Heard learned counsel for both sides.

2.      Here is an appeal filed u/s 15 of the erstwhile Consumer Protection Act, 1986 (hereinafter called the ‘Act’). Parties to this appeal shall be referred to with reference to their respective status before the District Forum.

3.   The factual matrix leading to the case of the complainant is that the complainant had purchased “Family Health Optima Insurance Policy” for his family members including his wife from the OPs in every year for last 3 years i.e. from 19.12.2010 to 18.12.2011. It is alleged inter alia that the complainant’s wife suffered from heart disease and hospitalized in Fortis Hospital Ltd, Bangalore from 24.7.2011 to 31.7.2011 whereafter she was treated for  Mitral Valve Repair with Teflon Strip Annuloplaty. Complainant alleged to have spent Rs.2,37,851/-. Thereafter, claim was made but the OPs denied to pay the claim amount stating that she has got pre-existing disease. Hence, complaint case was filed.

4.      OPs filed written version admitting about purchase of such Medi Claim policy by complainant for his wife and  family members continuously for 3 years. They have also admitted for receipt of the claim form for the treatment of Payal Modi the wife of complainant at Fortis Hospital. They have examined the records and found that the complainant has pre-existing disease i.e. Rheumatoid Heart disease with severe Mitral Regurgitation – Surgical Management. So, they repudiated the claim. They averred that the pre-existing disease came under exclusion Claus -I of the policy.

5.      After hearing both parties, the learned District Forum passed the following order:-

                             “xxx   xxx   xxx

            Considering the aforesaid facts and evidence on affidavit on record, we are of the considered opinion that there is no deficiency in service on the part of the opp.parties. The Consumer Complaint No. 228 of 2011 be and is hereby dismissed on contest. No cost.”

6.      Learned counsel for the appellant submitted that learned District Forum committed error in law by not considering the case of complainant with proper perspectives. According to him the complainant’s wife has Rheumatic disease  surfaced for the first time and has no other related disease earlier to it and OPs have not produced any document to prove the pre-existing disease. Learned District Forum has not applied judicial mind to the facts of the case properly and illegally dismissed the complaint. Therefore, he submitted to set aside the impugned order by allowing the appeal.

7.      Learned counsel for the respondents submitted that the learned District Forum has rightly analyzed the case whether the exclusion Clause – 1 applied to the case of the complainant. They further submitted that rightly the learned District Forum has relied on the discharge summery to find out pre-existing disease of Payal Modi. Therefore, the impugned order should be confirmed.

8.      Considered the submission of learned counsel for the parties and perused the impugned order including the DFR.

9.      It is admitted fact