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Showing contexts for: Inoculate in The New India Assurance Company Ltd. vs Smt. Vibha Yadav And Another on 22 September, 2022Matching Fragments
14. For the foregoing reasons, we are of the definite opinion that the District Commission, Haridwar is fully empowered to hear the complaint case of the respondent No. 1 - complainant.
15. The second question of consideration is before us whether there had been any violation / breach of any term and condition of the policy and the treatment of the complainant's son does not cover within the terms and conditions of the insurance policy.
16. The learned counsel for the appellant has contended that the learned Commission below has failed to consider that the injection, which was given to the son of respondent No. 1 - complainant was for the hormone growth and said treatment was not covered under the policy. Whereas the rival argument submitted by the respondent No. 1 - complainant is that the complainant's son was suffering from the disease, which does not come with the terms "Vaccination & Inoculation" of the policy.
17. We have perused the terms and conditions of the policy. These terms and conditions of the policy were neither submitted by the appellant company before the District Commission, nor such policy terms and conditions were supported and proved by the affidavit of the authorised officer of the company stating that these terms and conditions are still in existence in respect of the policy issued to the respondent No. 1 - complainant and these terms and conditions are presently applicable to the case of the respondent No. 1 - complainant. Nothing is available on record that the above mentioned policy terms and conditions regarding vaccination and inoculation were sent to the policy holder alongwith the policy. The Appeal No. 96 of The New India Assurance Co. Ltd. 22.09.2022 2016 Vs. Smt. Vibha Yadav respondent No. 1 - complainant has submitted the terms and conditions obtained with the mediclaim policy in the year of 2006-07 and 2012-13 wherein the signature alongwith seal is available at the bottom and these terms and conditions are in sequence without any gap, whereas the terms and conditions filed by the Insurance Company (paper No. 53 to 66) do not contain any seal and signature of the authorised signatory of the Insurance Company; these terms and conditions are not in sequence. Such facts create a doubt whether these terms and conditions are, indeed in existence.
In this case, the respondent No. 1 - complainant's son was under the treatment of Dr. S.K. Wangnoo, a senior consultant Endocrinology of Indraprastha Apollo Hospital, New Delhi.
19. The learned counsel has not argued that the abovementioned cited judgment was set aside by the Hon'ble National Commission or by the Hon'ble Apex Court. Thus, it is proved that the judgment above has become final.
20. In this case, the same respondent No. 1 - complainant, as mentioned in the above cited case, has brought the complaint against the repudiation order of the insurance company whereby the claim of the insured (i.e. respondent No. 1 - complainant's son Master Abhinav Yadav) was rejected under the exclusion clause 9.3 (Vaccination and Inoculation) of the policy. In the case in hand, the insured (claimant's son) fell ill on the relevant dates, i.e. 28.03.2013 to 29.03.2013 and was taken to Hospital, where he was under the treatment of Dr. S.K. Wangnoo, a senior doctor / consultant of Indraprastha Apollo Hospital, New Delhi.
22. In such circumstances, we are of the view that the exclusion clause 9.3 shall not be applicable because the document filed by the respondent No. 1- complainant has clearly depicted that Master Abhinav Yadav was suffering from growth hormone deficiency disease and NORDITROPIN was prescribed for his medication for growth hormone deficiency in order to maintain the survival and overall future well-being of the patient. As per the above certificate of Dr. S.K. Wangnoo NORDITROPIN is not a vaccination or inoculation, because the doctor Dr. S.K. Wangnoo (who was giving treatment to Master Abhinav Yadav, respondent No. 1 - complainant's son since 2006) has clearly certified that NORDITROPIN is not a vaccine or a booster dose of any vaccination. Hence, the mediclaim of the complainant is not covered within the exclusion clause of the policy.