T SURESH Vs. ORIENTAL INSURANCE CO LTD

JUDGEMENT

(1.) The petitioner is a medical practitioner in Ayurveda. He took out a Medi-Claim Policy in March, 2002 with the Oriental Insurance Company Limited - the 1st respondent. It was being renewed from time to time on payment of stipulated premium. The petitioner suffered ailment to his Kidney in the year 2005 and a surgery had to be conducted. Thereafter, it became necessary to put the petitioner on continuous Ambulatory Peritoneal Dialysis (CAPD), thrice in a day. The monthly expenditure is said to be in the range of Rs.20,000/- to Rs.25,000/-, and this has to continue till the transplantation of the kidney takes place.

(2.) The medical bills were submitted by the petitioner to the 1st respondent and they have cleared the submitted bills without any demur up to June 2008. However, when the petitioner submitted a claim on 06.06.2008, the 3rd respondent - the Divisional Manager of the 1st respondent, rejected the claim through letter dated 05.09.2008, on the ground that CAPD, which the petitioner was undergoing, was excluded from the coverage. The petitioner feels aggrieved by the action of the respondents.

(3.) The petitioner contends that the policy is a continuous one and once a particular disease and ailment was covered under the policy, it cannot be excluded during the subsistence of the policy. During the pendency of the writ petition, the petitioner remitted the premium of Rs.7,293/- on 16.03.2009, for renewal of the policy for the year 2009-10. However, it was not accepted on the 'ground that the ailment, which the petitioner was undergoing, is no longer under the coverage. W.P.M.P.No.14778 of 2009 is filed in that connection. Reliance is placed upon the judgment of the Supreme Court in United India Insurance Company Limited v. Manubhai Dhamasinhbhai Gajera (1) AIR 2009 SC 446 = 2008(8)SCJ 823.