NEW INDIA ASSURANCE COMPANY LTD. Vs. D. USHA RANI (DEAD) REP. BY HER HUSBAND
LAWS(APCDRC)-2008-7-3
ANDHRA PRADESH STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Decided on July 22,2008

NEW INDIA ASSURANCE COMPANY LTD. Appellant
VERSUS
D. Usha Rani (Dead) Rep. By Her Husband Respondents

JUDGEMENT

- (1.) HEARD the learned Counsel for the appellants on the delay excuse petition as well as on the appeal. Having heard the learned Counsel and on perusing the record, we are of the opinion that this matter can be disposed of at the stage of admission. This is an appeal preferred by the opposite parties against the order of the District Consumer Forum -1, Hyderabad, dated 2.11.2007 in C.C. No. 145 of 2006 in directing them to pay Rs. 49,804 together with interest at 12% per annum from 1.4.2005 till the date of realization and costs of Rs. 2,000.
(2.) THE case of the complainant in brief is that his wife, D. Usha Rani had taken a Mediclaim policy for the year 2000 -2001 mentioning that she had a pre -existing disease of diabetes. Despite the fact that she mentioned that she was suffering from diabetes, the Insurance Company had issued the said policy for Rs. 1,00,000. While so, when she was unwell she approached Global Hospital at Hyderabad, where the consultant opined that her kidneys were not functioning properly and diagnosed the disease as NIDDM, diabetic retinopathy, diabetic nephrology, which is end stage of renal disease. He suggested for continuous ambulatory peritoneal dialysis (CAPD). Accordingly, she underwent treatment and discharged on 16.9.2005. She spent Rs. 49,804 in this regard. Therefore, she claimed Rs. 49,804 towards reimbursement of medical expenses, Rs. 1,00,000 towards compensation and Rs. 10,000 towards costs.
(3.) THE Insurance Company resisted the complaint. However, it admitted that she was covered by a Mediclaim policy. The exclusion clause in column No. 4.1 of the agreement clearly states that "all diseases/injuries which are pre -existing when the covers incepts for the first time are excluded". By virtue of this, the complainant was ineligible for the claim amount. She was suffering from Type II diabetes which she did not mention at the time of obtaining the policy. Since the disease was in an advance stage, damage to several organs had taken place. They are complications of advanced diabetes. Therefore, she was not entitled to the amount claimed. The complainant filed Exs. A1 to A9. The opposite parties did not file any document.;


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