M.THANIKACHALAM, J. - (1.) The opposite party is appellant.
(2.) The complainant/respondent based upon the mediclaim insurance policy, issued by the opposite party to the complainant and his family members, lodged a claim for Rs.11,052.65 since his wife Jayanthi, one of the insured, underwent Endoscopic Sinius at M/s.Vega ENT Hospital, Coimbatore, which was not paid or settled by the opposite party, despite legal notice. Therefore, alleging deficiency in service, a consumer complaint came to be filed, not only for the recovery of the medical expenses, but also for compensation.
(3.) The opposite party admitting the mediclaim insurance policy, contending that the policy has not been renewed without any break, opposed the case of the complainant, that the insured by name Jayanthi had the disease, for which, she had taken treatment, for the past 10 years and therefore, as per the terms and conditions of the policy, they are not entitled to pay the expenses for pre-existing disease, under the Exclusion Clause and in this view, the non-payment of the claim, cannot be construed as deficiency in service.;