M.THANIKACHALAM J. - (1.) This appeal challenges the order in OP.370/2004, on the file of the District Consumer Disputes Redressal Forum, Chennai [North], wherein, a direction has been issued, which was considered as an adverse direction by the opposite party.
(2.) Brief facts:- The complainant had availed a mediclaim insurance policy from the opposite party on 20.05.2003 for one year, commencing from 20.05.2003 to 19.05.2004, for which, he had paid a premium of Rs.4389/-, wherein, the sum assured was Rs.1 lakh. During continuance of the policy, the complainant had taken treatment for Moderately Differentiated Adenocarcinoma Rectum, for which, he had taken treatment including surgery in the Apollo Speciality Hospital as inpatient from 03.08.2003 to 18.08.2003, for which, he was charged a sum of Rs.1,52,757/-.
(3.) The complainant based upon Hospitalization and Domiciliary Hospitalization Benefit Policy, lodged a claim, supplied the necessary documents, which was repudiated, on the ground of pre-existing disease and the claim is inadmissible, erroneously and unjustifiably. Issuance of legal notice also failed to rectify the deficiency committed by the opposite party, thereby the complainant was constrained to file the case for reimbursement of the medical expenses, as per the terms of the policy to the extent of Rs.1 lakh, in addition to, a sum of Rs.1,50,000/- towards compensation for mental agony.;