Insured availed indemnity under 1st mediclaim cover-obtained subsequent mediclaim cover with enhanced amount-second cover amounted o renewal of old mediclaim policy:

The insured had taken a mediclaim policy with the above insurer for a sum of Rs.55000/- for the period 1-7-98 to 30-6-99 and the insured availed of indemnity under the said policy in respect of the angioplasty undergone by him during November and December 1998. The insured again took a mediclaim policy in January 1999 for Rs.2.5 lacs in which it was duly disclosed the ailment of heart and angioplasty having been undergone under the previous policy. Inspite of this fact the insurer issued a new policy for Rs.2.5 lacs. The
insured thereafter had undergone angiography and bye-pass surgery in April 1999 and he remained hospitalized between 17-4-99 to 26-4-99. It was this operation which resulted into submission of the claim in question to the insurer. The insurer repudiated the claim on the ground of exclusion clause being operative. The insured filed a complaint with the district forum which allowed the same with an order directing the insurer to pay Rs.151845/- to the insured/complainant. The insurer preferred a appeal against the order with the state commission. The said exclusion clause read: “all diseases, injuries which are preexisting when the cover incepts for the first time”. It was submitted that the new policy for Rs.2.5 lacs taken by the insured was fresh policy and therefore the pre-existing ailment of heart was excluded. The court observed that at least to the extent of Rs.55000/- for which insured already had cover, the second cover amounted to the renewal of the mediclaim policy or it can well be said that the cover did not incept for the first time to that extent.

Held: The court directed the insurer to pay the complainant Rs.55000/- with interest @10% p.a. with costs Rs.1250/- within 8 weeks of the order.