Sri. P. Satheesh Chandran Nair (President):

                   The deceased complainant (herein after call complainant) filed this petition u/s.12 of the C.P. Act 1986 for getting a relief from the opposite party.

                   2. The case of the complainant is as follows:- The complainant Willson.K.Varghese availed a Health Insurance Policy from 1^st opposite party for the re-imbursement of the medical treatment expense of the complainant and his family members vide policy No. 395303368 dated: 26/05/2011.  According to the complainant the 1^st opposite party received the premium of Rs. 30,000/-(Thirty Thousnad) and the sum assured to the complainant is Rs. 5,00,000/- (Five lakh) and for his family members Rs. 3,00,000/- (Three Lakh).  It is further contended that up to March 2015 without any default the complainant paid the premium and altogether he paid an amount of Rs. 1,20,000/- as premium for 4 years.  On 21/07/2015 the complainant was subjected to Transarterial Radio Mobilisation Using Rhenium and Lipidol at Kovai Medical Center and Hospital Ltd., Coimbatore, Tamilnadu.  The said fact was duly intimated to the 1^st and 2^nd opposite party.  On 01/09/2015 again the complaint was admitted for second sitting of Transarterial Radio Mobilisation Using Rhenium and Lipidol and discharged on 05/09/2015.  And subsequently admitted on 09/10/2015 for the third sitting and discharged on 10/10/2015.   It is contended that complainant spent more than Rs. 2,00,000/-(Two lakh) each for all the above treatments.  According to him he filed a claim for these three hospitalization (12/09/2015, 16/10/2015 and 06/11/2015) and claimed an amount of Rs. 6,00,000/- from opposite parties.  According to him he has entitled to get an amount of Rs. 5,00,000/- as agreed by the 1^st opposite party in the policy.  As directed by the opposite parties the complainant produced certificate from the doctor to show that the history and duration of bowel obstruction and past laprotomy which was done to complainant which has no relation with the existing illness. On 09/10/2015 the 3^rd and 4th opposite   party as TPA of the 1^st opposite party rejected the claims of the complainant alleging that the complainant is having pre-existing illness.  It is contended that the liver cancer is primary in nature and the same is not associated with other illness or treatment.  According to the complainant as per clause 6(i) and (ii) of the conditions and privileges of the policy, the pre-existing conditions means any medical conditions or any related conditions for arising at some point prior to the commencement of this coverage, irrespective of whether any medical treatment or advise was sought by the insured.  It is further contended that the liver cancer is primary and not associated with any other illness and the same cannot be identified in its earlier stages and the symptom will visible only in the last moment.  Even though the complainant sent a legal notice to the opposite party the grievance of the complainant has not been redressed.  According to the complainant the opposite parties rejected the claim of the complainant on flimsy and untenable grounds.  All the acts of the opposite parties are clear deficiency in service and the opposite parties are liable to the complainant.  Hence, the complainant for realizing claim of Rs. 5,00,000/- compensation cost etc. etc from  the opposite parties.. 

3. This Forum entertained the complaint and issued notice to the opposite parties for their appearance.  The 1^st & 2^nd opposite party entered appearance and filed their common version.  Though the 3^rd opposite party received notice but failed to appear before the Forum hence on 07/04/2016 the 3^rd opposite party is declared exparte by this Forum.  This Forum issued notice to 4^th opposite party but either the notice return or seen served as per the records of this case.  The complainant has not taken any further steps against 4^th opposite party for their appearance.  So this Forum deleted the 4^th opposite party from the party array as per the submission of complainant.  The version of 1^st and 2^nd opposite party are as follows.  According to the opposite parties the version begins with two defenses. 1. ‘Willful suppression of material facts while availing policy.  2. Non applicability of claim vide policy consideration’.

