1. Brief facts of the case reveal from the record are that petitioner has taken a family mediclaim insurance policy from the respondent-National Insurance Company Limited (hereinafter referred as the Insurance Company) in the year 1996 and the said policy was being continuously renewed and since 2002 it was effective for the period from 22nd November to 21st November of the next year. The policy covered a sum of Rs. Three Lac.

2. Initially, the policy was for the petitioner, his wife and two children. In 1998-99 his mother was also added. In 2007, the policy was split into two, one covering the petitioner and his mother and the other covering his wife and two children. Initially, the premium of Rs.2825/- was paid in 1996 which increased to Rs.10,330/- excluding service tax and family discount. A total amount of Rs.20,885/- was thus paid for the year 2007-08.

3. The petitioner was diagnosed of suffering Common Variable Immune Deficiency (CVID) with Pancytopenia (below normal blood counts) and Malabsorption Syndrome (absorption and assimilation of food is affected) and calcium metabolism dysfunction for which he was put on intravenous monthly infusion w.e.f. September, 2004 under hospitalization. Later on, he developed Hodgkin’s Disease Stage IV (malignancy of lymphatic system) for which he undertook chemotherapy. He is under regular treatment and is required infusion every four to five weeks under hospitalization and was hospitalized in his own hospital namely; Dhuleshwar Hospital & Laser Skin Centre. The National Insurance Company Ltd. Jaipur Branch, Jaipur was releasing the expenses under the medi-claim policy as per the limit.

4. It is case of the petitioner that while he was granted reimbursement for the year 2003-04, 2004-05, 2005-06, 2006-07 and 2007-08, the petitioner’s policy was renewed through the agent namely; Alankrit, New Delhi (hereinafter referred as ‘TPA’). The TPA sent pre-acceptance vouchers for the claims after deducting hospitalization and nursing charges which was not accepted by the petitioner. The fifth claim was, however, submitted directly by sending cheque for the fifth hospitalization to which the petitioner submitted his objections and also filed a complaint before the Insurance Ombudsman.

5. The Insurance Ombudsman passed an order to make the payment with interest of 8%. Subsequent claims thereafter came to be refused and ultimately the petitioner stated to have sent a legal notice.

6. In November, 2008, the petitioner sent a premium amount of Rs.12,260/- for medi-claim policy of himself and his mother. However, the Branch Manager vide his letter dated 19/11/2008 refused and returned to the petitioner with a demand of renewal of policy through TPA for a premium amount of Rs.13,943/-. The same was also sent along with prescriptions to be signed along with proposal form which contained the conditions diferent from the original cover policy under which the petitioner was getting his insurance renewed.

7. Fearing discontinuance of the policy and also that a new policy may not be granted to the petitioner on account of his existing diseases, the petitioner submitted to the demand and signed prospectus to avoid any practice in the renewal of the policy under protest. Letter of protest was also sent duly received in the office of the respondents on 20/11/2008.

8. Learned counsel for the petitioner submitted that while the premium was increased, the coverage was the same. The condition was, however, put that the petitioner has to sign the prescriptions that the renewal would be done through TPA only and treatment in his own hospital would be excluded. In the prospectus of the Insurance Company, it was mentioned that the payment for the room rent was limited to only 1% of the sum insured subject to maximum of Rs.5,000/- and if admitted to ICU, 2% of the sum insured with maximum of Rs.10,000/- and overall limit under the head was 25% of the sum insured. The fees was also limited under the new policy upto 2