NATIONAL INSURANCE COMPANY LIMITED Vs. MONA OHRI

JUDGEMENT

(1.) THE appellants had issued the mediclaim insurance policy in the name of Kanta Ohri respondent No. 2 and to her family members covering the risk of hospitalisation/domiciliary hospitalisation vide policy dated 27.3.2003 valid for the period from 31.3.2000 to 30.3.2001. Mona Ohri respondent No. 1 was also covered by the mediclaim policy. Kanta Ohri respondent No. 2 was insured for an amount of Rs. 3 lacs while the remaining 4 family members including Mona Ohri respondent No. 1 were covered for an amount of Rs. 50,000 each.

(2.) IT was further pleaded that Mona Ohri was admitted in Iqbal Nursing Home and Hospital, Ludhiana (in short "Iqbal Hospital") on 16.6.2000. Myomectomy operation was done on 16.6.2000 and she was discharged from Iqbal Hospital on 23.6.2000. Intimation regarding the admission of Mona Ohri respondent No. 1 was given to the appellants by Vivek Ohri husband of respondent No. 1 vide letter dated 18.6.2000. After the discharge of respondent No. 1 from Iqbal Hospital, the insurance claim for Rs. 25,625 was lodged with the appellants vide letter dated 9.10.2000 and all the necessary documents were supplied along with this claim application. However, the insurance claim was repudiated by the appellants vide letter dated 18.12.2001. Hence, the complaint for recovery of the insurance claim of Rs. 25,625. Compensation, interest and costs were also prayed.

(3.) THE appellants filed the written reply. It was not denied that the appellants issued the mediclaim policy to Kanta Ohri respondent No. 2 for herself and for her family members for an amount of Rs. 5 lacs which was valid for the period from 31.3.2000 to 30.3.2001. It was also not denied that Mona Ohri respondent No. 1 was admitted in Iqbal Hospital and intimation of her admission was also received by the appellants. It was also admitted that the photocopies of the bills were received by the appellants but the bills were not for Rs. 25,625. It was admitted that the claim was repudiated for the reason that the disease was pre -existing because tumor in uterus takes many years to develop. Therefore, the repudiation was legal and valid. Dismissal of the complaint was prayed.