NEW INDIA ASSURANCE COMPANY LIMITED Vs. KARIM AHAMAD

JUDGEMENT

(1.) THE Branch Manager, New India Assurance Company Limited has filed this appeal challenging the validity of the order of the Rayagada District Forum directing him to pay the respondent No. 1 the mediclaim amounting to Rs. 11,175.16 paise with costs of Rs. 300/ -.

(2.) THE respondent No. 1 filed the complaint for a direction to the appellant to pay him the mediclaim amount together with compensation for mental agony and litigation expenses. His case is that he felt severe pain in his abdomen and consulted the doctor -respondent No. 2. On the advice of the doctor, he took admission at Sanjibini Medicare, Bhubaneshwar for treatment and on 22.10.2001, he was discharged from the hospital. He spent a sum of Rs. 11,175.16 paise towards his treatment in the hospital. He lodged a claim for the aforesaid amount which was repudiated by the appellant in letter dated 5.8.2002. Finding no other way, he filed the complaint.

(3.) THE appellant in his written version took the stand that the mediclaim stands excluded by Clauses 4.1 and 4.3 of the mediclaim insurance policy because of the fact that the disease was a pre -existing one and during the first year of the policy he was operated upon for the disease.