By Smt. Padmini Sudheesh, President<br /> <br /> Petitioner’s case in brief is as follows:<br /> <br /> The petitioner was a Kuri subscriber of 2nd respondent and had been insured with the 1st respondent under an Individual Medi-claim Policy No.440102/2004/481. On 8th November 2003 she was given birth to a child at GEM Hospital, Thrissur. Subsequently she had applied for the insurance amount. But the claim was repudiated on the ground of exclusion from the purview of policy conditions. Letters sent, but no remedy. Hence this complaint.<br /> <br /> 2. 1st respondent filed Counter is as follows: This respondent admitted that the petitioner had been insured with this respondent under an Individual Medi-claim Policy for a period from 20/6/03 to 19/6/04 subject to the conditions. The petitioner has availed treatment for delivery and as per clause 4.12 it is not covered and hence claim was repudiated. Since there is specific clause for repudiation petition may be dismissed.<br /> <br /> 3. Counter is filed by Respondent 2 by admitting the complaint.<br /> <br /> 4. Points for consideration are<br /> 1)Whether the petitioner is entitled for the claim amount ?<br /> 2) If entitled, by whom it is to be clear off ?<br /> 3)Reliefs and costs<br /> 5. The evidence consists of Exhibits P1 and P2 and Exhibits R1 to R5. Respondent 2 has no documents.<br /> 6. The first point is to be considered is whether the petitioner is entitled to get the claim amount. According to her she had joined Kuri in the2nd respondent Company and had been insured with the first respondent under the individual medi-claim policy. On 8th November 2003 she has delivered a child in the GEM Hospital, Thrisur and expenses incurred for the treatment. Subsequently she has applied for the claim amount. But the respondent No.1 had repudiated the claim on the ground that treatment arising from or feasible to pregnancy and childbirth are excluded from the purview of the policy benefits. As per Exhibit P2 she is entitled to recover the claim amount. But subsequently the Insurance Company had renewed the policy conditions and denied the maternity benefits. <br /> 7. As per Ext.P2 the petitioner is entitled for policy benefits. But as per Ext.R1 which is the renewed policy she is not entitled. The reason for not extending the maternity benefit to the period of R1 is not stated anywhere. Any way a receipt is produced by the petitioner showing that a sum of Rs.28,456/- was remitted by the Kuri Company to the first respondent. No other receipts are produced from either side to show further payment. It may be due to the non–remittance of the amount and latches on the part of 2nd respondent. So in the circumstances of the case we arrive at a conclusion that only because of the default on the part of 2nd respondent she has devoided the benefits of the policy. So the 2nd respondent is liable to provide the expenses shown in Ext. R2. The expenses incurred as per Ext. P2 is Rs.7,727/-.<br /> 8. In the result the petition is allowed and the 2nd respondent is directed to pay Rs.7,727/- (Rupees Seven thousand seven hundred and twenty seven only) to the petitioner. She is also entitled for Rs.2,000/- (Rupees Two thousand only) as compensation and Rs.500/- (Rupees Five hundred only) as costs. Comply this order within one month.<br /> Dictated to the Confidential Assistant, transcribed by her, corrected by me and pronounced in the open forum this the 30th day of May 2008.<br />