The exclusionary clause in the MED-I-CLAIM policy does not exclude liability for pre-existing diseases.

Mr. Justice S.S. Sandhawalia, J.—The true import of the first exclusionary clause of Hospitalisation and Domiciliary Hospitalisation Benefit Policy (MED-I-CLAIM) of the National Insurance Company Limited is the solitary but very significant question in this appeal.

2. The respondent Dr. R.K. Keswani is a distinguished professional who retired as the Professor and Head of the Department of Surgery and Director of Medical College Rohtak. He took out a Hospitalisation and Domiciliary Hospitalisation Benefit Policy of the appellant company for a period of one year from the 6th of March, 1990 to the 5th of March, 1991. In the original proposal from Dr. Keswani with total candour expressly and prominently mentioned that he was a chronic patient of Ischemic Heart Disease from 1969 to 1990 and had received treatment from Dr. S.C. Sachdeva, Professor of Medical College, Rohtak and was not fully cured of the same. The proposal form of the complainat-respondent was accepted and he made a payment of Rs. 1,350/- as the annual premium which was duly received and the relevant policy issued in his favour.

3. After more than four months of the commencement of the said policy Dr. Keswani developed prostrate gland trouble and on consulting a medical expert, he was advised that he should first take remedial action for his heart ailment. Accordingly for diagnostic purposes he got himself admitted in All India Institute of Medical Sciences, New Delhi on 30th of July, 1990 and was discharged on the following day with the advice that a Coronary By-pass Surgery was necessitated in his case. Consequently he later entered as an indoor patient in the aforesaid Institution at New Delhi on the 7th of September, 1990 and was operated for Coronary By-pass Surgery at his own expense and after convalesce was discharged from the said hospital. However, for his prostrate gland he again entered the said Institution on the 6th of October, 1990 and was operated on the 12th of that month and discharged thereafter on the 17th of October, 1990. There is no dispute that he had to personally bear all the expenses for the aforementioned hospitalisation as an indoor patient and he submitted three bills to the appellant company for reimbursement being Annexures ‘B’ ‘C and ‘D’ to the tune of Rs. 3520-45P, Rs. 25.790-38P and Rs. 7351-88P totalling a sum of Rs. 36,662-7IP. Far from considering or settling the said claim the appellant Company brusquely brushed them aside. This stand was purported to be taken on the ground that by virtue of the exclusionary Clause No. 1 of the Policy, there was no liability on the Company for the treatment of any pre-existing disease prior to the date of the policy. It was the appellant Company’s case that since on his own showing Dr. Keswani was a patient of heart disease since 1969, no medical expenses for the treatment thereof were payable. The complainant inevitably remonstrated with senior officials of the Company that the stand taken on its behalf was not correct, but repeated protestations to that effect were of no avail. Even as regards his second claim of expenses for the operation for the prostrate gland, the appellant Company instead of entertaining the same issued a letter dated the 31st of October, 1990 intimating that they had unilaterly cancelled the policy with immediate effect and as such no further claims could be entertained or sanctioned.

4. Driven to the wall Dr. Keswani then knocked at the door of the District Forum, Hisar for redress. The primal relief sought was the reimbursement of the medical expenses and the setting aside of the letter denying liability and the subsequent total cancellation of the policy. The complaint was supported by a host of unchallenged documents containing the opinion and advice of the medical experts and the bills paid in the All India Institute of Medical Sciences, New Delhi, as also the communications of the appellant company repudiating their liability. On notice being issued to the appell