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
liable to pay for
convalescence, general debility, rest cure, congenital diseases or defects or
anomalies. The Insurance Company has contended that the ailment for which ... insurance policy, which stated that
"Convalescence, general debility, rest cure, congenital diseases or defects or
anomalies of the insurance policy being ailment of congenital
suspected case of congenital heart disease or acute myocarditis and the corrective surgery could not be done being risky and the baby succumbed ... they failed to diagnose that he was actually suffering from the disease-congenital cyanotic heart, as a result whereof, he died, as he could
insured person in
connection with or in respect of Congenital diseases (Internal and
External). The District Commission has grossly erred while
travelling beyond the terms ... External)"
Clause 3.6 on Congenital Anomaly also is placed in
verbatim:
"3.6 CONGENITAL ANOMALY
Congenital Anomaly refers to a condition(s) which
Cataract, Benign Prostatic Hypertrophy,
Hysterectomy for Menorrhagia or Fibromyoma, Hernia Hydrocele, Congenital
Internal Disease, Fistula in Anus, Piles, Sinusitis and related disorders, Gall
Bladder Stone ... Family Medicare Policy, the expenses incurred on the treatment of
Congenital Internal diseases is not payable.
10. The basic question to be decided is, whether
Nandakumar has certified that the applicant is free from all
congenital diseases and or deformities. Dr. Shankar K.N.,
CMO, Bowring & Lady Curzon Hospitals
first two children were delivered and expired
due to prematurity and congenital problems. Thereafter, a female child was
born to the petitioner during February ... Paranthaman is
suffering from “EPIDEMOLYSIS BULLOSA SIMPLEX” throughout body,
a congenital disease of the skin-generalised bullous eruption of the whole
body, purulent haemorrhagic blisters
Annexure-I.
(iv) As the Colour Blindness is a congenital disease, to
obviate the induction of colour blind personnel in CAPFs &
Assam Rifles
Surgery has been contemplated. Sub-
clause (c) provides “Correction of all Congenital Heart Diseases”.
Therefore, wherever the treatments are taken for congenital heart diseases ... broadly
falling under the approved treatment of “Correction of all Congenital Heart
Diseases”. When it is falling under the list of treatments provided under
second respondent was
not medically fit as he was suffering from congenital heart
disease.
3
3. On the other hand, learned counsel appearing ... India
on the ground that the petitioner was found to have congenital heart disease.
8. The petitioner is now over 56 years of age. That
