SENIOR BRANCH MANAGER, LIC OF INDIA Vs. VEMURI RANGAIAH
LAWS(APCDRC)-2003-7-4
ANDHRA PRADESH STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Decided on July 24,2003

SENIOR BRANCH MANAGER, LIC OF INDIA Appellant
VERSUS
VEMURI RANGAIAH Respondents

JUDGEMENT

MAMATA LAKSHMANNA,MEMBER - (1.) THIS appeal has been filed by the opposite parties aggrieved by the order of the District Forum, Nellore in C.P. No. 566/1996.
(2.) THE complainant Shri Vemuri Rangaiah took Asha Deep policy from opposite parties on 19.11.1993 for Rs. 50,000/ - for a period of 15 years. After about 2 years on 13.7.1995 he underwent heart surgery in Madras General Hospital to restore adequate blood supply to his heart and he spent nearly Rs. 75,000/ -. As per the policy conditions he submitted his claim on 11.8.1995 to the first opposite party. But it was not settled. He, therefore, filed complaint in the District Forum with a request to direct the opposite parties to pay 50 per cent of the policy amount with interest at 24 per cent and the balance as per terms and conditions of the policy. He also requested that the instalments paid subsequent to the operation should be returned with 24 per cent interest per annum with compensation of Rs. 10,000/ - towards mental agony and costs.
(3.) THE opposite party contended that the policy covers only open heart bypass surgery performed on significantly narrowed occluded coronary arteries to restore adequate blood supply to heart and the surgery must have been proven to be necessary by means of coronary angiography and all other operations (e.g. Angioplasty or thrombolysis by coronary artery catheterisation) are specifically excluded . It is further contended that the complainant underwent valve replacement which was not covered under the policy and hence the claim was rightly rejected. The District Forum found that as per Ex. A4, the medical report from the Madras Government General Hospital the complainant was suffering from Rh. Mitral Stanogis (Sev) Aortic Stenosis (Severe) with Aortic Regurgitation Grade II, Pulmonary Hypertension (Severe) and was advised surgery. Therefore, there was narrowing of main artery arising out of the left ventricle of the heart clocking free flow of blood to the heart and as per the policy condition the coverage was not open heart bypass surgery performed on significantly narrowed coronary arteries to restore adequate blood supply to heart and the surgery must have been proven to be necessary by means of coronary angiography. Hence the surgery was covered as per the policy conditions. Therefore, Honble District Forum directed the opposite parties to pay Rs. 25,000/ - together with interest at 12 per cent per annum from 31.10.1996 the date of repudiation till the date of payment and the remaining half to be paid on maturity as per terms and conditions of the policy and also costs of Rs. 1,000/ - to be complied within 3 months.;


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