UNITED INDIA INSURANCE CO., LTD Vs. M. NARESH KUMAR

JUDGEMENT

(1.) The appeal is challenge to the order passed by the District forum-III Hyderabad, in C.C.No.902 of 2007.

(2.) Briefly stated the facts of the case as represented by the complainants are that they are the holders of individual mediclaim policy bearing NO.051501/48/06/20/000000691 dated 10.08.2006 issued by the opposite parties for a sum of Rs.2 lakh after collecting premium amount of Rs.3,500/-. In the first week of November 2006 Gynecologist advised the complainant no.2 to go for colonoscopy test at Swapna Nursing home. On 14.11.2006 after having been conducted the tests she was diagnosed with chronic cervicits with abnormal cellular pattern. Subsequently on 11.2.2007 the complainant no.2 was admitted to the Kirloskar Hospital where laproscopic hysterectomy was conducted by Dr.Padmini Gandham. The complainant submitted claim for hospitalization expenses through their agent Medsave was repudiated by the opposite parties.

(3.) The opposite party resisted the claim and it was contended that as per the terms of the conditions of the insurance policy particularly clause IV Point No.3 of the policy the claim of the complainant was excluded from the coverage. Hysterectomy as per clause 4.3 of the insurance policy is not covered in the first year of the inception of the policy.