DIVISIONAL MANAGER, THE ORIENTAL INSURANCE CO. LTD Vs. A.VIJAYKUMAR
TAMIL NADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION
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M. THANIKACHALAM J. -
(1.) Opposite party is the appellant.
(2.) The complainant had taken mediclaim insurance policy, from the
opposite party, not only for himself, but also for the family members,
from the year 2001, commencing from 27.6.2001, and the same was renewed,
even for the period 2003-2004.
(3.) In the month of January 2003, the complainants wife Kalaiselvi, had
excessive bleedings and severe abdomen pain, for which she had taken
treatment, in First Med Hospital at Chennai, where the disease was
diagnosed as Adenomysis, for which laparoscopic assisted vaginal and
hysterectomy, was done on 18.1.2003, for which she was hospitalized from
24.1.2003. The complainant had spent a total sum of Rs.27,666.95/-, out
which a sum of Rs.12,463.75/-, was reimbursed, since the complainant is
working in a bank. Based upon the policy, though the complainant had not
claimed any amount from the year 2001, for this treatment, claim was
lodged for the balance, which was repudiated unjustifiably by the
opposite party, as if it was a pre-existing one, or the complainant had
suppressed the material facts, thereby causing not only mental agony, but
also monetary loss, for which they should be directed to pay a sum of
Rs.1 lakh, in addition to the expenses incurred, viz. Rs.15,203.20/-.
Hence the complaint.;
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