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
improve the blood clotting system. For the patient suffering from this congenital disease, surgery and subsequent treatment is only palliative in nature ... much delay with a complicated congenital heart problem. She was born with several deformities. Even after congenital heart disease was detected in August
findings confirmed the diagnosis of ostium secondum atrial septal
defect, a congenital heart disease.
Later on she was advised to get herself admitted ... birth and heart
disease would be internal disease which
cannot be seen by naked eye. The
insured was having internal heart disease right from birth
exclusion clause no. 4.4.6.2, which limits payment in case of congenital disease to only 10% of the average sum insured in the preceding four years ... urethral Dilation, excision of ureterocele done. Undoubtedly, UDT is a congenital disease as it usually forms at an early stage, may be at the time
also Clause 4.8 of Mediclaim prospects/policy that all congenital external diseases and defects are excluded from the scope of the policy.
3. Respondent filed ... Convalescence, General debility, "Run down" condition or rest cure, congenital external diseases or defects or anomalies, sterility, venereal diseases, intentional self-injury
mediclaim policy which precludes reimbursement of expenses
for congenital internal disease in the first year of the policy. On merits, it
was not denied that ... disease in question or suppression
of any material facts in this regard by the respondents. He contended that even
if a disease is congenital
suffering from diabetes, TB, high or low blood
pressure or any other disease. The insuree had taken only a few days leave for acute enteritis ... recovered.
He did not suffer from any permanent ailments or congenital disease and
there was also no nexus between the cause of his death
Cataract, Benign Prostatic Hypertrophy.
Hysterectomy for Menorrahagia or Fibromyoma, Hernia, Hydrocele, Congenital
Internal Disease, Fistula in anus, Piles, Sinusitis and related disorders are
not payable ... complainant was treated at the Escorts Hospital is
nothing but Congenital Heart Disease
(CHD) but the same was not disclosed in the proposal form
