The said reply was filed on 3rd March, 2011. A reply was filed to the complaint by respondent No.1 stating that appellant's claim was rightly rejected by respondent No.2 on the ground of nondisclosure of a preexisting disease as the treatment report of the appellant showed prior medication such as statins, which is a lipid lowering medicine. Being aggrieved, the appellant filed a complaint under Section 21 (9) of the Consumer Protection Act, 1986 (hereinafter referred to as "Act" for brevity) against the respondents, being Consumer Complaint No.92/2010 before the Commission. However, by its letter dated 9th April, 2010, respondent No.1 reiterated its repudiation of the claim made by the appellant.Ĩ. In this regard a representation was sent on 16th November, 2009. The appellant protested against the repudiation and requested his claim to be settled on a priority basis as the Medical Centre and the other centre in the USA where he had taken treatment had started pressing for release of payment. the bill raised by the Medical Centre for USD 2,29,719. The said repudiation was with regard to Bill No.1 i.e. 2 stating that his claim had been repudiated as the appellant had a history of hyperlipidaemia and diabetes and the policy did not cover perexisting conditions and complications arising therefrom. On 22nd August, 2009, appellant received a letter from respondent No. The same letter was also sent to respondent No. On 19th August, 2009, the appellant sent a letter annexing all bills in original as well as the discharge summary to the Divisional Manager of respondent No. Two and a half months thereafter, appellant started receiving bills from the cardio vascular wing of the Medical Centre and SFO Medical Centre towards the treatment he received at their facility. The appellant was discharged on 24th May, 2009.Ħ.
M/s Corris International sought certain documents regarding details of treatment given by the Medical Centre as well as details of the mediclaim policy for the purpose of considering the same for indemnifying the appellant. 1 and 2, which was to provide emergency assistance and claims administration services to the insured. In order to avail the benefit under the mediclaim policy, appellant's soninlaw contacted M/s Corris International, a foreign collaborator of respondent No. His wife got him admitted at the SFO Medical Centre at San Francisco airport and after he received initial medical treatment, he was shifted to the Mills Peninsula Medical Centre (hereinafter referred to as "Medical Centre" for the sake of brevity) where angioplasty was performed on the appellant on 19th May, 2009 and 22nd May and three stents were inserted to remove the blockage from the heart vessels.ĥ. On exiting the customs section at San Francisco airport, appellant felt weak and started sweating. from Delhi airport and reached San Francisco on the same day at around 2:00 p.m. Thereafter, the appellant boarded a flight to San Francisco, USA on 19th May, 2009 at around 1:00 a.m. The insurer thereafter accepted the proposal form and issued the Overseas Mediclaim Business and Holiday Policy bearing Policy Number 199/ 44/70000008 valid from 19th May, 2009 to 1st June, 2009, to the appellant.
The representative of the respondent insurer on receipt of the medical reports assured the appellant that on verification of the same the policy would be issued.Ĥ. Jitendra Jain, the doctor who examined the appellant had answered "normal" and "no" respectively. There was another query regarding any possible illness or disease for which the appellant may require medical treatment in the ensuing trip to the USA. In the medical exam report, a specific query was sought as to whether any abnormalities were observed in the electrocardiogram test of the appellant. No other adverse medical condition was found.ģ. On his medical examination, the report categorically noted that the appellant had diabetestype II (also known as diabetes mellitus). 1 insurance company prior to the consideration of his request for issuance of a mediclaim policy. The appellant was medically examined at the instance of respondent No. The facts in a nutshell are that the appellant had sought an overseas mediclaim policyB (hereinafter referred to as "mediclaim policy") as he intended to travel to the United States of America ("USA") to attend the wedding of his sisterinlaw's daughter. 92/2010 by which the complaint filed by the appellant was dismissed.Ģ. This appeal assails order dated 22nd May, 2015, passed by the National Consumer Disputes Redressal Commission (hereinafter referred to as "the Commission" for brevity) in Consumer Complaint No.