4.  In para wise explanation 1^st and 2^nd opposite party admitted that the complainant availed a Health Insurance Policy as stated in the complaint and also denied that opposite parties have not assured to pay all treatment expenses since the complainant policy is not a medi-claim policy.  It is contended that the policy of the complainant is a unit link Health Insurance Policy therefore the policy benefit is subject to the terms and conditions and exclusion clause of the policy.  It is admitted that the said policy was issued under LIC’s Health Protection Plus Plan (T902) to the complainant and his family members.  It is further contended that opposite parties received earlier premium up to 05/2015 and the due date of next premium was on 26/05/2016.  As per the version of the opposite parties it is admitted that the complainant was treated as stated in the compliant.  According to the opposite parties, though the complainant claimed a sum of amount for the 3 hospitalization the re-imbursement of the treatment does not come under the listed surgery under plan 902.  Therefore opposite parties are not liable to pay any major surgical benefit to the complainant as claimed.  It is contended that the complainant has underwent a laparotomy for Bowel obstruction which was done in 1982 on the complainant and purposefully complainant suppressed this pre-existing disease in the proposal form dated: 01/05/2011.  It is further contended that there is no deficiency in service on the side of the opposite parties.  Since, the claim of the complainant is rejected based on the insurance policy conditions the opposite parties prayed to dismiss the complaint with cost to the opposite parties.  At the time of trial it is reported that the complainant was died on 01/02/2016 so that the legal representatives of the complainant filed a petition as IA. 65/16 dated: 03/06/2016 for impleading legal heirs of the complainant for proceeding with the case.  This Forum allowed the above said IA. 65/16 and impleaded the legal heirs of the complainant as additional complainant 2 to 4 in this case. 

                5. We peruse the complaint, version and records before us and framed the following issues for consideration:

1. Whether the complaint is maintainable before this Forum?
2. Whether the opposite parties committed any deficiency in service against the complainant?
3. Regarding the relief and costs?

                 In order to prove the case of the complainants, the additional complaint No.2 the wife of the deceased de-facto complainant she who filed a proof affidavit and she is examined as PW1 in this case.  Ext. A1 to A14 and Ext. B1 & B2 are also marked through PW1. Ext. A1 is the Policy document dated: 26/05/2011 issued by 1^st opposite party to complainant.  Ext. A2 is the policy conditions and privileges issued by 1^st opposite party.  Ext. A3 is the Scan report dated: 16/07/2015 by Devi Scans Ltd to complainant. Ext. A4 is the report of treatment dated: 21/07/2015 by Kowai Medical Centre.  Ext. A5 is the treatment report dated: 02/09/2015 issued by Kovai Medical Centre.  Ext. A6 is the discharge summary dated: 05/09/2015 issued by Kowai Medical Centre.  Ext. A7 discharge summary dated: 12/10/2015 issued by Kovai Medical Centre.  Ext.A8 Claim requirement letter dated: 18/09/2015 issued by 3^rd opposite party.  Ext. A9 is the Letter/Certificate dated: 09/10/2015 issued by Dr. Mathew Cherian to 3^rd opposite party.  Ext. A10 is the Claim requirement letter dated: 23/10/2015 issued by 3^rd opposite party.  Ext. A11 Claim rejection letter dated: 09/11/2015 issued by 3^rd opposite party.  Ext. A12 is the letter dated: 09/11/2015 issued by 2^nd opposite party.  Ext. A13 is the claim rejection letter dated: 30/11/2015 issued by 2^nd opposite party.  Ext. A14 is the email of the complainant dated: 09/12/2015 by Adv. Unni to the opposite parties.  Ext. B1 is the copy of proposal form of policy document dated: 12/05/2011.  Ext. B2 is the copy of Proposal Form for LIC’s Health Plus Policy dated:12/05/2011.  The PW2 is an ophthalmologist by name Dr. P.L. Rena who was examined in favour of the complainant.  On the other side DW1 one Sreedevi.S. Nair of LIC of India, Kottayam Branch was examined and through her Ext. B1(a) & B2(a) are also marked. Ext. B1(a) is the copy of policy conditions and privileges dated: 26/05/2011.Ext. B2(a) is the hospital treatment form dated:09/10/2015. After the closure of evidence we heard both parties.  The learned counsel appearing for the opposite parties filed an argument note apart from hearing advanced by him.

