Thiru Justice A. Raman, President—The complaint relates to a mediclaim. The mediclaim was for a period from 30.3.1995 to 29.3.1996. The complainant claimed a sum of Rs. 28,362/- towards the treatment cost met by him for his wife who was treated at Apollo Hospital for Gall Stones Disease. She was admitted in the hospital on 21.1.1996 and was discharged on 24.1.1996. Their main contention is that it was a pre-existing disease and, therefore, the exclusion clause would apply. According to the opposite party, the complainant’s wife had history of illness for two years duration and she was having progressive pain for over two years and she was admitted as an inpatient with a known case of ‘Symptomatic cholelithiasis’. Therefore, on the basis of exclusive clause, the claim was repudiated.

2. Ex. B2 is the xerox copy of the discharge summary. The diagnosis shows that it was a Gall Stone Disease. The operation done was ‘Laparoscopic Cholecystectomy’. It is noted that the patient had a history of abdominal pain especially in the right upper quadrant 2 years duration, colicky in nature, sometimes associated with fever and rigors. They have also mentioned it that she was a known case of ‘