BRANCH MANAGER, M/S.UNITED INDIA INSURANCE CO. LTD Vs. S.I. KRISHNASAMY
TAMIL NADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION
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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.;
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