First Appeal No. A/10/610 (Arisen out of Order Dated 05/05/2010 in Case No. 41/2008 of District DCF, South Mumbai). Case: Madhav Chandu Kanchan Vs 1. New India Assurance Company Limited, Through Branch Manager, Mumbai, 2. T. T. K. Healthcare Services Private Limited, Mumbai. Maharashtra State Consumer Disputes Redressal Commission

Case NumberFirst Appeal No. A/10/610 (Arisen out of Order Dated 05/05/2010 in Case No. 41/2008 of District DCF, South Mumbai)
JudgesP. N. Kashalkar (Member) & S. P. Lale (Member)
IssueConsumer Law
Judgement DateFebruary 08, 2011
CourtMaharashtra State Consumer Disputes Redressal Commission


P. N. Kashalkar (Member)

  1. We heard appellant in person and Mr.Deepak Sharma, Advocate for the respondents.

  2. We are finding that this appeal has been filed by the original complainant whose complaint was dismissed by the District Consumer Disputes Redressal Forum, South Mumbai by order dated 05/05/2010.

  3. There is delay of 18 days in filing this appeal for which condonation of delay application No.315/2010 has been filed. Just and sufficient cause has been made out in the condonation of delay application which is supported by the affidavit. Since, it is the appeal filed by the complainant himself, we do not want to impose cost while allowing the condonation of delay application preferred by the appellant. We allow the condonation of delay application and condone the delay to decide the appeal on merits.

  4. The appellant had taken mediclaim policy in the year 2001. He had renewed the medi-claim policy every year. The assured sum was 1 Lakh. It was Hospitalization and Domiciliary Hospitalization Benefit Policy. Besides amount assured, the complainant was to receive cumulative bonus of 25,000/-, if in case he does not claim any medi-claim in any year. For every year 5,000/- was payable. The sum assured was 1 Lakh and cumulative bonus was 25,000/- [@ 5,000/- for each year for which he had not claimed any medi-claim]. It so happened that in February 2007 he had approached Dr.Dilip Patil, who took ECG and Dr.Dilip Patil then found some difficult situation and therefore, he suggested that the complainant should get done Echo 2D Test. Accordingly said test was undergone by the complainant in Wockhardt Hospital, who after conducting the test suggested the complainant to do Angiography. Accordingly, on 11/06/2007 he got admitted in P.D. Hinduja National Hospital where he had done Angiography at the hands of Dr.Chandrashekhar Ponde. After discharge from the said hospital, he lodged medi-claim for the amount of 26,148/- with the respondent/Insurance Company. Respondent/Insurance Company after considering the papers submitted by the appellant repudiated the claim on the ground that the claim was for pre-existing disease. Respondent informed the appellant that appellant was having Hyper Tension for the last 20 years and therefore, when he purchased mediclaim policy, he was already having disease of Hyper Tension and heart ailment for which he had got done Angiography in P.D. Hinduja Hospital on 12/06/2007. Angiography of the Coronary...

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