M.THANIKACHALAM, J. - (1.) The opposite party is the appellant.
(2.) The complainant / respondent, who had taken hospitalization and domiciliary hospitalization benefit policy, has undergone bye-pass heart surgery, incurring a expense of Rs.2,71,000/-, approached the opposite party for reimbursement, repudiated on the ground of pre-existing disease, which is branded by him as deficiency in service, and on these grounds, a consumer complaint was filed, for the recovery of a sum of Rs.271000/-, towards medical expenses, and Rs.1 lakh towards compensation.
(3.) The opposite party/ appellant, not challenging the mediclaim policy, justified their repudiation, since the complainant had suppressed the material facts, at the time of giving proposal, as well as he had taken treatment for pre-existing disease, which are not covered under the policy, and therefore the non-settlement of the claim, will not come within the meaning of deficiency in service.;