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
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
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
rejected the claim that
his son Shubham Gupta was diagnosed as congenital heart disease,
which is excluded under the terms and conditions of the policy ... internal diseases fall under the exclusion clause. The heart
disease of the son of the complainant, who had taken the treatment
was congenital disease
stated
that he was not aware whether accused was having any congenital
disease when he examined him. He deposed that accused
diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy, Hernia, Hysrocoele, Interal congenital Defects/Diseases or Anomalies, fistula in Anus, Piles, Chronic Fissure in Anus, Pilonidal ... congenital Defects/diseases or Anomalies, Fistula in Anus, Piles, Chronic Fissure in Anus, Pilonidal Sinus, Sinusitis, Stone disease of any size, Benign Lumps/growths
Colour Doppler : (Done on 14.05.2011 at Escorts Heart
Centre, Raipur).
Impression : Congenital Heart Disease. Situs Solitus, Levocardia.
AV - VA concordance. Small restrictive perimembranous VSD
(size ... which
it is mentioned thus :-
// 33 //
"Final Impression :-
Acynotic Congenital Heart Disease.
S/P - AVR + Permimembranous VSD Closure.
S.D.S.
Normal Segmental Analysis
disease/defect, Fistula in anus, Piles, Sinusitis and related
disorders, galistones and renal stone removal are not payable.
If these diseases (other than congenital internal ... Insured is aware of the existence of the congenital
internal disease/defect before inception of the policy it will be
treated as Pre-existing
upon appellant/OP to show that child was suffering from pre-existing disease at the time of taking the policy.
10. It has also come ... substantiate its stand that the child was suffering from congenital disease or that his father was aware of the same, as was alleged
diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy, hermia, Hysrocoele, Internal Congenital Defects/Diseases or Anomalies, Fistula in Anus, Piles, Chronic Fissure in Anus. Pilonidal ... congenital Defects/Diseases or Anomalies. Fistula in Anus, Pilies Chronic Fissure in Anus, Pilonidal Sinus. Sinusitis Stone disease of any size, Benign Lumps/ growths
