CHANDRAKANTH RAO Vs. J.SIDDHA LINGAIAH SWAMY

JUDGEMENT

(1.) The opposite parties, the New India Assurance Company Limited, preferred this appeal against the order of the District Forum directing it to pay the amount covered under the medi-claim policy with interest and costs.

(2.) The case of the complainant in brief is that the Insurance Company issued a medi-claim policy to him promising that it would come to his aid and also helpful to get monetary benefits towards medical expenses. An amount of Rs.5075/- was collected towards yearly premium covering the period from 26.8.2005 to 25.8.2006 for an assured sum of Rs.1,00,000/-. While so, he suffered from pain and vision problem in his right eye and thereafter he went to Shri Ganapati Netralaya, Jalna for check up. They diagnosed it as right photo dynamic therapy plus intravitreal avastin. An operation was conducted on 28.7.2006 and was discharged on 29.7.2006. Altogether he had spent an amount of Rs.91,382/- towards medical expenses. When he submitted claim, the same was repudiated on the ground that the ailment was pre existing. Aggrieved by the said repudiation, he filed the complaint claiming Rs.91,382/- together with compensation of Rs.50,000/- and costs.

(3.) The Insurance Company resisted the case. While denying each and every allegation made in the complaint, it alleged that the policy was obtained in order to have wrongful gain. The complainant was aged 65 years. He underwent operation in the right eye for cataract surgery in the year 1995 and left eye cataract surgery in 2004. The doctor after going through the record opined that the deceased had pre existing ailment and therefore the claim was repudiated.