NATIONAL INSURANCE COMPANY LTD. Vs. P.R. NARAYANAN KARTHA

JUDGEMENT

(1.) THE appellant is the opposite party/National Insurance Company in OP No. 645/02 in the file of CDRF, Ernakulam. The appellant is under orders to pay the claim amount to the complainant subject to the sum assured and also Rs. 250 towards costs.

(2.) THE case of the complainant is that he had subscribed to a mediclaim policy with the opposite party with respect to himself, his wife and two children and that during the period of the policy his wife was treated for the illness lumbar spine. She was admitted at Krishnan Hospital on 24.12.2001 and discharged on 5.1.2002. She had also undergone Ayurvedic treatment for one month earlier. A sum of Rs. 16,547.64 was spent for the treatment of the hospital. The opposite party repudiated the claim alleging that the complainant's wife was having the particular illness even 6 months prior to the taking of the policy. The above statement is not true. The complainant has claimed Rs. 15,000 as treatment expenses.

(3.) IT is the case of the appellant/opposite party that the wife of the complainant was having the illness of compressive radiculopathy. The medical opinion is that the disease was pre -existing as on the date of inception of the insurance coverage i.e., 4.7.2001. She was under Ayurvedic treatment for a very long time. She was treated by Dr. T.K. Shailaja, Charath Pharmacy, Poonithura. It was hence that the claim was repudiated.