcer infection. It have a duration of one and half years and prolonged diabetes will cause renal failure also for which she had undergone treatment. 5. The Ext. X-1 case sheet pertaining to the treatment of Beefatumma also shows that Smt. Beefatumma was a poorly controlled known diabetic since 20 years. 6. Therefore the contention forwarded by the opposite parties that the mediclaim of Beefathumma was repudiated on the ground of pre-existing disease is acceptable and hence the repudiation of mediclaim of Beefathumma cannot be regarded as a deficiency in service. In the result the complaint fails and hence we dismiss the complaint without any costs. Sd/- Sd/- Sd/- MEMBER MEMBER PRESIDENT Exts. A1.4-9-06 repudiation letter. A2.Photocopy of Mediclaim/Insurance Claim form A3. Photocopy of Claim intimation A4. 18-8-04 photocopy of letter issued by OP to Abdul Raheem. X-1. Admission Record of Smt.Beefathumma issued by High Land Hospital, Mangalore. B1.25-8-06 letter issued by Dr.B.H. Krishna Moorthy Rao to Divisional Manager, National Insurance Company , Mangalore. B2. Certified copy of Policy DW1. Dr. B.H.Krishna Moorthy Rao. Sd/- Sd/- Sd/- MEMBER MEMBER PRESIDENT Pj/ Forwarded by Order SENIOR SUPERINTENDENT
......................K.T.Sidhiq
......................P.P.Shymaladevi
......................P.Ramadevi | | 
