Decided on April 08,2004

Ch Venkatesham Respondents


- (1.) OPPOSITE parties are the appellants. Aggrieved by the order of the District Forum, Nalgonda, in C. D. No.68/2000 dated 5.3.2003, the present appeal has been filed. The facts in brief are set out hereunder: the complainant is an Advocate. The first opposite party is the Branch Office of the second opposite party at Suryapet. On 6.8.1998, he obtained Mediclaim policy for Rs.2,00,000/ - bearing No.160/99 from the first opposite party for a period of one year effective from 6.8.1998 for himself and his wife, Vijayalaxmi by paying premium of Rs.2,930/ - by way of cheque. The first opposite party issued a policy after satisfying the health condition. In October, 1998 the complainant had motions and vomitings and on consultation of the doctor, he was advised to get himself admitted in a hospital. He ultimately got himself admitted in Satya Kidney Centre, Himayathanagar, Hyderabad on 24.10.1998 and was an in -patient. The doctors observed that both the kidnies were not functioning and stated that he required kidney transplantation of atleast one kidney. As he was ready to meet the expenses of kidney transplantation, the left kidney of his wife, which was found suitable, was fixed on 9.12.1998. He was discharged on 23.12.1998. He incurred expenses of Rs.2,20,000/ -. He submitted the bills and claimed Rs.2,00,000/ - only. It is the case of the complainant that he informed the first opposite party that he was admitted in Satya Kidney Centre for treatment. On 30.11.1998, the opposite parties asked him to send all the medical reports pertaining to his illness. On 31.12.1998, the first opposite party asked him to send cash bills, medical/diagnosis report, discharge summary and case sheet for taking further action under the policy. On 23.2.1999, the complainant sent the required data and documents to the first opposite party. The opposite parties repudiated the claim. Hence, he approached the District Forum for appropriate relief.
(2.) THE first opposite party filed a counter which was adopted by the second opposite party.
(3.) THE District Forum conducted a detailed inquiry and based on the record, held that the opposite parties are liable to pay Rs.1,76,305/ - together with interest at 9 per cent per annum from 8.10.1999 till realisation and also costs of Rs.500/ -. Aggrieved by the said order, the present appeal has been filed. The learned Counsel for the appellants, Mr. A. Anasuya contended that the District Forum did not look into the diagnosis report which will conclusively establish that on the date of obtaining the policy, the complainant was suffering from kidney problem, but the same was not disclosed.;

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