DIVISIONAL MANAGER, UNITED INDIA INSURANCE COMPANY LIMITED Vs. AITHA

JUDGEMENT

(1.) THIS appeal is preferred by the opposite party in OP.90/2000 of the CDRF, Kasaragod against the order dated 03.01.2001 wherein the appellant was directed to pay a sum of Rs. 5000 towards medical expenses and treatment charges incurred by the complainant along with compensation of Rs. 500 and costs of Rs. 500 within two months failing which the amount of Rs. 5,000 (Rs. 5,000 + compensation of Rs. 500) will carry interest at the rate of 12% per annum from the date of the order till realization.

(2.) THE case of the complainant bereft of unnecessary details in the complaint is that he is a painter by profession and he insured his life and his family members under œJan Arogya Bima Policy by paying a premium of Rs. 240 for the period from 30.6.1999 to 29.6.2000 i.e., the period of one year. During the period of policy the complainant underwent the treatment for œFistula in Ano on 11.9.99 and was discharged on 16.9.99 for which he had spent more than Rs. 10,000 towards medical expenses. The complainant alleges that though the claim was made before the opposite party it was repudiated on the ground that during the first year of the operation of the insurance cover, the expense for the treatment of the disease undergone by him was not payable. As the claim was repudiated the complaint was filed praying for directions to the opposite party to pay the assured sum of Rs. 5,000/ - covered under the policy and to pay Rs. 5,000/ - towards mental agony and sufferings along with costs.

(3.) IN the version filed by the opposite party the policy was admitted. But it was contended that ˜Fistula in Ano was not covered during the first year of policy which was specifically stated in the policy and as such the repudiation was only justifiable and there was no deficiency of service on the part of the opposite party and prayed for the dismissal of the complaint.