ORIENTAL INSURANCE CO.LTD. Vs. M.J.VARKEY

JUDGEMENT

(1.) The appellant is the opposite party/insurance company in OP. No. 550/04 in the file of CDRF, Ernakulam. The appellant is under orders to pay the claim amount and cost of Rs.1000 to the complainant.

(2.) It is the case of the complainant is that he is having the medi -claim policy with the opposite party/appellant for about the last decade. His wife was suffering from sleep apnoea and was admitted at Medical Trust Hospital on 16.12.2003. The doctor concerned suggested that it is better to avoid surgical intervention and advised continuous Positive Airway Pressure Therapy. As advised by the doctor he purchased Continuous Positive Airway Pressure machine for a sum of Rs. 43,000/ -. The claim submitted was repudiated mentioning that the particular machine would not come within the scope of liability covered by the policy.

(3.) The opposite party/appellant had contended that the claim was referred to M/s. T.T.K. Health Care Services Private Limited for processing. But the claim was repudiated as the particular machine is not included in the list of permissible items.