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[3] Complainant submitted that on 06/06/2010 he was required to undergo Angiography in P.D.Hinduja Hospital and for that purpose he was required to spend Rs.31,303/-. Subsequently he had undergone Bypass surgery on 18/06/2010 and for that purpose he paid amount of Rs.3,67,378/- He also incurred amount of Rs.4979/- for post operation expenses. Thus he was required to make total expenditure of Rs.4,03,660/- for his illness. Complainant further submitted that on 29/01/2010 and 08/02/2010 his wife had undergone Cataract operation on her eyes. For that purpose he was required to make total expenditure of Rs.1,23,193/-. Complainant submitted that he had made insurance claim in respect of himself and his wife with opponent No.2. However, opponent No.2 had rejected both the claims on different grounds. Hence, complainant filed this complaint against opponents for getting total insurance claim of Rs.5,77,853/- from opponents alongwith interest on that amount alongwith costs and compensation. [4] Opponent No.1 contested complaint by filing their written version on record. They submitted that the contract of insurance policy was in between complainant and opponent No.2. Opponent No.1 had only taken insurance policy for complainant from opponent No.2. Opponent No.2 is liable to pay the insurance claim of complainant. They submitted that they have not given any deficiency in service to complainant and hence complaint filed against them be dismissed.

[5] Opponent No.2 contested complaint by filing their written version on record. They submitted that complainant had taken insurance policy from opponent No.2 and the same was for the period from 04/03/2010 to 4 (A/15/1205) 03/03/2011. The cataract operation of wife of complainant had taken place on 29/01/2010 and 08/02/2010. During this period complainant was not having insurance cover and hence complainant is not entitled to get this insurance claim from opponent. They also submitted that from medical papers of complainant it has become clear that complainant was having pre- disease of hypertension, diabetes, coronary artery etc. Because of these diseases he was required to undergo angiography. They submitted that if any disease is arising out of the pre-existing disease then for such disease policy is excluded for initial four years as per the terms and conditions of the policy at Sr.No.4.1. Hence, they submitted that complainant was not entitled to get insurance claim in respect of this disease for initial period of four years and hence Insurance Company had rightly repudiated the claim of complainant. Hence, they submitted that they have not given any deficiency in service to the complainant, hence complaint filed by complainant be dismissed.

[11] As per the insurance policy the insurance cover is given for the period 04/03/2010 to 03/03/2011. Cataract operation of wife of complainant had taken place on 29/01/2010 and 08/02/2010. Admittedly during this period complainant was not having insurance cover. Hence, complainant was not entitled to get insurance claim in respect of cataract operation of his wife. Ld.District Forum had rightly rejected claim of complainant in that respect. Complainant has not preferred any appeal against that order and accepted the same.

[12] On perusal of record it has become clear that complainant had to undergo angiography in Hinduja Hospital on 06/06/2010. Further he had to undergo by-pass surgery in the same hospital on 18/06/2010. He was required to make total expenditure of Rs.4,03,660/- for his illness. Complainant had made insurance claim in respect of this amount with opponent No.2. However, opponent No.2 has rejected the claim of complainant on the basis of terms and conditions of insurance policy at Sr.No.4.1. It is the contention of Ld.Advocate appearing for appellant/ opponent No.2 that complainant was known patient of hypertension since last 12 years, coronary artery disease inferior wall myocardial infarction since last 10 yrs and DM since 2 years. It is her contention that only because of this, complainant required to undergo angiography on 06/06/2010. It is her contention that if any disease had taken place because of old existing disease then insurance cover is excluded for the same for initial period of four years. For that purpose, she relied on the terms and conditions of 8 (A/15/1205) insurance policy at Sr.No.4.1. On perusal of medical papers of complainant it appears that he was suffering from hypertension and other diseases since last many years. However, there is no evidence on record that only because of pre-existing diseases complainant was required to undergo angiography on 06/06/2010. We are of the opinion that complainant was required to undergo angiography only because of this disease is required to be proved by the opponent No.2 as opponent No.2 has repudiated claim of complainant on this ground. However, opponent No.2 has not produced any evidence in that respect on record. Merely complainant was suffering from hypertension and other diseases, it cannot be presumed that he had to undergo angiography only because of pre-existing disease unless there is opinion given in that respect by consulting doctor of complainant. On the contrary, on perusal of medical papers of complainant it has become clear that he was not on continuous medication for this reason. It also appears probable that angiography of complainant may not be because of pre- existing disease of complainant. Looking to these facts of the case we are of the opinion that the rejection of the claim of complainant in this respect by the opponent No.2 is not proper. Hence, complainant is entitled to get the insurance claim in respect of his angiography. Accordingly the Ld.District Forum it appears that Ld.District Forum had directed the opponent No.2 to pay amount of Rs.4,03,660/- to the complainant in respect of his medical claim. We have already considered that the medical claim of wife of complainant cannot be given as during the period when she had undergone cataract operation medical claim was not available to the complainant. Amount of Rs.1,23,193/- is claimed by the complainant in respect of his cataract operation of his wife. Hence, complainant is not entitled to get this amount. However, the learned District Forum has directed opponent Nos.1 and 3 to give this amount to complainant. Opponent Nos.1 and 3 have not preferred any appeal against the order passed by the learned District Forum. Hence, we are of the opinion that the order passed by the learned District Forum against opponent No.2 to pay the amount of Rs.4,03,660/- to 9 (A/15/1205) complainant alongwith interest on that amount alongwith costs and compensation is legal and correct. Hence, appeal is to be dismissed. Hence, we proceed to pass the following order-