6. Point No.1:- The case of the opposite party is that the case is not

maintainable before the Forum since the complainant willfully made certain suppression of materials facts while availing policy and also pleaded that as per the policy condition of the said policy there is no applicability for complainant’s claim.  When we appreciate the evidence before the Forum we can understood that the deceased de-facto complainant who availed a policy as per Ext. A1 and it also proves that the policy was valid at the time of claiming the benefit against the opposite parties and also to be seen that de-facto complainant paid the premium to opposite parties without any default.  Therefore it can be easily inferred that the complainant is an insured and the opposite parties are insurer of the complainants.  In the light of this evidence we can arrived a conclusion to the effect that the complainants are a consumers and the opposite parties are service providers of the complainants.  Point No. 1 found in favour of the complainant.

7. Point No.2 &3:-    For the sake of convenience we would like to consider the Point No.2 and 3 together.  The main issue to be answered is whether the opposite parties committed any deficiency in service or unfair trade practice as alleged by the complainants.  In order to substantiate the case of the complainants the additional complaint No.2 examined as PW1 and filed proof affidavit along with 14 documents.  Ext. A1 and A2 proves that the de-facto complainant availed an LIC’s Health Protection Plus Plan (Table 902) UIN:512L2533V01) and the said scheme is covered a major surgical benefits of Rs. 5,00,000/- for the principles insured and Rs.3,00,000/- to his spouse and for one child another Rs. 3,00,000 are also assured.  We can also see that on 26/05/2011 the policy was commenced and expiry date of ‘hospital cash benefit’ and ‘major surgery benefit’ would expired on 26/05/2038, 26/05/2040, 26/05/2025 respectively. Ext. A2 is the said policy’s conditions and privileges.  The exclusion clause of the hospital cash benefit scheme is described in clause 6(i) and the exclusion clause of the major surgical benefits are described in clause 6(ii) of the said Ext. A2.  When we refer Ext. A3 the scan report dated: 16/07/2015 which was issued from Devi Scans Private Limited it is reported that a possibility to be considered for Intra hepatic cholangiocarcinoma and Hepatocellular carcinoma to the complainant.  Ext. A4 we can see that on 21/07/2015 the complainant was admitted in kovai Medical Center and Hospital Limited, Coimbatore and conducted a Transarterial Radio Embolisation Using Rhenuim and Lipidol on him for Hepatocellular carcinoma and the said treatment was successfully performed.  When we refer Ext. A5 it can be seen that the 2nd sitting of Transarterial Radio Embolisation Using Rhenuim and Lipidol was also successfully performed on deceased complainant on 02/09/2015.  It is to be noted that on 05/09/2015 as per Ext. A6 the said complainant was discharged from Kovai Medical Center and Hospital Limited, Coimbatore with a final diagnosis that he is suffering large Hepatocellular carcinoma in segment VII, VIII & IV with multiple lymph nodal masses.  On 12/10/2015 also the said complainant again admitted and discharged for the same disease from the same hospital and also find that, at that time the complainant was suffering with Hepatocellular carcinoma in segment VII, VIII & IV with extra hepatic spread as per Ext. A7.  Ext. A8 shows that the opposite party sent a letter to the complainant to furnish history and duration of Bowel obstruction and past Laprotomy done.  In reply to that letter doctor who treated on the complainant at Kowai Medical Center Hospital  - Dr. P. Mathew Cherian issued a letter to 4^th opposite party (Managing Director, Corporate Office, Plot No.577, Udyog Vihar, Phase V, Gurgaon, Haryana 122016) with a finding that there is  no relation between Bowel obstruction and laprotomy done with current cancer condition of the complainant.  As per Ext. A10 it also shows that 4^th opposite party again sent a requirement letter to the complainant asking to provide the history and duration of Bowel obstruction and past laprotomy done to him.  When we refer Ext.A11 it is find that on 09/11/2015 4^th opposite party e-meditek’s which is functioning at Gurgaon, Haryana as its corporate office repudiated the claim of the complainant on ground that the complainant was suffering pre-existing illness irrespective of prior medical treatment or advice.   In the light of Ext. A11 it is to be understood that the claim of the complainant was rejected by 4^th opposite party only on ground that the insured suffered pre-existing illness.  Ext. A12 is a letter which shows that 2^nd opposite party of LIC Divisional Office, Kottayam has forwarded a letter of the complainant to their health department for appropriate action.  When we refer Ext. A13 we can understood that it is a reply of 2^nd opposite party to the deceased complainant.  In that letter the 3 claims of the complainant i.e, Health Claim No. 15010472 dated: 12/09/2015, 15012654 dated: 16/10/2015, 15014111 dated: 06/11/2015 are mentioned and as per this Ext. A13 the reason for the repudiation of the above said claims are ‘pre-existing disease’ ‘irrespective of prior treatment or advice’.  Ext. A14 is the complaint dated: 09/12/2015 issued by the counsel of the complainant with regard to the repudiation of the claim and a request to redress the grievances of the complainant.  When we evaluate the above evidence adduced by the complainant we can understood that the complainant availed an LIC’s Health Protection Plus Plan (table 902) on 26/05/2011 and the policy was valid at the time of preferring the claim and the sum assured for major surgery benefit is Rs. 5,00,000/-.  When we refer Ext. A3 to A7 it is proved that the deceased complainant was treated in Kowai Medical Center on 21/07/2015, 02/09/2015 & 12/10/2015 as per Ext. A4, Ext. A5 & Ext. A7 respectively.  It is also noted that the complainant was admitted for the treatment in connection with the Hepatocellular carcinoma.   On the basis of the repudiation letter Ext. A11 dated: 09/11/2015 and Ext.A13 dated: 30/11/2015 the only reason for the repudiation of the claim is pre-existing disease of the complainant.  It is true that the opposite party seriously contented that the policy in question is not a medi-claim policy indemnifying the hospitalization expenses and the repudiation of the claim is subject to the terms and conditions of the exclusion clause of the policy.  The 1^st & 2^nd opposite party admitted that the said policy was issued under LIC Health Protection Plus Plan (T902) to the complainant.  The learned counsel appearing for the 1^st and 2^nd opposite party further argued that the above three hospitalization and the 3 claims was for Transarterial /arterial Radio Embolisation Using Rhenuim which does not come under the listed surgeries under plan 902 hence the major surgery benefits are not payable to the complainant.  It is also pointed out that the deceased complainant was undergone for a laprotomy for Bowel obstruction in 1982 and the said Bowel obstruction can be considered as a pre-existing disease.

