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        The Apex Commission further observed" In hindsight, every one realizes much later that the symptoms were indicative of a disease. But common people are not at all familiar with the medical knowledge and so they cannot diagnose their own diseases. If they were expected to be so aware of their medical condition at all times, there would be no use of insurance policies":

15.    Another point strenuously urged upon is that the complainant's son was admitted in the cosmetic surgery, Unit of Apollo Hospital, Chennai which is clearly mentioned in the discharge summary dated 27.12.2000. It is argued that as per exclusion clause 4.5 of  the contract  of insurance, the appellant insurance-company is not liable to make any payment in respect of any expenses whatsoever incurred by any insured person in connection with or in respect of any cosmetic surgery or aesthetic treatment unless the same is necessary for treatment of a disease not excluded therein. In the instant case , according to appellant, the complainant's son was admitted in the cosmetic surgery Unit  of the hospital and the operation performed  was liposuction with excisions. In support of this submission, the appellant has  relied upon the opinion of its panel doctor Mr. Utpal Sharma , who stated that the operation conducted on the patient has got two parts i.e. liposuction, which means consmetic removal of fats  ferment area and excisions, which means cutting of a part of an organ and the said operation involves consmetic surgery and  in absence of any of the complications in Gynaecomastia as mentioned in clause 4.5, the claim would not be payable and for this reason the claim was repudiated. The learned District Forum, as argued  by the appellant, gave no finding or justification as to why the repudiation in question is not maintainable. 

Age of the patient               : 23 years
 

Date of Admission                : 26.12.2000
 

Date of surgery                   : 26.12.2000
 

Date of discharge                        : 27.12.2000
 

Diagnosis & findings             : Bilateral Gynaecomastia
 

Operation performed           : Liposuction with excision
 

Surgeon                             : Dr. R. Murugesan
 

Anaestietist                         : Dr. Raghavendar 
 

Sd/                                        APOLLO HOSPITALS 
 

Dr.R.Murugesan        21, Greams Lane, Chennai-600006
 

                                Phone 8293333, 8280200"
 

 
18.    The insured Vikram Singhania was unmistakably diagnosed as having suffered from Bilateral Gynaecomastia. He was, therefore, operated upon by way of liposuction with excision. The insured was mainly suffering from Gynaecomastia and the operation was conducted to cure the said disease. No doubt, the insured was admitted in the cosmetic surgery unit of the hospital, but the discharge summary does not mention that a cosmetic surgery was conducted on the insured. Even assuming that cosmetic surgery was done, there is no material on record that the  cosmetic surgery was done primarily for the purpose of cosmetic or aesthetic treatment. The primary treatment given to the insured  was for Gynaecomastia. The surgeon in Apollo hospital sought to cure the disease by conducting liposuction with excision operation under G.A.