UNITED INDIA INSURANCE CO. LTD. Vs. SATISH AGGARWAL

JUDGEMENT

(1.) THE petitioner was the opposite party before the District Forum, where the respondent/complainant had filed a complaint alleging deficiency in service on the part of the petitioner.

(2.) UNDISPUTED facts of the case are that the respondent/complainant had obtained a Hospitalisation and Domiciliary Hospitalisation Benefit Policy valid for one year for the period from 4.8.1994 to 3.8.1995, which as per policy issued by the petitioner, clearly stated that the policy was a renewal of the policy taken earlier for the period 3.8.1993 to 2.8.1994. During the life of the policy, valid from 4.8.1994 to 3.8.1995, the respondent/complainant suffered from enlargement of the prostrate and was advised surgery for removal of the enlargement for which he was hospitalized and the surgery was carried out.When the respondent/complainant submitted a claim of Rs. 38,385 on 6.6.1995, it was repudiated on the ground that it was not admissible under exclusion Clause 2.1.13, which reads as follows:

(3.) IT is in these circumstances, a complaint was filed before the District Forum, which allowed the complaint and directed the petitioner to reimburse the claimed amount with interest @ 12% p.a. within 30 days along with cost of Rs. 2,000.