SENIOR BRANCH MANAGER, LIC OF INDIA Vs. VEMURI RANGAIAH
ANDHRA PRADESH STATE CONSUMER DISPUTES REDRESSAL COMMISSION
SENIOR BRANCH MANAGER, LIC OF INDIA
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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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