                        8. On the basis of the rival contention put forward by 1^st & 2^nd opposite party we have to consider whether the Bowel obstruction happened to this complainant in 1982 was a pre-existing disease or if there any connection between the said Bowel obstruction and Hepatocellular carcinoma.  In order to get a definite answer for this issue we have to verify the evidence adduced by both sides in this case.  In-cross PW1 answered “Ext. A9 letter ൽ 1982 ൽ he underwent laprotomy and bowel obstruction’ എന്ന് എഴുതിയിട്ടുണ്ടോ എന്ന് എനിക്ക് അറിയില്ല. എൻറെ ഭർത്താവ് policy എടുക്കുന്ന സമയത്ത് bowel obstruction ശരിയാക്കാൻ surgery നടത്തി എന്ന വിവരം മറച്ചുവച്ചു എന്നത് എനിക്കറിയില്ല. (Q &A) എൻറെ ഭർത്താവിന് policy amount ലഭിക്കാൻ അർഹതയില്ല എന്നത് ശരിയല്ല”.  Though the learned counsel asked a specific question with regard to the Bowel obstruction of the deceased complainant and subsequent surgery alleged to be conducted on 1982, there is no expert evidence before us to see that the Bowel obstruction was a pre-existing disease and it related to the Hepatocellular carcinoma. When we examine the deposition of PW2 the doctor who employed as an Oncologist at MCH, Kottayam deposed in chief “large Hepatocellular carcinoma എന്ന് പറഞ്ഞാൽ കരളിന് വരുന്ന primary cancer ആണ്.   In chief she again adds “Bowel obstruction എന്നാൽ എന്താണ് (A) സാധാരണഗതിയിൽ കുടലിന് ഉണ്ടാകുന്ന അസുഖം ആണ് . (Q) ഈ അസുഖത്തിന് എന്താണ് treatment. (A) സാധാരണ ആയി surgery വിഭാഗത്തിലെ doctor നെ ആണ് കാണുന്നത് . പ്രാഥമിക പരിശോധനയ്ക്ക് ശേഷം Bowel obstruction ആണ് എന്ന് കണ്ടതിന് ശേഷം വയർ തുറന്ന് എന്താണ് കാരണം എന്ന് കണ്ട് ചീത്തയായി പോയ  intestine കണ്ട് അത് കട്ട് ചെയ്ത് ബാക്കി കൂട്ടിയോജിപ്പിക്കും . (Q)  Bowel obstruction ഉം liver cancer ഉം തമ്മിൽ എന്തെങ്കിലും ബന്ധം ഉണ്ടോ . (A) ഇല്ല Bowel obstruction liver cancer ന് ഒരു കാരണമേ ആകാറില്ല”. According to PW2 it is specifically deposed that there is no relation between Bowel obstruction and liver cancer and emphatically deposed that the Bowel obstruction is not at all a reason for a liver cancer.  In-cross she answered “gastric system ൽ ഒരു അവയവത്തിന് നടത്തുന്ന surgery, gastric system ൽ പെട്ട മറ്റ് അവയവങ്ങളിലെയ്ക്കും ബാധിക്കൻ സാധ്യതയില്ലേ (A) ഇല്ല. എനിക്ക് gastrientrogy ൽ Specialization  ഇല്ല.  (Q) Bowel surgery ൽ  നിന്ന് after effect ആയി ഉണ്ടായ അസുഖം ആണ്   liver cancer ലേക്ക് നയിച്ചത് എന്നും പറയുന്നു. (A) ശരിയല്ല”.   In further question she answered “treatment record കാണാതെ നിങ്ങൾക്ക് ആധികാരികമായി പറയാൻ കഴിയുകയില്ലല്ലേ. (A) ചോദ്യങ്ങൾക്ക് മറുപടി പറയാൻ കഴിയും. ”.  In the light of the answer given by PW2 in cross-examination it can be easily inferred that there is no relation between Bowel obstruction and liver cancer and also it can be assume that Bowel obstruction is not at all a reason for the liver cancer.  If so the main question to be answered is that the Hepatocellular carcinoma (liver cancer) is comes under exclusion clause as per the terms and conditions of the policy.  The learned counsel of 1^st & 2^nd opposite parties argued that the liver cancer – Transarterial Radio Embolisation Using Rhenuim does not comes under the listed surgeries as plan under 902 as per exclusion clause 6(ii) and the hospital cash benefit claim of the complainants are also not comes under exclusion clause 6(i) of the above said policy terms and conditions.  When we evaluate the evidence adduced by DW1, in-cross examination we can see that “Ext. A8 പ്രകാരം മരിച്ച യഥാർത്ഥ ഹർജിക്കാരൻ bowel obstruction and past laprotomy certificate ഹജരാക്കണമെന്ന് മാത്രമേ പറഞ്ഞിട്ടുള്ളൂ. അതിൻപ്രകാരം Ext. A9 ൽ Bowel obstruction നും  laparotomy യും തമ്മിൽ നിലവിലുള്ള cancer condition ന് ബന്ധമില്ല എന്ന് പറഞ്ഞിട്ടുണ്ട്.   Ext. A11 പ്രകാരം “pre –existing illness irrespective of prayer medical treatment or advice” ആണ് repudiation കാരണം എന്നല്ലേ പറഞ്ഞിരിക്കുന്നത് . അതെ  In another question DW1 answered “ Ext. A1 എന്തു പോളിസിയാണ്? Health insurance plan ആണ് ഈ പോളിസി hospitalization benefit നു വേണ്ടിയാണ് LIC കൊടുക്കുന്നത്. അങ്ങനെയെങ്കിൽ Ext. A1 പോളിസി pre-medical checkup നിർബന്ധിതമല്ലേ? അതെ. അപ്രകാരം ഈ കേസിലെ മരിച്ച വിൽസൺ വർഗ്ഗീസ് pre-medical ചെക്കപ്പ് നിങ്ങൾ നടത്തിയ ശേഷമല്ലേ ഈ സ്കീമിൽ പ്രവേശിപ്പിച്ചത്? അതെ 20/02/2013 ൽ I.R.D.A  മെഡിക്ലെയിമിനേയും Health Insurance നേയും സംബന്ധിച്ച്  quick line പ്രസിദ്ധീകരിച്ചിട്ടുണ്ട്. അതിലെ  Annexure I Clause 16 ൻ പ്രകാരം  pre-existing illness എന്നത്  policy എടുത്ത്  48 മാസങ്ങൾക്കു മുൻപ് ചികിത്സിച്ചതോ  doctor Advice ചെയ്തതോ ആയ രോഗങ്ങളെ കുറിച്ചാണല്ലോ പറഞ്ഞിരിക്കുന്നത്. രേഖനോക്കാതെ എനിക്ക് പറയാൻ കഴിയില്ല   I.R.D.A പ്രകാരം കാൻസർ ഉൾപ്പെടെയുള്ള ചികിത്സകൾ ഈ സ്കീമിൽ കവറിംഗ് ലഭിയ്ക്കുമല്ലോ . ഇല്ല”.

