M. THANIKACHALAM J. - (1.) The unsuccessful opposite party is the appellant.
(2.) The facts in brief leading to this appeal:- The complainant had taken a mediclaim insurance policy with the opposite party on 15.12.99, covering the period from 17.12.99 to 16.12.2000, not only for himself, but also for his wife. Under the policy, the opposite party had undertaken to reimburse the expenses incurred in respect of the disease or injury, which required hospitalization.
(3.) On 24.1.2000, the complainant went to Vijaya Hospital for check up and as advised, Angiography was taken, leading to CABG Surgery, being an inpatient till 26.1.2000, for which, the complainant had incurred an expense of more than Rs.1,42,485/-, for which, with necessary documents, a claim was lodged. Unfortunately, the opposite party repudiated the claim as if the complainant had taken treatment for a pre-existing disease, as if it is excluded under the terms and conditions of the policy, which is incorrect. Even after the issuance of notice, the deficiency committed by the opposite party was not rectified, whereas continued, thereby compelling the complainant to file a case, for the recovery of the amount, in addition to, compensation for mental agony.;