M. THANIKACHALAM J. - (1.) The complainant in OP.No.497/1998, on the file of District Forum, Chennai (South), unable to succeed before the District Forum, has come to this commission, as appellant.
(2.) The complainant/ appellant, took a Group Medical Personal Accident policy, for the period from 1.10.1996 to 30.9.1997, paying the necessary premium. The complainant was treated at Shanavas Nursing, for the removal of stone on the left kidney, between the period 10.2.97 to 112.2.97 and 17.2.97 to 20.2.97. Thereafter, for the period from 29.5.97 to 1.6.97 and 14.7.97 to 17.7.97, for the same complaint, the complainant was treated, and the stone was removed. Similarly, for the right side kidney also he was treated and as a whole the complainant has spent a sum of Rs.37,358.40/-. When the complainant lodged a claim, the opposite party rejected the same unreasonably, without any basis, thereby they have committed deficiency in service, for which they should be held responsible. Thus a claim came to be filed for the reimbursement of Rs.37,358.40/-, for Rs.30000/- being the compensation, and for another sum of Rs.20000/- for wrongful hospitalization claim, with cost.
(3.) The opposite party/respondent, questioning the veracity of the allegations, available in the complaint, have stated that the complainant had not disclosed the pre-existing disease at the time of giving proposal for taking policy, that the discharge summaries revealed the fact that he had taken treatment only for the pre-existing disease, which are excluded, under the policy and therefore the repudiation made by the opposite party is well within their right, which cannot be termed as deficiency in service, thereby prayed for the dismissal of the claim.;