                   9. In the light of the above deposition by DW1 we can safely come to a conclusion that Ext. A1 policy is a policy for hospitalization benefit and even at the time of availing the policy the insurance company themselves conducted a medical check up on the insured to know whether the insured is suffering any kind of disease or not.  It is also admitted that as per Ext. A2 page 5 we cannot see any explanation to point out that the cancer or any like diseases are excluded from the treatment benefit as per the said insurance scheme.  In order to substantiate the contention of the complainant the complainant’s learned counsel asked a question to DW1 the question and answer is as follows:  “Ext. Ext. A2 5-þmw പേജിൽ  major surgical benefit എന്ന head ൽ cancer റോ ഇതു സംബന്ധമായ ചികിത്സ  medical insurance benefit ൽ നിന്നും  exclude ചെയ്തതായി കാണുന്നില്ലോ?  No answer”.  In the light of the answer given by the DW1 in this case and also when we refer Ext. A2 page 5 there is no description showing that the cancer or any kind of allied diseases are exempted from major surgical benefit as per             Ext. A2.

                   10.  When we examine page 5 of Ext. A2 there is no clause which explains “exclusion applicable to major surgical benefit which not permitted to re-imburse the surgical expenses” can be seen.  It is true that clause 6 II(1) ‘surgeries not listed in the surgical benefit Annexure’ are excluded. When we go through surgical benefit Annexure page 16 the lever and pancreases are including in the list of surgery therefore we can safely arrived a conclusion to the effect that the surgery related to liver is clearly comes under the LIC’s Health Protection Plus Condition and privileges.  As per Ext. A2 page 16 the insured is eligible to get 60% of the sum assured for the said surgery.  In-cross DW1 further answered “Ext. A2 page 16  surgical benefit Annexure F¶ head  bone maro Transplantation, Liver and pancreases എന്നിവ ഉൾപ്പെട്ടിട്ടുണ്ട് . ഈ കേസിലെ വിൽസൺ HeptoCellular Casinoma  ആണെന്ന് അറിയാം ഈ അസുഖം  liver cancer ആണ് ഇതിൻറെയടിസ്ഥാനത്തിൽ policy holder ക്ക് ഉണ്ടായ  liver cancer ന്  policy  തുക ലഭിക്കുന്നതിന് പൂർണ്ണമായ ആവകാശമുണ്ടല്ലോ?   ഇല്ല”. 

                11. In the light of the above discussion we can find that the additional complainants in the case are succeeded to prove a definite case against the opposite parties and also find that the opposite parties are committed clear deficiency in service against the complainant in respect of the re-imbursement of insurance claim as per Ext. A1 policy.  Considering the evidence before the Forum it can be seen that opposite party 1, 2 & 3 are jointly and severely liable to the complainant.  Hence, Point No. 2 and 3 also are found in favour of the complainant.  

