Date of filing: 26-06-2007 Date of order: 20-10-2009 IN THE CONSUMER DISPUTES REDRESSAL FORUM, KASARAGOD C.C.No.45/07 Dated this, the 20th day October 2009 PRESENT SRI.K.T.SIDHIQ : PRESIDENT SMT.P. RAMADEVI : MEMBER Panduranga Kini.M, S/o. Naraharikini.M, (Opp) Old Police Station } Complainant Carstreet, Manjeshwar, Kasaragod. Pin: 671 323. (Adv.C.K.Unnikrishnan, Kasaragod) 1. The Manager, LIC, Divisonal Office, Jeevan Prakash, PB.No.177, Kozhikode. } Opposite parties 2. The Manager, Life Insurance Corporation of India, Kasaragod Branch, Kasaragod. (Adv.P.V.Jayarajan, Kasaragod) O R D E R SRI.K.T.SIDHIQ, PRESIDENT On the ground that the medi claim of the complainant for the surgery undergone by him for meningothelial Meningioma does not come under the purview of policy conditions, the opposite party rejected the claim for Benefit (B) part of the policy of the complainant. Hence the complaint alleging deficiency in service on the part of opposite parties. 2. According to opposite parties the clause 11 (b) Benefit B of the policy is available on the occurrence of any of the following contingencies i) Omitted since not relevant ii) Omitted since not relevant ` iii) The Life Assured suffers from Cancer (Malignant) (that is, the presence of uncontrolled growth and spread of cancer cells which destroy the tissues in which they arise with a potential for invading adjacent structures and capable of spreading to distant organ.) This includes leukaemia, Hodgkin’s Disease and invasive malignant Melanoma of skin but excludes Carcinoma in situ, Tumors associated with HIV infections, non-invasive localized cancers and all other skin cancers. 3. According to opposite party the disease of the complainant is not covered by the policy and hence the claim of the complainant is rejected. . 4. Complainant filed affidavit and faced cross-examination as PW1 by the counsel for the opposite party. Exts A1 to A4 marked. Dr. Divakara Rao who treated the complainant was examined as PW2. For opposite party Sri. B.S. Naik, the Manager, Legal & HPF of LIC filed affidavit and faced cross-examination by the counsel for complainant. Exts B1 to B7 marked. Both sides heard. 5. As per Ext.A2 the discharge summary issued by PW2 the complainant had undergone the procedure Left Frontal Craniotomy and excision of a meningioma since he was suffering from head-ache. As per the diagnosis he was suffering from LEFT FRONTAL MENINGIOMA (Brain Tumor) 6. Now the only issue to be settled in this complaint is whether the Meningioma comes within the exclusion of clause of Benefit ‘B” of the policy or not? 7. PW2 Dr. Divakara Rao who performed Left Frontal Craniotomy and excision of a Meningioma has deposed that the Meningothelial Meningioma is not malignant primarily. Meningioma is a benign slow growing tumor of the meninges. Meningothelial Meningioma can turn meningiothelial sarcoma if not treated. 8. The learned counsel for the complainant Sri.Unnikrishnan tried to maintain that the Divisional Medical Referee has not properly evaluated the disease of the complainant and therefore the opinion to reject the claim was without due application of mind. 9. According to him the complainant was suffering from Meningothelial meningioma that is a brain tumor. According to him Benefit (B) part of 11 (b) (iii) no where excludes meningiothelial meningioma. It only excludes Carcinoma in situ, Tumors associated with HIV infections, non-invasive localized cancers and all other skin cancers. 10. We find some substance in the argument of the learned counsel for the complainant. The medical literature says that Brain Tumors are the growth of the cells in the Central Nervous System consisting brain and spinal cord. A tumor may be either benign or malign. A benign tumor can continue to grow, but the cells do not spread from the original site. But in malignant tumor, the cells can invade and destroy surrounding tissue and may spread to other parts of the brain. 11. Meningioma is a tumor of the meninges, which are protective membranes around the brain and spinal cord. A meningioma can start any part of the brain or spinal cord, but the most common sites are the cerebral hemispheres of the brain, made up of the four lobes. Most Meningiomas are benign. Malignant meningiomas are extremely rare. 12. Signs and symptoms of MeningiomaMeningiomas are usually slow growing tumors and the main symptoms arise from increased pressure within the skull (raised intra-cranial pressure). That may be due to a blockage in the ventricles (fluid-filled spaces of the brain) that leads to a build-up of Cerebro Spinal Fluid (CSF). CSF is the fluid that surrounds and protect the brain and spinal cord. The increased pressure may also caused by swelling around the tumor itself. 13. Raised intra-cranial pressure can cause head aches, sickness (vomiting) and visual problems. Changes in behaviour and personality are general signs of a brain tumor. Epileptic fits can be an early symptoms. 14. Meningiomas can grow in different parts of the brains and symptoms will relate to the area of the brain that is affected if the left side of the brain is affected there may be problems with speech, such as slurring or muddling words. 15. The above literature shows that Meningioma is a serious disease and that may affect patient’s speech if not treated. The Ext.A2 Discharge Summary shows that the complainant had head-ache since 6 years and loss of consciousness. On going through the above literature and the discharge summary of the complainant we also feels that the alleged Divisional Medical Referee has rejected the claim of the complainant without due application of mind. 16. As rightly contended by the learned counsel for the complainant Sri. Unnikrishnan. Benefit (B) part of 11 (b)(iii) nowhere excludes meningioma (meningothelial) from the Benefits clause irrespective of it’s nature whether it is benign or malign. 17. Hence it is clear that the rejection of the claim of the complainant amounts to deficiency in service on the part of the opposite parties. Therefore the complaint is allowed and the opposite party is directed to pay the sum assured Rs.50,000/- to the complainant with a cost of Rs.2500/-. Time for compliance is limited to 30 days from the date of receipt of copy of the order. Failing which the opposite party is further directed to pay interest @ 9% for the principal amount Rs.50,000/- from the date of complaint till date of payment. Sd/- Sd/- MEMB ER PRESIDENT Exts. A1.Policy Certificate issued by OPs A2. Photocopy of Discharge Summary A3. Letter issued by OP to Sri. Panduranga Kini.M. A4. Series Bills B1. Letter sent by complainant to opposite parties B2. Proposal for Insurance submitted by the complainant. B3. Addendum to proposal Under Asha Deep Plan (Table 121) B4. 5-10-06 Claim letter submitted by the complainant. B5. 2-11-06 Letter sent by the complainant to OP. B6. Cancer Claim under Asha Deep Policy. B7. Medical Attendant’s Report. PW1. M.Panduranga Kini PW2 Dr.A.Divaker Rao DW1.B.S.Naik Sd/- Sd/- MEMBER PRESIDENT Pj/ Forwarded by Order SENIOR SUPERINTENDENT
......................K.T.Sidhiq
......................P.Ramadevi | | 
