SENIOR BRANCH MANAGER Vs. P. KANNAN MARIMUTHU
TAMIL NADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION
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M. THANIKACHALAM J. -
(1.) The opposite parties are the appellants.
(2.) The facts leading to the appeal:
The complainant having taken Asha Deep policy, from the opposite party,
had underwent a double valve replacement surgery on 16.3.2006, for which
he was charged at Rs.2,04,743/-. Under the policy, the maximum amount
assured was Rs.3 lakhs, in which the complainant is entitled to be
reimbursed 50% viz. Rs.150000/-, for which a claim was made, repudiated,
as if under Article 11(b), the complainant is not entitled to any
expenses incurred, improperly, not properly reading the article, which
should be construed as deficiency and negligence, which had caused,
mental agony to the complainant. Hence the claim for the recovery of a
sum of RS.1,75,000/-.
(3.) The opposite parties, accepting the policy, opposed the claim, that as
per the condition and privileges available in the policy, a claim can be
made, only on the happening of any of the contingencies, given in the
policy document, which contemplates only open heart by-pass surgery,
leading to surgery, necessarily, by means of coronary angiography, and
not for valve replacement, on which basis, justifiably and reasonably,
they have repudiated the claim, which cannot be described as deficiency
in service, thereby praying for the dismissal of the complaint.;
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