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from O.P.nos.1&2.  She had supplied all the papers asked for by O.P.nos.1&2 but vide letter dated 30/11/2007, O.P.no.1 repudiated her claim on the ground that complainant was suffering from COPD/Bronchial Asthma since last 30 years.  She had not disclosed her ailment of Bronchial Asthma in her proposal form.  Therefore, as per exclusion clause no.4.1 since the said ailment was pre-existing ailment or complications arising out of pre-existing ailment, they expressed their inability to reimburse her medical hospital charges. According to her when she was taken to Holy Family Hospital, attending doctor recorded questionnaire from her daughter and mistakenly her daughter had disclosed that the patient was suffering from  Bronchial Asthma for last 30 years.  Her daughter then addressed a letter dated 06/8/2007 to the O.Ps stating that complainant was never suffering from Asthama and any wrong information given by her should be overlooked.

Complainant pleaded that she was never suffering from COPD/Bronchial Asthma for the last 30 years.  She pleaded that because of repudiation letter she has suffered mental stress and agony at this old age.  She is still under treatment and medicines and she needs complete rest.  She brought this fact to the notice of O.Ps but O.Ps behaved with her in most callous manner and refused her claim.  She therefore alleges that O.Ps are guilty of neglect and deficiency in service and, therefore, O.Ps are bound to pay her a sum of `1,43,622/-

as hospital expenses and she lodged a claim with the Insurance company in terms of mediclaim policy issued by the O.Ps. The claim was repudiated by O.P.no.2 on behalf of O.P.no.1 on the ground that she was suffering from COPD/Bronchial Asthma for the last 30 years and also from Hypertension and Diabetes Mellitus since 10 years as per discharge card issued by Holy Family Hospital, Bandra and, therefore, relying upon clause 4.1 of the policy, Insurance company repudiated the claim since the ailment of Sleep Apnoea was the complication arising out of COPD or Bronchial Asthma, which was pre-existing disease of the complainant.

We are finding that the Insurance company had rightly repudiated the claim for the simple reason that the complainant was admitted in Holy Family Hospital for the alleged ailment of Sleep Apnoea syndrome with Respiratory failure during the fifth year of policy and the documents submitted by the patient like discharge card suggested that she was suffering from COPD/Bronchial Asthma for the last 30 years and also from Hypertension and Diabetes Mellitus since 10 years and according to Insurance company Sleep Apnoea syndrome with Respiratory failure was the direct complication of her ailment of  COPD/Bronchial Asthma.  Therefore, in our view the Insurance company/O.P. herein had rightly repudiated the claim of the complainant and we are finding no substance in the complaint lodged by the complainant.  It is pertinent to note that the information about her ailment was given to the hospital by the complainants own daughter and her daughter by way of damage control exercise wrote letter to the Insurance company saying that she was not aware of the mothers ailment.  She was not a doctor and she had miscommunicated about the ailment of her mother to Holy Family Hospital.  This was clearly an after thought.