M. THANIKACHALAM J. - (1.) The opposite party who suffered an adverse order in the hands of the District Forum, Cuddalore, is the appellant. 2. The 1st complainant, having taken a mediclaim policy on 31.7.2000, for Rs.50000/-, by paying premium, again renewed the same by paying premium of Rs.803/- for the period covering 27.7.01 to 26.7.02. Thereafter, when she suffered knee pain, approached Dr. Mohandas, who advised her to take proper treatment, for which she approached MIOT Hospital, Chennai, there she was operated, for which a sum of Rs.59,454/- was spent. On the basis of the mediclaim policy, when the complainant lodged a claim, the same was repudiated, resulting seeking for redressal before the Consumer Forum.
(2.) The opposite party/appellant, admitting the mediclaim policy, in their written version, had stated that the 1st complainant failed to disclose the pre-existing disease, at the time of taking up mediclaim policy, which amounts to suppression of material facts, that when claim was made, she was directed to produce the necessary documents, for taking treatment previously, which was not complied with, and therefore under the terms and conditions of the policy, the claim was repudiated, which cannot be termed as deficiency in service, warranting compensation.
(3.) Based upon the averments, the District Forum considered the rival claims, including the documents, relied on by either parties, as well as proof affidavits filed by them. The evaluation brought to surface, that the refusal to pay the medical expenses by the opposite party, is deficiency of service, that the 1st complainant was suffering from knee pain only after the renewal of the policy, i.e., on and after 2.4.2001, and the non-disclosure of the same cannot be termed as suppression of pre-existing disease, that during the currency of the renewal policy, operation was done, which should follow not only the sum assured should be paid, but also for the mental agony a sum of Rs.5000/- should be paid as compensation. Thus, concluding as per the order dt.6.4.2005, direction has been issued, which is under challenge before us.;