policy. Clause
4.1 of Ext.P1 policy shows that all congenital diseases
W.P.(C) No.33846/10
: 2 :
(internal and external) are excluded ... records show that the disease of the
petitioner was a congenital disease, the respondents cannot
be faulted for the view they have taken
below:-
"The District Forum while interpreting the congenital heart defect or congenital heart disease has not distinguished the words congenital heart defect ... commission. It is not possible to meaningfully distinguish between congenital heart defect and congenital heart disease. A defect at birth would manifest itself sooner
ground that the claimant had a pre-existing
congenital disease, which was not disclosed, while taking the policy in
question. The claim of the complainant ... complainant had
a congenital problem. It is, however, to
be determined whether this problem could be described as congenital internal
disease
panel doctor the disease suffered by you is a manifestation of congenital disease which is not covered as per exclusion no. 4.3 of the policy ... complainant was rightly repudiated because the disease suffered by him was congenital disease, which is not covered for indemnification as per Exclusion Clause
certificate further reflects that the
petitioner is suffering disability due to congenital disease,
meaning thereby that disability of petitioner is the result of a
disease ... case of the
petitioner, admittedly, she was suffering from a congenital
disease right from her birth which had taken place in the year
heart beat of the child or there was past history of congenital heart
disease in the mother - father of the child or in foetal hydrops ... addition
to considerable infant morbidity in developed countries. Prenatal
diagnosis of congenital disease provides information for decisions
during pregnancy and appropriate treatment perinatally (timed
delivery
Institute and Research Center
Limited, Okhla Road, New Delh due to congenital heart disease on
09.03.2022 and discharged on 19.03.2022. After the treatment ... year Male, was
admitted in Fortis Hospital for treatment of congenital heart disease
which required Aortic Valve replacement. It was found that
amount. But they refused as his son was suffering from congenital
disease and his case fell under the exclusion clause of the policy ... above said policy was different from the Medi Guard policy and
congenital disease was falling under exclusion clause 4.1 of the
Individual Health Insurance policy
decide
the appeal as follows:
The patient was suffering from congenital disease viz. VSD. The fact that the
patient had the congenital disease ... unfortunately, the complainant's son, who was
suffering from congenital disease, lost his life, for which the 1st opposite party cannot be
blamed. Without
disease mentioned
on the pre-authorization letter of hospital was external congenital
disease, it is not covered under the insurance policy in hand and
cashless ... this disease, that the cause of disease is unknown. Before the use
of radiographs, Perthes disease was hidden under the gambit of
tuberculousis disease. Early
