Decided on May 21,2009

T.D. Kochunarayanan Respondents


- (1.)THE above appeal is preferred from the order dated 24.2.2003 passed by CDRF, Thrissur in OP.297/02. The appellant herein was the opposite party in the said complaint which was preferred by the respondent herein as complainant claiming the mediclaim of Rs. 15,831.94. The complainant alleged deficiency in service on the part of the opposite party/Insurance Company in repudiating the insurance claim. The opposite party entered appearance and contended that there was pre -existing disease and so under the exclusion clause the claim was repudiated Thus, the opposite party justified their action in repudiating the insurance claim put forward by the complaint.
(2.)BEFORE the Forum below the Doctor who first treated the complainant and issued Rl certificate was examined as PW1. Ext. P1 Insurance Certificate was also marked on the side of the complainant. From the side of the opposite party Rl to R12 documents were produced and marked. On appreciation of the evidence on record, the Forum below passed the impugned order directing the opposite party/Insurance Company to pay the insurance claim of Rs. 15,831.94 with 12% interest per annum and Rs. 2,000 as compensation and cost of Rs. 600. Hence the present appeal by the opposite party/Insurance Company.
(3.)WE heard both sides. The learned Counsel for the appellant/Insurance Company submitted his arguments based on the grounds urged in the memorandum of the present appeal. He relied on Rl certificate issued by PW1 and R10 discharge summary issued from Amrutha Institute of Medical Science and Research Center and submitted that the complainant/insured was having pre -existing disease. Thus, the appellant justified his action in repudiating the claim. Therefore the appellant requested for setting aside the impugned order passed by the Forum below. On the other hand, the respondent/complainant supported the findings and conclusions of the Forum below. He much relied on the testimony of PW1, the Doctor who issued Rl certificate and canvassed for the position that the period of 6 months mentioned in Rl certificate is only an approximate one and that the Forum below has rightly found the issue in favour of the complainant/insured. Thus, the respondent requested for dismissal of the present appeal.
The points that arise for consideration are - 1. Whether the appellant/opposite party/Insurance Company has succeeded in establishing their case that the complainant was having pre -existence disease or that the claim is hit by the exclusion clause contained in R12 policy conditions? 2. Is there any sustainable ground to interfere with the impugned order dated 24.2.2003 passed by CDRF, Thrissur in OP 297/02? Points 1 and 2:

Click here to view full judgement.
Copyright © Regent Computronics Pvt.Ltd.