By Smt. Padmini Sudheesh, President: The petitioners case is as follows: The petitioner had taken one medical insurance policy under the Scheme Medi Guard Policy of the respondent company on 5.6.06 by payment of Rs.1025/- towards premium. The policy bearing No.100606/48/06/12/00000593 issued by the 2nd respondent is valid for the period from 5.6.06 to 4.6.07 and the sum insured is Rs.25,000/-. The petitioner was admitted for treatment in Jubilee Mission Medical College, Thrissur due to diarrhoea and vomiting on 20.3.07 and treated there till 23.3.07 and spent Rs.3307/- for the treatment. Petitioner lodged a claim with the 2nd respondent as per the terms of policy along with medical bills, treatment and policy agreement. The 2nd respondent vide his letter dated 18.6.07 informed the petitioner that the claim has been rejected stating the reason pre-existing disease. The claim was for the actual amount spent for the treatment in hospital for the diseases diarrhoea and vomiting and not any other disease existing prior to the issue of above policy and the repudiation of the claim is wrong, arbitrarily and against law. Hence the petition. 2. Respondents have filed counter as follows: The petitioner was treated for Type-2 DM/Hypothyroid, which was a pre-existing disease. There is no deficiency of service in rejecting the claim. The treatment records of the complainant show that the amount claimed was spent for clinical investigation and treatment of her pre-existing disease. As per the conditions contained in the policy she is not entitled to get the treatment expenses for her pre-existing disease. Hence dismiss the complaint. 3. The points for consideration are: (1) Whether the petitioner is entitled for the compensation as prayed? (2) Reliefs and costs. 4. The evidence consists of Exts. R1 to R6. 5. Points-1 & 2: According to the petitioner as per the policy, she is entitled for the treatment expenses. But the claim was repudiated stating that expenses for treatment of pre-existing disease are excluded from policy benefits. Before taking the policy no medical check-up is required stating the existence of any disease. So the contention of exclusion of pre-existing disease from the purview of the policy benefit is not at all admissible. After receiving the premium and making attractive offers usually the Insurance Company are rejecting the benefit on unreasonable grounds. It is not fair. Ext. R2 shows the medicines taken. As per that, medicines are also taken for diarrhoea and vomiting. At the same time medicines are taken for Hypothyroid also. The insurance is being taken for financial assistance and if it is rejected on unreasonable grounds, the very purpose will be futile. So the petitioner is entitled for the insurance benefits. The quantum of expenses claimed by the petitioner is Rs.3307/-. The respondents have no case that the amount is not correct or excess. So the petitioner is entitled for the claimed amount of Rs.3307/-. As per Ext. R3, the expenditure is Rs.3381/-. This is also not disputed. 6. In the result, the petition is allowed and the respondent is directed to pay Rs.3381/- (Rupees three thousand three hundred and eighty one only) to the petitioner with interest at the rate of 12% per annum from 20.3.07 and 6% interest from today till realisation. She is also entitled for Rs.500/- (Rupees five hundred only) as costs. Time for payment one month. Dictated to the Confidential Assistant, transcribed by her, corrected by me and pronounced in the open Forum, this the 30th day of June 2008.
