M.THANIKACHALAM J. - (1.) The respondent as complainant filed a complaint before the District Forum against the appellant/opposite party praying for the direction to the opposite party to pay Rs.1 lakh along with interest at the rate of 12% per annum, to pay Rs.50,000/- towards loss, pain, suffering and mental agony and to pay the cost. The District Forum allowed the complaint, against the said order, this appeal is preferred praying to set aside the order of the District Forum dt.09.06.2007 in C.C.4/2005. This appeal coming before us for hearing finally on 07.04.2011, upon hearing the arguments of the appellant counsel and perused the documents, as well as the order of the District Forum, this Commission made the following order: The opposite party is the appellant.
(2.) The respondent / complainant, for himself and for his family members, have taken a mediclaim policy for the period from 23.09.2002 to 22.09.2003, under which, the coverage given for the complainant alone was Rs.2 lakhs. The complainant had taken treatment on 5.7.2002 and on 4.10.2002 for renal problem and he has no problem of chest pain, prior to the operation.
(3.) On 17.07.2003, the complainant was admitted in Kovai Hospital Center for coronary angiogram and after angioplasty, he was discharged from the hospital on 23.7.2003 for which he had incurred an expense of Rs.1 lakh. The complainant claiming the above said amount, based upon the policy, lodged a claim, it was repudiated on false and frivolous grounds, as if, the disease for which the complainant had taken treatment, was pre-existing one, which is highly unfair and negligent act, on the part of the opposite party, thereby they have committed deficiency, compelling the complainant to file a case, not only for reimbursement of the medical expenses under policy, but also to pay a sum of Rs.50,000/- as compensation, for loss and mental agony.;