12. In the result, we pass following the orders:

1. The Opposite parties 1,2&3 are directed to re-imburse an amount of Rs.3,00,000/-(Rupees Three lakhs only) (60% of this sum assured) to the complainants with 10% interest from the date of filing of this case onwards  i.e., 03/02/2016.
2. The Opposite parties 1,2&3 are also directed to pay a compensation of Rs. 25,000/- (Rupees Twenty Five thousand only) and a cost of Rs. 3,000/- (Rupees Three thousand only) to the complainants with 10% interest from the date of order onwards. 

                     Dictated to the Confidential Assistant, transcribed and typed by her, corrected by me and pronounced in the Open Forum on this the 30^th day of June, 2017.

                                                                                               (Sd/-)

                                                       P. Satheesh Chandran Nair,

                                                                        (President)

Smt. Sheela Jacob (Member):       (Sd/-)

Appendix:

Witness examined on the side of the complainant:

PW1  :  Alice Wilson

PW2  :  P.L. Rena

Exhibits marked on the side of the complainant:

A1 :  Policy document dated: 26/05/2011 issued by 1^st opposite party to

         complainant

A2 :  Policy conditions and privileges issued by 1^st opposite party

A3 :  Scan report dated: 16/07/2015 by Devi Scans Ltd to complainant

A4 :  Report of treatment dated: 21/07/2015 by Kowai Medical Centre

A5 :  Treatment report dated: 02/09/2015 issued by Kovai Medical Centre

A6 :  Discharge summary dated: 05/09/2015 issued by Kowai Medical Centre

A7 :  Discharge summary dated: 12/10/2015 issued by Kovai Medical Centre

A8 :  Claim requirement letter dated: 18/09/2015 issued by 3^rd opposite party

A9 :  Letter/Certificate dated: 09/10/2015 issued by Dr. Mathew Cherian to 3^rd 

         opposite party

A10: Claim requirement letter dated: 23/10/2015 issued by 3^rd opposite party

A11: Claim rejection letter dated: 09/11/2015 issued by 3^rd opposite party

A12: Letter dated: 09/11/2015 issued by 2^nd opposite party

A13: Claim rejection letter dated: 30/11/2015 issued by 2^nd opposite party

A14: Email for complainant dated: 09/12/2015 by Adv. Unni to the opposite

        parties

Witness examined on the side of the opposite parties:

DW1  : Sreedevi S Nair

Exhibits marked on the side of the opposite parties: 

B1: Copy of policy document dated: 12/05/2011

B2: Copy of Proposal Form for LIC’s Health Plus Policy dated:12/05/2011

                                                                                                                           (By Order)

Copy to:- 1) Wilson .K. Varghese,

Kunnumpurathu House,

                    Narakathani. P.O, Vennikulam,

                             Pathanamthitta 689 544.

                        2) Alice Wilson,

                   W/o Wilson.K. Varghese,

                      Do – do

                3) Melwin Saira Wilson,

                        D/o Wilson.K. Varghese

                        Do – do

4. Melinta Marium Wilson,

                         D/o Wilson.K. Varghese,

                              Do  - do                                                 

5. Life Insurance Corporation Ltd.,

                 Represented by Branch Manager,

                 P.B. No. 48, Marthoma Buildings,

                 T.K. Road, Thiruvalla.

6. The Manager,

                 CRM Department, LIC,

                 Divisional Office, “Jeevan Prakash”,

                 P.B. No. 609, Nagampadom, Kottayam – 686 001.

7. The Branch Manager,

E Meditek (TPA) Services Ltd, KPV Estate,

4^th Floor, Civil Line Road,

Opposite ING Vysya Bank,

Palarivattom.P.O, Ernakulam.

8. Represented  by Managing Director

E Meditek (TPA) Services Ltd,

Corporate Office, Plot No.577,

Udyog Vihar, Phase V, Gurgaon, Haryana 122016.

9. The Stock File.