IMPORTANT POINT
Insurance company cannot be asked to exceed limits of its liability.

V.K. Jain, Presiding Member—The complainant took a mediclaim policy for himself and his wife from United India Insurance Co. Ltd. on 20-04-2010 for a sum of Rs.2,50,000/-. The policy was got renewed on two occasions. The wife of the complainant having developed stomach pain consulted Andhra Hospital at Vijaywada and was referred to Soumya Multi Speciality Hospital, Hyderabad for surgery. She was discharged from the aforesaid hospital after the surgery advised to her had been performed. The complainant claims to have incurred expenditure of Rs.1,63,263/- on the treatment of his wife. However, the insurance company allowed the claim submitted by him only to the extent of Rs.50,000/-, on the ground that his wife had undergone hysterectomy and as per the terms of the policy the claim in respect of hysterectomy was restricted to a maximum of Rs.50,000.

2. Being aggrieved from the aforesaid view taken by the insurance company the complainant approached the concerned District Forum seeking payment of the balance amount along with damages and cost of litigation.

3. The complaint was resisted by the insurance company on the same ground on which the claim had been restricted to Rs.50,000/-.

4. Vide its order dated 26-08-2013 the concerned District Forum restricted the claim admissible to the complainant to Rs.50,000/- which the insurance company had agreed to pay before the said forum.

5. Being aggrieved from the order passed by the District Forum the complainant approached the concerned State Commission by way of an appeal. Vide impugned order dated 25-08-2014 the appeal filed by the complainant was dismissed by the State Commission. Being still dissatisfied he is before us by way of this revision petition.

6. We asked the learned counsel for the petitioner/complainant to confirm from the complainant as to whether his wife had undergone hysterectomy which involves removal of uterus or not. The learned counsel on taking instructions states that the uterus of the wife of the complainant was actually removed. It is, thus, evident that the wife of the complainant had undergone hysterectomy. It would also be pertinent to note here that the complainant had not named the surgery undergone by his wife in the complaint filed by him.

7. A perusal of the insurance policy would show that in case of the insured undergoing hysterectomy the claim was to be restricted to 20% of the insured amount with a maximum of Rs.50,000/-. Therefore, the insurance company was absolutely justified in restricting the claim to Rs.50,000/-. Consequently, the orders passed by the fora below cannot be faulted with and the same are accordingly affirmed. The revision petition is devoid of any merit and is hereby dismissed with no order as to cost.

Revision Petition dismissed.

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