1.    This  appeal challenges the order dated 06/08/2009 passed by the District Consumer Forum, Yavatmal partly allowing the Consumer Complaint bearing no. 99 of 2009 thereby directing the OP Insurance Company to pay the complainant Rs. 50,000/- towards the mediclaim with 6 percent P.A. interest to be applied from 25/03/2008 on the said amount and to give concession of Rs. 5,439/- in the yearly premium to be deposited by the insured and to refund the amount of premium of Rs. 5,439/- which was accepted by the Insurance Company in November 2008 with 6 percent P.A. interest thereon and Rs. 1,500/- towards cost of proceedings.

2.    Respondent Rajesh Agrawal to be referred as Complainant and appellant Life Insurance Corporation of India to be referred as OP for the sake of brevity.

3.    Brief facts giving rise to this appeal are:-

4.    Complainant Rajesh had taken Ashadeep Policy on 11/11/1997 for sum assured of Rs. 1,00,000/- and he was paying yearly premium of Rs. 5,439/- It being a mediclaim policy. It covered risk for four ailments namely Cancer, Paralysis, (resulting into permanent disabilities), Disease in respect of Kidney and Heart and disease relating to Blood Circulations. As per the policy conditions 50 percent of the sum insured would be payable immediately.

5.    The Complainant developed certain symptoms of Heart disease on 26/05/2007 and therefore he consulted Dr. Karia at Yavatmal. The complainant was admitted in his Hospital from 26/05/2007 to 03/06/2007 where certain medical tests were conducted on the complainant and the complainant was diagnosed with Ischaemic Heart Disease.  The Complainant incurred expense of Rs. 18,000/- towards the medical treatment and Rs. 2,500/- towards the pathological tests which were conducted on the complainant. The complainant was discharged on 3/6/2007 and his further treatment was taken at Wockhart Hospital at Nagpur for which he incurred expense of Rs. 15,000/-. The complainant had to further undergo Thelium Test for proposed Heart surgery and the complainant incurred expense of Rs. 12,000/-. The complainant underwent the Heart surgery by PTCA with stent treatment surgery on 10/08/2007 and he incurred an expense of Rs. 90,000/-

6.    The complainant submitted the Insurance Claim on 28/01/2008 for PTCA operation under the Ashadeep Policy. The OP by letter 25/03/2008 repuated the claim as it was not covered under the policy conditions. The Complaint dated 27/08/2008 again called upon the OP to settle his mediclaim under the Ashadeep Policy. Since the OP failed to take cognizance, alleging deficiency in service the complainant filed a Consumer Complaint claiming reimbursement of 50 percent of the sum assured immediately as per the policy condition, to suspend further payment of premium from the date of entitlement of claim, and the balance sum assured to be given to the complainant with bonus on maturity, Rs. 1,00,000/- towards mental and physical harassment and Rs. 15,000/- towards cost of proceedings.

7.    The OP resisted the complaint by filing its written version and denied all the adverse allegations .The policy is admitted. The OP submitted that risk was covered for four diseases, and that the insured complainant had made claim under the “Heart and blood circulations disease”. There is a contractual relationship