Rakesh Kumar Jain, J. - (1.) This petition is directed against the order dated 13.2.2014 by which application filed by respondent No.1 under the Legal Services Authority Act, 1987 (for short 'the Act') has been allowed and the petitioner has been directed to pay Rs.3,00,000/- to respondent No.1 within 45 days, failing which it has been ordered to pay interest @ 9% per annum from the date of institution of the application till payment.
(2.) In brief, respondent No.1 obtained "Happy Family Floater Policy" [for short 'the Policy'] from the petitioner vide Policy No.215391/48/2013/718, valid from 8.10.2012 till mid night of 7.10.2013, by which as many as six members of the family of respondent No.1 were covered. The sum assured in the policy was Rs.3,00,000/- only. Father of respondent No.1 felt severe chest pain on 27.5.2013 and was taken to Sethi Hospital, Gurgaon where he remained admitted upto 28.5.2013 and due to his critical condition, referred to Medanta Global Health Private Limited, Gurgaon. A sum of Rs.12,016/- was incurred on his treatment at Sethi Hospital, Gurgaon and after that he remained admitted in Medanta Health Private Limited, Gurgaon from 28.5.2013 to 2.6.2013 and had coronary angiography on 29.5.2013 which revealed Triple Vessel disease. He also had coronary stenting to RCA on 31.5.2013 on which an amount of Rs.3,79,729/- was spent. The total amount spent by respondent No.1 on the treatment of his father Hari Chand was Rs.3,91,450/-.
(3.) Learned counsel for the petitioner has submitted that the father of respondent No.1 was suffering from pre-existing disease of Hypertension and Diabetes for more than 2 years, therefore, "pre-existing condition" of the Policy has to be applied. He has relied upon the preliminary report of Medanta Health Private Limited, Gurgaon in which it is mentioned in the medical history that the patient is a known case of hypertension and diabetes. However, the Permanent Lok Adalat has rejected this argument observing that there is no document or prescription supplied/produced by the petitioner to show that prior to the commencement of Policy dated 8.10.2012, Hari Chand father of respondent No.1, was suffering from the alleged disease and therefore, exclusion of clause 'pre-existing disease' is not attracted.;