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i) to release the balance claim amount of Rs.1,60,000/-

along with interest @18% per annum; and

ii) any other relief which the complainant may found to be entitled in law for causing mental torture and agony.

3. Upon notice, opposite party appeared and filed their written reply taking preliminary objection that the complaint is not maintainable and is bad for non-joinder of the necessary party and there is no deficiency in service on the part of the opposite party. It is further pleaded that as per the policy conditions, if the complainant is not satisfied with the decision of the Insurance Company then he has right to appeal to the Regional Office of the Insurance Company or the Grievance Cell of the head office of the Insurance Company or the Ombudsman appointed by the Central Government. The claim of the claimant is not covered under the purview of exclusion clause 4.5 of OBC-Mediclaim Insurance Policy and according to that the claim of the complainant was not payable and the complainant was duly informed qua the same. It is admitted that the policy No.233902/48/2016/2720, valid for the period 27.08.2015 to 26.08.2016, which was issued to the complainant-Amarjit Singh, Smt. Kawaljit Kaur and Harmandeep Singh but the same was issued, subject to the terms and conditions of the policy. It is further pleaded that as per the claim document and other medical record, it was observed by Medi Assist India Pvt. Ltd. that as per the discharge summary the insured is admitted for treatment of High Myopia with Astigmatism (Refractive error). The treatment of refractive error is actually considered as correction of eye sight for cosmetic purpose as per the policy guidelines, which is excluded under clause 4.5 of the policy and accordingly the claim was denied.

7. The appellant/opposite party filed its written arguments as well as orally submitted that as per the discharge summary of the patient, he was diagnosed with High Myopia with Astigmatism, which is an eye sight problem and not a disease. He further referred that as per the clause 4.5, such type of eye treatment is excluded from coverage of the policy. He further pleaded that as per surgery i.e. TICL (which stands for Toric Implantable Collamer Lens), which is a surgery for correction of nearsightedness (Myopia) and astigmatism is not covered under the policy terms and conditions but these facts are not taken into consideration by the District Commission and it wrongly allowed the complaint on the irrelevant pleas taken by the respondent/complainant.

11. As per the above mentioned discharge summary, it is clear that Harmandeep Singh i.e. son of the respondent/complainant was operated upon for his eyes when he was diagnosed with High Myopia with Astigmatism, whereas learned counsel for the appellant/opposite party laid much stress upon the fact that this type of surgery is not covered under the policy as per clause 4.5. However, the perusal of the above said clause 4.5 reveals that there is no such bar that the disease like High Myopia with Astigmatism is not covered under the policy. On the other hand, in the medical terms, the definition of High Myopia with Astigmatism is defined as under:

"High myopia with astigmatism is a combination of two eye conditions that can cause blurred vision and make it difficult to see:
• Myopia Also known as nearsightedness, myopia occurs when the eyes are too long and images are focused in front of the retina, resulting in blurry distance vision. High myopia is when a patient has more than 6 diopters of myopia. • Astigmatism Causes blurry vision at all distances. Astigmatism and myopia can occur together in one eye, and this combination can make vision even more complicated.