M.THANIKACHALAM, J. - (1.) M.THANIKACHALAM, J. The unsuccessful complainant, is the appellant.
(2.) The facts necessary for the disposal of the case are: The complainant had taken mediclaim policy, from the opposite party not only for himself, but also for his family members, covering the period 2.11.2001 to 1.11.2002, assuring for each member Rs.1 lakh. In the month of March 2002, the complainant felt giddiness, for which he had consulted the doctor at Vijay Hospital, who advised him to admit as inpatient, where after examination angiogram was done, including angioplasty, incurring a sum of Rs.97504/-. Based upon the policy, the complainant lodged a claim, which was repudiated, as if the claim of the complainant comes under Clause 4.1, which is incorrect. The complainant had no pre-existing disease, and the problem occurred, just one month, prior to the date of taking the treatment, which was not properly considered by the opposite party, should be construed as negligence, as well as deficiency, causing mental agony also. Hence the complaint.
(3.) The opposite party, admitting the policy, questioning the jurisdiction of the Forum, resisted the case, interalia contending, that as per the opinion of the doctors, the complainant had pre-existing disease, at the time of inception of the policy, and therefore repudiation was done justifiably, which cannot be termed as negligence, or deficiency in service, thereby praying for the dismissal of the complaint.;