A.K.ANNAMALAI, J. - (1.) The opposite parties are the appellants.
(2.) The Complainant filed a complaint against opposite parties 1 and 2 and against 3rd opposite party claiming for mediclaim policy amount for the treatment availed at the foreign country for Rs.4,90,225/- (US Dollors 9317.60) and for Rs.5,00,000/- as compensation for mental agony.
(3.) The brief details of the complaint are as follows :- The complainant had taken overseas medi-claim policy for the period of travel and stay from April 2004 to October 2004 in USA from the opposite parties. The opposite parties after thorough medical examination have issued the policy for Rs.5 Lakh U.S $ and also received premium of Rs.30,560/-. The policy was issued to the complainant and the complainant left India in April 2004 to USA to join his son Dr.Sathish, On 12.5.2004, while he was on morning walk he felt breathlessness for a short while and he was admitted in Shands Hospital attached to University of Florida, USA as an outpatient. The lungs specialist Doctor, after thorough examination discharged the complainant within few hours on the same day. The hospital preferred a claim of Rs.9317 US dollars for the treatment given to the complainant. The agent of the 3rd opposite party did not pay the money though the complainant was in possession of valid insurance policy. At last the complainant?s son paid the amount to the hospital. On a claim to the opposite parties, it was repudiated on the ground that the complainant took chest x-ray in December 2003 and as such he was not entitled to payment of the bill placed by the hospital authorities. The chest X-ray was taken only to find out whether there was any enlargement of the heart and has no relevance to the treatment given by the Shands Hospital for Hilar and Mediastinaland Lymphaderopathy. The opposite parties issued the policy only after the senior cardiologists of the opposite parties, examined him. Hence the reason for denying the medi-claim policy amount is not convincing and refusal is nothing but deficiency in service. The disease referred by Shands Health Care USA is not pre-existing disease since only in the year 2004 complainant was affected with breathlessness while he was on morning walk and took treatment in Shands Hospital. Hence, the complainant filed the complaint claiming Rs.4,90,255/- (US dollars 9317.60) paid by him and also a sum of Rs.5,00,000/- as compensation for mental agony.;