M. THANIKACHALAM J. - (1.) The insurance company, who suffered an adverse order in he hands of the District Forum, Chennai (North), is the appellant.
(2.) The respondent/ complainant had taken a mediclaim policy with the appellant/ opposite party for the period from 28.2.2003 to 27.2.2004, by paying a premium of Rs.1973/- under policy No.501800/48/02/8500901. Thereafter, when he suffered nasal block, approached an ENT surgeon Dr.Krishna Kumar, who treated him, diagnosing that the complainant was having deviated nasal septum to left Bilateral Sinonasal Polyposis, for which a surgery also was done. Totally the doctor charged or the claimant spent a sum of Rs.21,307/-, which is to be reimbursed by the insurance company, on the basis of the policy referred above.
(3.) The complainant lodged a claim, which was repudiated by the opposite party on untenable grounds, which is illegal and void, as if the claim was not permissible, since the ailment was pre-existing, at the time of the proposal of the policy. Despite a demand and legal notice, since the insurance company failed to answer the claim, it should be construed as deficiency in service, and therefore, the claim is lodged for suitable direction.;