THOMAS AUGUSTINE Vs. UNITED INDIA INSURANCE COMPANY LIMITED

JUDGEMENT

(1.) ACCEPTING the case of the insurance company in OP 245/04 on the file of the Consumer Disputes Redressal Forum, Ernakulam that the policy under which the mediclaim was made by the appellant was a fresh policy and the exclusion clause applied to the facts of the case the lower Forum dismissed the complaint filed by the appellant/complainant. He filed the complaint seeking redressal of his grievance against the repudiation of the claim made by him, the respondent herein. Aggrieved by the order passed by the Forum below dismissing his complaint the complainant filed this appeal.

(2.) AFTER hearing the learned Counsel for the appellant on the question whether the appeal is to be admitted or not we are of the view no ground is prima facie made out to admit the appeal.

(3.) THE claim of the appellant was repudiated by the insurance company on the ground that the policy issued for the period 7.3.2003 to 6.3.2004 was a fresh policy and the exclusion clause is applicable on the ground that the treatment for multiple fibroid uterus was undergone by the wife of complainant in the first year. In Ex. A3 produced by the appellant before the lower Forum the reason for repudiation of the mediclaim is stated and the reason given is that though the policy is seen incepted in 1992 a break is seen in the policy i.e., 3.11.2002 to 7.3.2003 (gap of three months) and hence the current policy being a fresh one, the first year s exclusion is applicable. Fibroid uterus falls under the first year exclusion as per the policy condition. Contention of appellant is that the policy covering the period 7.3.2003 to 6.3.2004 is not a fresh policy was contended by the insurance company and it is a renewal or continuation of the earlier policy taken by him for the period 4.12.2001 to 3.12.2002.