KILLAMPALLI JAGESWARA RAO Vs. DIVISIONAL MANAGER,UNITED INDIA INSURANCE CO. LTD

JUDGEMENT

(1.) The complainant is the appellant. Being dissatisfied with the order dated 21.8.2007 passed by the District Forum West Godavari in C.C.No.148 of 2004 the complainant has filed the appeal contending that pulmonary hypertension is a cardiac ailment and all the diseases for which he had taken treatment are connected to the cardiac ailment. Dyspnea is a cardiac disease and during the treatment the complainant had developed diabetes and other ancillary diseases due to use of various medicines.

(2.) The facts of the case are that the complainant is a member of IMA which had obtained insurance policy, special tailormade health care insurance policy from the opposite parties no.1 to 3. The complainant had undergone treatment for Dyspnea for the period from 3.5.2003 to 4.5.2003 in Mullapudivenkata Ramana Memorial Hospital, Tanuku and later undergone treatment in Sanjeevini Emergency Hospital, Tanuku and Apollo Hospital Chennai from the period 4.5.2003 to 19.5.2003 and the complainant said to have incurred an expenditure of Rs.52,562/- towards medical expenditure. The claim submitted by the complainant was repudiated by the opposite parties on the ground that the complainant had previous history of pre-existing disease and suppressed the material fact relating to his health status at the time of obtaining the insurance policy.

(3.) The opposite parties resisted the claim contending that his claim was not admissible as per the terms and conditions of the insurance policy. In view of the issue of the policy at Hyderabad and the correspondence made with the opposite party no.1 at Hyderabad, the District Forum West Godavari has no jurisdiction to entertain the complaint. The complainant has suppressed the material fact relating to his health except stating that he suffered from facial palsy and vocal cord palsy two years and one year respectively prior to the date of the proposal form. On verification of the record the opposite parties came to know that the complainant had taken treatment for diabetes mellitus, hypertension, coronary artery disease, respiratory failure type-II, left ventricular failure, chronic obstructive pulmonary disease, brochial asthama, CAD, hypercholostromic TVD etc. The surgery the complainant had undergone is a pre-existing disease. The opposite parties contended that the repudiation was proper and justified.