A.K.ANNAMALAI J. - (1.) The opposite parties are the appellants.
(2.) The complainant filed a complaint against the opposite parties before the District Forum claiming for a sum of Rs.3,00,000/- towards the medical claim amount on the basis of policy and Rs.30,000/- for deficiency of service and Rs.20,000/- for compensation for mental agony and for costs.
(3.) The details of the complaint in brief are as follows :- The complainant has insured his health with the Life Insurance Corporation of India for Rs.3,00,000/- on 4.3.1988 and he was paying premium regularly. In the month of September 1999 he had developed some uneasiness and underwent medical examination. He was subsequently admitted to Amirta Institution of Medical Sciences and Research Centre, Elmakkara and it was diagnosed that he had inadequate blood supply to his heart was short and he underwent open heart surgery Arterial Septal defects closure on 8.9.1999 in Amirta Institute of Medical Science and Research Centre. The complainant submitted his claim with the 4th opposite party for the expenses incurred by him in the hospital. But the 3rd opposite party repudiated the claim on the ground that the benefit of B is available for Arterial Septal Detect as per the policy condition. The complainant made further representation to the 2nd opposite party on 4.12.2000 and again the Review Committee has not communicated its decision to the complainant which amounts to deficiency in service.;