SHANO WADHAWAN Vs. NATIONAL INSURANCE COMPANY LTD

JUDGEMENT

(1.) The present appeal has been filed assailing the order of District Forum-VI, Kasturba Gandhi Marg, New Delhi dated 1.6.1999, passed in Complaint Case No.515/97 entitled Ms. Shano Wadhawan V/s. National Insurance Company Limited.

(2.) The relevant facts, in brief, are that the appellant had filed a complaint under Sec.12 of the Consumer Protection Act, 1986 (hereinafter referred to as the 'act'), before the District Forum with the grievance that the respondent had wrongly repudiated the mediclaim of the appellant on the ground that the disease for which the treatment was taken by the appellant was pre-existing disease.

(3.) The appellant was a joint holder of 1000 units of the GIC Growth Plus II Scheme of the respondent having the Face Value of Rs.10,000/-. In terms of the said scheme, the appellant was entitled to Medical Insurance Cover for the reimbursement of pre-hospitalization and post-hospitalization expenses to the extent of 3 times the amount of investment per annum subject to an upper limit of Rs.1,50,000/-. The appellant was admitted in Holy Family Hospital, New Delhi for the treatment of acute pain and swelling in the knee joint of both the legs on 13.3.1996 and was discharged on 16.3.1996. Thereafter, the appellant submitted her claim for the reimbursement of the expenses incurred in respect of the hospitalization and treatment incurred, i. e. Rs.5,294.95. However, the said claim of the appellant was repudiated on the ground that the disease for which the treatment was undertaken by the appellant was pre-existing. The appellant, therefore, filed a complaint before the District Forum praying for directions to the respondent to reimburse the amount of Rs.5,294.95 together with interest @ 18% p. a. w. e. f.26.3.1996 alongwith compensation and costs.