| Address: Ernakulam, Kerala, 6820505 |
Complainant m. J. Martin mulerikkal house narakkal p. O. Ernakulam
Is the claimant in policy number 761000340162800000470 of the new india issurance co. Limited. Raman centre, iind foor, valanjambalam, ernakulam -682 016
1. The claim of the complainant is rejected by the opposite party as per order dated 10.03.2017.
2. The complainant joined the opposite parties family health insurance scheme on 16.10.2015. The period of the scheme was 16.10.2015 to 15/10/2016. The complainant taken the policy for the health covering to his family which includes wife and his three children’s with him. Total sum insured for the policy is rs. 2, 00, 000/-. He paid the premium amount for one year on 14/10/2015. From 16/10/2015 to 15/10/2016, the opposite party is liable to protect the insurer as per the conditions.
3. It is submitted that, while taking the policy the agent promise that, if the insured person during the period of insurance, incurs hospitalization expenses which are reasonable and customary and medically necessary for treatment of any illness or injury sustaining in accident, the opposite party will reimburse, such expense incurred by the claimant.
Believing the assurance of the company the petitioner taken the medical claim for his whole family. Thereafter on 22.01.2017, wife of the respondent is admitted in medical trust hospital, she was a 39 years old lady, who is suffered from hypothyroidism and bronchial asthma patient. She was admitted in the hospital with the complaints of multiple joint pain. Consulting doctor directed her for born scan. And the same was done on 23.01.17, bill of the whole body scan and details of the same is producedthere after she was discharged on 24.1.2017. The discharge summary was produced.. And the hospital bill was produced. The total bill incurred is rs. 18, 016/- (Eighteen thousand and sixteen rupees) but the claim of the complainant is rejected by the respondent stating thet as per clause 4.4.11 “ charged incurred at hospital primary for diagnosis, x-ray or laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive existence or presence of any illness or injury for which confinement is required at hospital will not come under the policy Was this information helpful? | 
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