NATIONAL INSURANCE CO LTD Vs. SARLABEN JAYANTIBHAI PATEL

JUDGEMENT

(1.) By this revision petition, we propose to dispose of above-noted revision petitions involving similar question of law and facts.

(2.) Briefly stated, facts relevant for the disposal of this revision petition are that Shri Jayanti Kumar Manibhai Patel obtained Hospitalization and Domiciliary Hospitalization Benefit Policy covering himself as well as his wife, namely, respondent/complainant Sarlaben Jayantibhai Patel on 15.4.2001. Shri Jayanti Kumar Manibhai Patel got the policy renewed from time to time without any break. In the year 2003 the respondent/complainant developed some problem in her legs and she was diagnosed Bilateral Osteoarthritis Knee (Left) for which she had to undergo total knee replacement (Left) at Ashirvad Hospital. She was admitted in the hospital on 28.2.2003 and discharged on 13.3.2003. However, her treatment continued till 16.4.2003. Complainant incurred total expense of Rs.2,50,000/- for her surgery, treatment and medicines. An insurance claim was filed but it was repudiated. Being aggrieved the complainant filed consumer complaint No.720/2006 in Anand District Consumer Disputes Redressal Forum.

(3.) Subsequent to the replacement of knee (Left) the complainant developed problem in her right knee for which she had to undergo knee replacement surgery (Right). For the said treatment she incurred total expense of Rs.2,87,793/-. An insurance claim in respect of the said surgery was also filed. The opposite party, however, repudiated the claim. Being aggrieved of repudiation of said claim complainant filed consumer complaint No.304/2008 at Anand District Consumer Disputes Redressal Forum.