KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION

                            VAZHUTHACAUD THIRUVANANTHAPURAM                                                                                                                   

 APPEAL NO.710/09

                             JUDGMENT DATED 4.2.2011

PRESENT

JUSTICE SHRI.K.R.UDAYABHANU                --  PRESIDENT

SRI.S.CHANDRAMOHAN NAIR                       --  MEMBER

Rima Antony,

D/0 T.R.Antony, Thanchan house,

 Unity Nagar,                                                        --  APPELLANT

Kuriachira, Thrissur.

(By Adv.G.S.Kalkura)

                 Vs.

United India Insurance Co.Ltd,

Simis Complex, PB No.57,                                --  RESPONDENT

Kuruppam Road,

Thrissur.                       

     (By Adv.R.Jagadish Kumar)

JUDGMENT

JUSTICE SHRI.K.R.UDAYABHANU,PRESIDENT

          The appellant is the complainant in OP.384/05 in the file of CDRF, Thrissur.  The appeal stands dismissed.

          2. The matter relates to the medi-claim which has been repudiated.  The case of the complainant is that she underwent treatment for compound myopic astigmatism both eyes and she incurred a sum of Rs.36,490/- and  the same has been repudiated without proper reasons.

          3. The opposite parties/Insurance Company has contended that Dr.R.Satheesh of Insight Mediclaim Analyst has reported that myopic astigmatism   is a refractory error of the eye and that the commonest treatment is wearing glasses and that it is a pre-existing disease and that it is starts from child hood.    The policy excludes pre-existing diseases.

          4. The evidence adduced consisted of the testimony of  Ext.P1, RW1,  &  Exts R1 to R14.   

          5. The Forum has dismissed the complaint relying on Ext.R12 wherein it is mentioned that the complainant was a soft contact lens wearer and hence the condition is pre-existing.  We find that the evidence of RW1 who issued Ext.R7 certificate was rejected by the Forum itself observing that he is not an expert.  We find that he himself has admitted there is having MBBS and diploma in Anesthesia and Critical Care.  Evidently, he is not an eye specialist.  There is no reason as to why the Insurance Company has referred the matter to such a person.  It is seen from Ext.R7 report of RW1 itself that the complainant is having policy from  3.9.02 onwards.  Ext.R12 report of Dr.John William is dated 1.10.04 therein the complainant has been advised to stop wearing contact lens.    If the contention of the opposite party is to be sustained it should be proved that the complainant was having compound bi lateral myopic astigmatism prior to 3.9.02.  There is absolutely no evidence in this regard.

          6. In these circumstances, we find that the order of the Forum cannot be sustained and the same is set aside.  The opposite parties are directed to make the payment which is supported by R8 bill which  is for a sum of Rs.36,490/-.  In the circumstances, the opposite parties/respondents are directed to pay Rs. 36,490/- to the complainant with interest at 9% per annum from 15.4.05 the date of the complaint.  The complainant is also entitled to cost of Rs.5,000/-.  The amounts are to be paid within 3 months from the date of receipt of this order, failing which the complainant will be entitled for interest at 12% from 4.2.2011 the date of this order. 

          Office will forward the LCR along with   copy of this order to the Forum urgently.

JUSTICE  K.R.UDAYABHANU --  PRESIDENT

 S.CHANDRAMOHAN NAIR --  MEMBER