DR RAHUL AGARWAL Vs. NATIONAL INSURANCE CO LTD.

JUDGEMENT

(1.) Brief facts of the case reveal from the record are that petitioner has taken a family medi-claim insurance policy from the respondent-National Insurance Company Limited (hereinafter referred as the Insurance Company) in the year 1996 and the said policy was being continuously renewed and since 2002 it was effective for the period from 22nd Nov. to 21st Nov. of the next year. The policy covered a sum of Rs. Three Lac.

(2.) Initially, the policy was for the petitioner, his wife and two children. In 1998-99 his mother was also added. In 2007, the policy was split into two, one covering the petitioner and his mother and the other covering his wife and two children. Initially, the premium of Rs. 2825.00 was paid in 1996 which increased to Rs. 10,330.00 excluding service tax and family discount. A total amount of Rs. 20,885.00 was thus paid for the year 2007-08.

(3.) The petitioner was diagnosed of suffering Common Variable Immune Deficiency (CVID) with Pancytopenia (below normal blood counts) and Malabsorption Syndrome (absorption and assimilation of food is affected) and calcium metabolism dysfunction for which he was put on intravenous monthly infusion w.e.f. Sept., 2004 under hospitalization. Later on, he developed Hodgkin's Disease Stage IV (malignancy of lymphatic system) for which he undertook chemotherapy. He is under regular treatment and is required infusion every four to five weeks under hospitalization and was hospitalized in his own hospital namely; Dhuleshwar HospitalLaser Skin Centre. The National Insurance Company Ltd. Jaipur Branch, Jaipur was releasing the expenses under the medi-claim policy as per the limit.