In Brief
The appellant held individual mediclaim policies for his family since 2007 before switching to a family mediclaim policy in 2014 with a Rs. 5 lakh sum insured. When his son required hospitalization incurring Rs. 8.55 lakh in medical bills, the insurer initially repudiated the claim but later paid Rs. 27,550. The Court held that since the policy was continuously renewed without pre-existing disease exclusions from inception, the insurer cannot rely on such a plea. The claimant is entitled to 50% of the family sum insured (Rs. 2.50 lakh) as maximum per individual illness, minus amounts already paid, plus Rs. 50,000 for harassment and Rs. 30,000 for litigation costs with 7.5% interest.
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