(1.) This appeal is by the complainant challenging the order of the DF dismissing his complaint. The facts in this case are as follows: the complainant is an employee of OP1. OP3 is the Insurance Company which has undertaken to reimburse the medical expenditure incurred for himself and his family members as per the terms and conditions of the policy. The wife of the complainant by name Smt. Bhagyalakshmi was suffering from severe abdominal pain and, therefore, approached K. K. Hospital for check-up on 12.6.2004. The doctor in the K. K. Hospital conducted certain tests and found the patient was pregnant. But since the wife of the complainant continue to suffer severe pain in the abdomen she was referred to Bhagwan Mahaveer Jain Hospital. In the said hospital, she was admitted as an in-patient from 12.6.2004 to 18.6.2004. In the Bhagwan Mahaveer Jain Hospital, it is found on examination, she has to undergo surgery for Ectopic Pregnancy. Accordingly, emergency Laparotomy was conducted. In respect of this, the complainant had spent a sum of Rs.30,000. Thereafter, the complainant made a claim with the Insurance Company for reimbursement of medical expenditure. The Insurance Company refused to reimburse the medical expenditure on the ground the policy obtained by the complainant specifically excludes the 3rd pregnancy. This has made the complainant to file the complaint before the DF.
(2.) The DF accepting the defence put forward by the Insurance Company dismissed the complaint. This order is under challenge by the complainant in this appeal.
(3.) It is not in dispute that the patient i. e. , the wife of the complainant had 2 children who were aged about 17 years and 14 years respect