N.KANNADASAN, J. - (1.) The appellant is the 1st opposite party and the respondent is the complainant before the District Forum.
(2.) The complaint is filed under the following circumstances: The complainant is the wife of Tr. K. Asoka Kumar, who is the proprietor of a Air Cargo Agency. In the year 1994, the said Mr. Asoka Kumar has taken a policy for a period from 1.10.94 to 30.9.1995. Subsequently, the policy was renewed continuously till 2003. In the policy issued on 8.1.2003, the 1st opposite party introduced a clause Subject to policy clause form No.GH 200310 attached hereto. The policy holder was not a heart patient till 1995, and for the first time, he has suffered an ailment and underwent a bye-pass surgery in the year 1995, and the 1st opposite party reimbursed the hospitalization expenses. When the policy was renewed, a specific clause was incorporated by indicating that the policy holder is not entitled to claim any amount for the pre-existing disease. Even in the year 2000, the policy holder made a representation to delete the exclusion clause, wherein the heart disease was referred to, while seeking renewal. According to the complainant, on 7.11.2003, the opposite party informed him that the heart disease in the policy was wrongly mentioned and the same had been deleted. Eventhough the original policy was taken for a sum of Rs.85000/-, when the same was renewed at a later date, it was enhanced to Rs.5 lakhs. When the policy holder was admitted subsequently at Malar Hospital, Chennai, a claim was made for a sum of about Rs.4,53,000/-, which was rejected and hence the complaint.
(3.) The complaint was resisted by the 1st opposite party to the effect that as per clause 5.6 of the policy, the policy is restricted to the old sum insured under the relevant previous policy and accordingly the policy holder was entitled only to the extent of Rs.85000/- for which the policy was originally obtained and the policy holder was not entitled to the additional claim.;