P.D.MUNGEE vs New India Insurance Co.Ltd.

THIS is a complainant''s appeal against the order dated 2.9.1997 passed in Case No. 645/1993 by the District Consumer Disputes Redressal Forum, Bhopal (for short the ''District Forum'').

BRIEF facts giving rise to this appeal are thus that the appellant had taken four mediclaim hospitalization and domiciliary hospitalization benefit policies from the respondent No. 4 described as below : Policy No. 24501060001789 dated 28.12.1989 to 27.12.1990 No. 4945010600442 dated 4.1.1991 to 3.1.1992 No. 4945010600363 dated 31.1.1992 to 29.1.1993 No. 4945148400253 dated 30.1.1993 to 29.1.1994 The appellant on medical advice was operated for Prostrate Gland on 6.7.1992 and for that he was admitted in Amulya Hospital, E-3/15, Arera Colony and remained as an indoor patient from 6.7.1992 to 13.7.1992 under the treatment and care of Dr. S.L. Parulkar. The appellant claimed the amount of Rs. 9,579.35 paise, but, the claim was repudiated vide letter dated 15.2.1993 on the ground that the appellant''s claim was not covered for the first year. The complaint filed before the District Forum was resisted by the respondents. The District Forum held that under the exclusion Clause 2.1.13 the claim was not payable.

Having heard learned Counsel for the parties, we are of the opinion that in view of the exclusion clause though the policy was taken by the appellant from time to time but the mediclaim policy being a contract of one year which terminates on the expiry of the policy, and if a policy is taken thereafter, it is treated as a fresh contract. Therefore, in terms of the exclusion clause, the appellant was not entitled to claim. However, if the policy would have been renewed prior to the expiry of the policy then certainly the appellant would have been entitled to claim the benefits. In the present case, prior to expiry of policy the complainant did not renew his policy and after a gap of 27 days from the date of expiry of the policy obtained a fresh policy, therefore, the appellant was not entitled to claim the benefit in view of the exclusion clause. In the circumstances, there was no deficiency in service on the part of the respondents.

IN the result, the appeal fails and is dismissed with no order as to costs. A copy of this order be conveyed to the parties and a copy be sent to the District Forum alongwith the record of the case. Appeal dismissed.