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.;