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Showing contexts for: paranoid schizophrenia in National Insurance Company Limited ... vs P Venkateswara Hande Hyderabad on 9 June, 2013Matching Fragments
03.The second respondent again fell ill in the month of March, 2008 and she was admitted to Asha Hospital at Hyderabad on 19.03.2008 and she was discharged therefrom on 26.03.2008. She was diagnosed to have suffered from paranoid schizophrenia and stated to have incurred a sum of Rs.15,000/- towards hospitalization charges. The appellant no. 1 repudiated the claim on the premise that paranoid schizophrenia is excluded from the coverage of risk by the required terms of insurance policy. The respondents field complaint in CC No. 18/2011 before the District Forum which has been pending for disposal
08.The second appellant had not chosen to contest the claim.
09.In support of his claim the first respondent filed his affidavit and the documents, Ex. A-1 to A-11 and on behalf of the appellant- Insurance company its divisional manager filed his affidavit and Insurance policy, Ex. B-1
10.The District Forum has allowed the complaint on the premise that the appellant no. 1 issued renewed insurance policy and by virtue of the original terms of the policy, the appellants are liable to indemnify the respondents of the medical expenditure she had incurred for the treatment of Paranoid Schizophrenia. The District Forum awarded an amount of Rs.29,772/- along with interest @ 9% p.a. and Rs.3,000/- towards compensation and Rs.2,000/- towards costs.
12.The point for consideration is whether the order of the District Forum suffers from mis-appreciation of facts or law ?
13.The issuance of insurance policy bearing No. 551302/48/09/8500000907 in the year 2004 and it being renewed from year to year till 2010 without any break or interruption, the second respondent suffering from psychotic disorder viz., paranoid Schizophrenia and her undergoing treatment therefor as also settlement of the claim thereof, have not been under any dispute between the parties. The second respondent was hospitalized with the same illness i.e, Paranoid schizophrenia and she was treated as inpatient in Asha Hospital from 16.606.2010 to 28.06.2010.
18. The appellant honoured the claim for reimbursement of medical expenditure incurred for treatment of paranoid schizophrenia of the second respondent during subsistence of the renewed Mediclaim Insurance Policy. In the aforementioned decision, it was held that any modification of terms of insurance policy during its renewal made from time to time will not have application to the claim which has to be processed basing on the terms of the insurance policy issued for the first time. Thus, the appellant is estopped from contending that the disease and treatment thereof, viz. paranoid schizophrenia is excluded from the scope of risk by the revised terms of the insurance policy.