M.THANIKACHALAM, J. - (1.) The complainant having failed before the District Forum, in claiming medical reimbursement, based upon mediclaim policy, has come before this commission, as appellant.
(2.) The complainant /appellant, disclosing his pre-existing disease of diabetes, had taken a mediclaim policy, for a sum of Rs.1 lakh, for the period from 19.3.2005 to 18.3.2006, and so far no claim was made. The complainant was hospitalized for treatment of non-healing ulcer second toe, and osteomylitis of second toe, from 25.1.2006 to 29.1.2006, incurring a total expenses of Rs.31,639.40/- and later incurring an expenses of RS.4334/- towards dressing and medicine. Thus, in all, a sum of Rs.35,973.42/-.
(3.) Based upon the mediclaim policy, when the complainant lodged a claim, it was rejected/repudiated, on the ground that the treatment given to the complainant was for diabetes, which was a pre-existing disease, erroneously, forgetting the fact, that the complainant has not taken treatment for diabetes, which was also endorsed by Insurance Ombudsman, when appealed, thereby all of them committed deficiency in service. Despite notice, since the amount not settled, the complainant is constrained to file the case, for reimbursement of the medical expenses, in addition to the compensation of Rs.1 lakh, for mental agony.;