RANJANA KAR MUKHERJEE Vs. SENIOR DIVISIONAL MANAGER

JUDGEMENT

(1.) THIS appeal is directed against the judgment and order passed by the learned District Forum, Jalpaiguri in case No. CC 2010/58 dismissing thereby the claim for reimbursement of L 1,40,200/ -.

(2.) THE case of the appellant/complainant, in short, is that she is a lady aged 50 years and has been suffering from Menorrhagia, Ecoli and recurrent. UTI. She visited AIIMS, New Delhi. The diagnosis was Type -2 D.M./Anaemia Hypothyroidism etc. There was no whisper of IHD and no management was prescribed for IHD. The local physician Dr. B. K. Biswas was consulted on 04.01.08. In the side note of the prescription he remarked IHD for the first time but without any management and reference for check up by a Cardiologist. The patient thereafter went to CMC, Vellore with her problems on 15.01.08. Thorough investigations were done. The prescription of Dr. Biswas was placed before them but they did not give any importance to it. The patient again visited CMC, Vellore for review on 11.03.08. Thereafter, she visited AMRI Hospital on 22.06.05 where she had undergone the treatment made by Dr. Amitava Mukherjee, Urologist. The diagnosis was D.M., UTI and Menorrhagia and the treatment was done accordingly. On 26.06.09 the doctor for the first time recommended Coronary Angioplasty. The O.P.'s Health Plus Plan was taken by her on 21.02.08 providing for benefits including major surgery expenses upto L 2 lakhs. The claim was made, but the O.P. repudiated such claim. The complainant filed a complaint before the learned District Forum claiming L 1,40,200/ - being the amount of I the expenses, L 50,000/ - as compensation and cost of litigation of L 5,000/ -.

(3.) THE learned Counsel appearing for the appellant submits that the policy was taken on 21.02.08 and no document has been filed by the respondent to prove that prior to that date the appellant had been suffering from Ischaemic Heart Disease (IHD) for which she was hospitalized and treated. It is contended that there is nothing to show that the appellant had the knowledge of the disease (IHD) at the time of opening such policy, it is submitted that only in one prescription of Dr. B.K. Biswas dt.04.01.08 there was mention at the left hand corner about D.M./IHD which is not sufficient to prove that the patient had been suffering frown IHD and that treatment for such ailment was made. It is contended that Dr. Amitava Mukherjee of AMRI Hospital issued a certificate from which it would appear that the diagnosis of IHD was confirmed only on 27.06.09.