Mrs. Silpi Majumder, Member—This appeal has been directed by the Appellant/Complainant against the judgment passed by the learned District Forum, Unit-II, Kolkata, on 23.6.2010 in the case No.67/2009, whereby the learned Forum was pleased to dismiss the complaint on contest without any cost.

2. The brief fact of the case of the Complainant is that he purchased Hospitalization and Domiciliary and Hospitalization Benefit-Individual mediclaim policy which was valid from 8.11.2003 to 7.11.2004 from the OPs for himself, his wife and two minor sons on payment of requisite premium. The said policy was renewed annually on payment of premium and lastly it was renewed for the period from 8.11.2008 to 7.11.2009. On 11.2.2004 the Complainant underwent a lapchole surgical procedure for removal of gallstone at Woodlands Hospitals and Medical Research Centre, Kolkata. The Complainant claimed reimbursement of medical expenses incurred by him towards the lapchole surgical procedure at Woodlands Hospital. Sometime after undergoing the Lapchole surgical procedure the Complainant developed pain in his left leg and underwent treatment. Having ailed to get substantial relief in his leg-back pain ailment the Complainant approached a Neuro Surgeon of the Apollo Gleleagles Hospitals at Kolkata on 18.4.2004. On his advice the Complainant got admitted in the said hospital on 18.4.2004. After various diagnostic tests and several investigations Dr. Ghosh of the Apollo Hospitals opined that the complainant’s case is a cardiac one, he referred the Complainant to Dr.Aftab Khan, a consultant cardiologist of the said hospital. The complainant states that even at the discharge summary issued by the said hospitals the complainant was advised post discharge follow-up with Dr. Ghosh. At the time of discharge from the Apollo Hospitals the complainant was prescribed some injections and medicines along with pain killer medicine. Soon after his discharge from the said hospital the Complainant lodged a claim for reimbursement of medical expenses for a sum of Rs. 26,393 with the OPs. But the TPA repudiated the claim of the Complainant through the letter dated 17.11.2004. As per the repudiation letter the claim was rejected on the following grounds:

“it is the opinion of the claims adjudication department and the doctors, that due to the underlines reasons your claim has been adjudicated to be ‘No Claim’ in nature and thus not payable under the rules guiding the policy. This is a first year policy (5 months), but the patient had history of low back pain for the last six months. This means that the symptoms were definitely pre-existing and the claim is not payable.”

3. Being aggrieved by the repudiation of his claim the Complainant requested TPA to review the matter through a letter dated 10.12,2004, but the TPA vide its letter dated 30.12.2004 stuck to his earlier decision of repudiation. The Complainant recovered and resumed his normal work towards the end of the year 2004 and was leading normal life till November 2006. But all of a sudden on November 2006 he was having back pain. After initial treatment by his personal physician he was referred to Dr. Debasis Chakrobarty a specialist Neurologist of Kolkata. Dr. Chakrobarty suggested certain steps including MRI of brain and as there was no satisfactory response to his treatment he was recommended admission in AMRI Hospital under his care. In order to avoid admission to the Hospital the Complainant again reverted back to his family physician who after some treatment advised admission to Bellevue Clinic and the Complainant was admitted to Bellevue Clinic on 21.3.2007 under the care of Dr. Prokash Sancheti and was discharged therefrom on 1.4.2007. The Complainant submitted a claim for reimbursement of the Bellevue Clinic’s bill aggregating to Rs.1,04,153 which was registered by the Insurance Company. The TPA issuing a letter dated 12.9.2007 asked the Complainant to submit the original money receipt of Bellevue Clinic a