Decided on July 06,2009

Branch Manager, New Indian Assurance Co.Ltd. Appellant
Savadasan Damodaran Respondents


R.K.UDAYABHANU, J. - (1.)THE appellants are the opposite parties/New India Assurance Co. Ltd. in OP 147 of 2001 in the file of CDRF, Pathanamthitta. The opposite party is under orders to pay a sum of Rs. 75,378 with interest at 12% per annum from the date of the petition, till the date of judgment and thereafter at 6% till realization. It is also ordered that the appellant would pay a sum of Rs. 20,000 as compensation and cost of Rs. 3,000.
(2.)THE case of the complainant is that he is an NRI working in Dubai and that he had availed the policy of the appellants vide, Pravasi Sureksha Kudumba Arogya Scheme for the period from 20.8.1999 to 19.8.2004 on paying a premium of Rs. 5,080 with the assured sum of Rs. 2,00,000. On 10.1.2000 during the period of operation of the policy the petitioner was admitted that NSS Medical Mission Hospital, Panthalam on account of stomach and back pain. He was discharged on 11.2.2000 with reference to a higher center. He was admitted that SUT Hospital, Thiruvananthapuram on 11.1.2000 and was an inpatient up to 25.1.2000 for ureteric calculus and renal failure. After having discharged from the above hospital he was admitted at Medical Trust Hospital, Cochin on 27.1.2000 and was an inpatient up to 7.2.2000. He was again admitted at the Medical Trust Hospital on 21.2.2000 up to 26.2.2000 and thereafter from 13.3.2000 to 23.3.2000. The hospital bill amounted to Rs. 75,378. The opposite parties repudiated the claim on the ground that the failure of the kidney of the complainant was on account of his pre -existing illness of multifold diabetes and hypertension. It is denied that the complainant was having the above pre -existing illnesses. Hence the petitioner has sought for reimbursement of the medical expenses together with compensation etc.
(3.)IN the version filed the opposite party/ appellant admitted the existence of the alleged policy. It is contended that the petitioner was bound in to disclose the minute details regarding his health condition in the proposal. As per Section VII (1) of the Policy Conditions the complications arising from pre -existing diseases are excluded from the purview of the policy. It was hence that the claim was repudiated. As per the diagnosis of SUT Hospital he had not undergone any previous treatment despite the illness which was in existence for a long period. The petitioner was a known diabetic and having hypertension for number of years and the same could have developed into mild nephropathy. The multifold diabetes and hypertension can lead to kidney failure. The obstruction in the left uretor could have precipitated the condition. As the complainant was having pre -existing illness of diabetes and hypertension the claim was repudiated.
The evidence adduced consisted of the testimony of PW1 DWs 1 to 3, Ex P1 to P 9 and R1 to R4.

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