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Judgment
THE complaint arises out of a medi-claim. THE complaint was dismissed by the lower Forum. Hence the complainant has preferred this appeal.
AFTER perusing the records, we are satisfied that the order passed by the lower Forum is a well-considered order and there are no grounds to interfere with it. The husband of the complainant had taken a mediclaim insurance policy for one year from 6.2.1997 to 5.2.1998. The complainant''s husband was treated at MIOT Hospital on 12.3.1997. He was admitted in the hospital on 12.3.1997 and discharged from the hospital on 13.4.1997. The complainant''s husband died on 24.4.1997. The complainant claimed a sum of Rs. 98,000/- for the treatment charges which was repudiated by the opposite party. The first ground of repudiation is on the basis of the fact that the complainant''s husband was treated at the MIOT Hospital within 30 days of the date of inception of the policy and, therefore, the claim is not payable since it would fall out of the purview of the exclusion Clause 4.2 of the policy. The other grounds urged is that the complainant''s husband was suffering from the illness which was pre-existing disease and, therefore, the claim stood excluded as per the conditions of the policy. The documents produced by the complainant marked as Exs. A-1 to A-11 and the documents which have been brought on the side of the opposite parties marked as Exs. B-1 to B-18 all show that the deceased was suffering from the illness for which he was treated at MIOT Hospital and the illness occurred within 30 days from the date of inception of the policy. From the documents we find that after verifying the medical records, the doctor had opined that it was Leukaemia from which the complainant was suffering and that was detected on 24.2.1997. Ex. B-18 is the letter written by Dr. T.K. Bavaswamy Rao stating that the deceased died of acute lympholytic leukaemia and that the deceased might have been suffering from malignancy in his body and the blood of the deceased started showing sings of leukaemia and on 4.3.1997 it was finally diagnosed as acute lympholytic leukaemia and the deceased had proposed a mediclaim policy on 6.2.1997 and his illness was pre-existing at that time. The execlusion clause under 4.1 reads as follows: "Such diseases which have been in existence at the time of proposing this insurance ... Complications arising from pre-existing disease will be considered part of that pre-existing condition."
Therefore, viewed from any angle, the repudiation by the opposite parties cannot be faulted with. Even if it is considered as not a pre-existing disease, the fact that he was treated in MIOT Hospital and Devaki Hospital within 30 days from the date of inception of the policy would exclude the claim under Clause 4.2 of the policy. That apart, the fact remains as evidenced by Ex. B-18 and other reports that it must have been a pre-existing disease, thus attracting the operation of Clause 4.1 of the policy. Therefore, the repudiation by the opposite parties was justified in the circumstances and the lower Forum came to the correct conclusion with regard to the same. Hence we are of the view that there is no merit in this appeal.
In the result, this appeal is dismissed, but in the circumstances without costs. Appeal dismissed.