Smt.Bindhu M.Thomas,
The Petitioner's case is as follows:
The petitioner took a mediclaim policy for himself and his family in the year 2002 believing the advertisements made by the opposite party through various medias and pamphlets stating that their mediclaim policy will cover the expenses incurred for allopathy, ayurveda homeo and unani treatments for policy holders. He states that the policy was renewed periodically. On 19.3.2006, the petitioner renewed the said policy for himself and his wife for Rs.1,00,000/- each and Rs.50,000/- each for his children. The petitioner's wife was suffering from Rheumatic Arthritis and had undergone ayurvedic treatment at Cochin Arya Vaidysala, Thripunithura as an inpatient from 19.9.2006 to 3.10.2006. The petitioner incurred treatment expenses Rs.27,365/-. According to the petitioner the above said hospital is an approved ayurvedic -2- hospital of the opposite party. The petitioner submitted a claim for Rs.27,365/- along with relevant bills issued by the said hospital. The petitioner alleges that the opposite party repudiated the claim on the ground that the said policy do not cover the expenses incurred for Ayurvedic treatments. Hence the petitioner prays for a direction to opposite party to pay an amount of Rs.39,595/- and cost of proceedings.
The opposite party entered appearance contenting that the claim was repudiated for valid reasons. According to them the said policy is not a renewed policy but it is a new policy and it does not cover the expenses incurred for Ayurvedic treatments. The opposite party contented that the claim made by the petitioner on the basis of the terms and conditions of the policy issued on 19.3.2006 is not maintainable and prayed to dismiss the petition with cost.
The points for determination are: Whether there is deficiency in service or unfair trade practice on the part of the opposite parties? Reliefs and costs?
Evidence consists of the affidavits filed by the petitioner and opposite party. Exhibits A1 to A6, B1 and C1.
Point No.1.
The petitioner alleges that he joined the mediclaim policy believing the advertisements made by the opposite party through various medias and pamphlets stating that this mediclaim policy will cover the expenses incurred for allopathy, ayurveda, homeo -3- and unani treatments for the policyholders. The pamplet is marked as exhibit A1. In A1 it is clearly stated that ayurvedic treatments are included under the mediclaim policy of the opposite party. Petitioner states that he joined the policy on 18.3.2002 and the same was renewed every year and that he is entitled to claim the expenses incurred for ayurvedic treatments.
According to the opposite party they have excluded all types of ayurvedic treatments from the scope of the policy by affixing seal on the face of the original policy w.e.f. 19.3.2004 and subsequent renewals. The opposite party had repudiated the petitioner's mediclaim policy based on the said exclusion clause.
As per the direction of this forum the counsel of the opposite party produced the photocopy of the previous policy certificate for the period 19.3.2005 to 18.3.2006. It is marked as exhibit C1. On perusal of the 'C1' document, we found that ayurvedic treatments were excluded by means of a seal during the previous policy period also. The very same exclusion clause is found to exist on the exhibit 'A3' policy dated 15.3.2006. Hence we are of the opinion that there was no suppression of material information by the opposite party. The insured had developed Rheumatic Arthritis and had undergone ayurvedic treatment from 19.9.2006 to 3.10.2006. The said treatment was during the period of subsistence of the alleged policy ie between 19.3.2006 and 18.3.2007.Exhibit 'C1' reveals that from the date of receipt of the policy certificate onwards the petitioner was in knowledge of the sealed “exclusion clause”. If the petitioner had any objection regarding the sealed exclusion clause, he had enough time and opportunity either to raise objection or to cancel the policy. In this instant case the petitioner raised -4- objection about the exclusion clause only when his insurance claim was repudiated. Considering the above mentioned circumstances we find that there is no unfair trade practice or deficiency in service on the part of opposite party.
Point No.2.
In view of the findings in point No.1, the petition is dismissed. Considering the facts and circumstances of the case no cost and compensation is ordered.
......................Bindhu M Thomas
......................K.N Radhakrishnan
......................Santhosh Kesava Nath P | | 
