Date of Filing:23/08/2016

Date of Order:24/09/2018

BEFORE THE BANGALORE I ADDITIONAL DISTRICT CONSUMER DISPUTES REDRESSAL FORUM SHANTHINAGAR BANGALORE -  27.

Dated:24^th DAY OF SEPTEMBER 2018

PRESENT

SRI.H.R. SRINIVAS, B.Sc., LL.B. Rtd. Prl. District & Sessions Judge And PRESIDENT

SRI D.SURESH, B.Com., LL.B., MEMBER

COMPLAINT NO.1154/2016

Vs

ORDER

BY SRI.H.R.SRINIVAS, PRESIDENT.

1.     This Complaint is filed by the Complainants under Section 12 of Consumer Protection Act 1986, against the Opposite Party (herein referred in short as O.P) alleging the deficiency in service as well as unfair trade practice and to direct the O.P. to pay a sum of Rs.2,23,248/- along with interest at the rate of 18% per annum from the date of submission of claims i.e., 31.3.2015 till the date of realization. Further O.P to be directed to pay Rs.2,00,000/- damages towards mental agony, harassment, stress and inconvenience caused and  cost of the proceedings and to pass such other reliefs as this Hon’ble Forum deems fit. 

2.     The brief facts of the complaint are that, one Sri  G. Narahari is the husband of O.p.No.1 and father of O.P.No.2 and 3. From here onwards he is addressed as deceased.  Deceased and O.P. obtained diabetes save insurance floater policy from O.P by paying the fixed premium as the deceased and O.P.No.1 were suffering from Type -1 diabetes. The insurance policy No. is P/700002/01/2015/009808. The duration of the policy was from 26.07.2014 to 25.07.2015.  At the time of obtaining the policy, they had disclosed that they are having diabetes and hypertension.  Though deceased had suffered mild stroke, the same was cured and the agent who represented O.P was informed the same and he informed that since he is not suffering from the said stroke at present (at the time of obtaining the policy) and as the said illness is cured it need not be mentioned in the proposal form and hence he wrote only diabetes and hypertension in the column prior or no illness and the policy was admitted.  Deceased never suffered or was aware of having any breathing problems and lungs related ailment prior to obtaining the policy.

3.     During August 2014, deceased developed getting continuous cough and contacted general physician to get a treatment. On 20.08.2014 he had difficulty in breathing and the frequency in the cough increased. He was taken to Apollo Hospital, Jayanagar, 3^rd Block, Bangalore, for examination.  The doctor of the hospital got him admitted to emergency care and treated for the day and sent to home. The pulmonologist at the hospital suggested to the deceased to undergo medical test such as X-ray, CT Scan, Lung function test.  After the said tests, it was diagnosed that deceased was having Interstitial Lung Disease (ILD) and directed to come after two weeks for review and consultation and checkup. Since September 2014, he was under treatment for ILD by pulmonologist and was under continuous medication.  During the end of October 2014, he was admitted for exacerbation of his recently diagnosed ILD and admitted to the above hospital on 28.10.2014. Though he wanted to avail cashless treatment by informing the O.P on 30.10.2014, the same was denied due to non-disclosure of material facts at the time of inception of the policy, specifically stating that old stroke Cerebra Vascular Accident (CVA) has not been disclosed. On the same day, the doctor treating the deceased gave a letter stating that deceased had no history of ILD prior to 20.08.2014 and that the old stroke /CVA was unrelated to and had no association with the present condition and hospitalization.  The same was intimated to the O.P but O.P did not respond to the same and complainant NO.2 was informed by O.P that the deceased could try for reimburse and hospitalization after discharge.   After six days of treatment as inpatient, during the first hospitalization, deceased was discharged on 3.11.2014. The hospital charged Rs.1,12,656/- as hospitalization charges.  Again the deceased has to be hospitalized on 11.11.2014 due to acute exacerbation of ILD. Since his condition deteriorated, he was kept in ICU for treatment and on 16.11.2014 he died in the hospital. Again the hospital authorities charged Rs.1,10,592/- as hospitalization charges.  All the original medical records were submitted by them and made a claim in respect of the medical insurance policy along with letter on 31.03.2015. O.P neither responded to the letter nor intimated them regarding the claim being admitted or not even after submission of the claim. 

4.     It is further contended that neither Complainant No.1 nor the deceased have ever suppressed any material facts at the time of obtaining the insurance policy.   Deceased was not even aware of any ILD at the time of obtaining the said policy.  Even  if he was suffering from ILD, it was not within his knowledge as on the date of subscribing the said policy (July 2014). Only in the last week of August 2014, when suffered breathlessness, he came to know of ILD.  Hence there was no occasion for him to conceal the same.

5.     Further in the year 1995 he had an old stroke /CVA and recovered from it. He was not taking any medication for the stroke and had been working for full time since 1996 till his death. He retired as District and Session Judge in the year 2011. Afterwards also, he was a active legal practitioner. For about 3 to 4 months only, during 1995, he took medical leave due to the sufferance of the stroke and afterwards, he was healthy till hospitalization in October 2014. This itself shows that inspite of the mild stroke which was cured, he was active in service for nearly two decades and had no health issues and the said stroke has no way connected to the ILD  suffered in 2014.

6.     It is further submitted that, as by practice, the treating doctors questions the patient regarding the previous ailment to get the information and the same would be written in the notes.  It is not for the patient to decide if the information that he is providing is related to the present disease or not. It is the doctor who is an expert to examine and give opinion as to the previous disease has or has any relation to the present medical condition. The treating doctor certificate that deceased’s earlier stroke had no connection with suffering of ILD proves the point that there was no material information which was hidden by the deceased when he availed the policy.  On the strength of the certificate of the doctor only, they approached the O.P for reimbursement of the claim which is not approved by them. They are entitled to receive the full reimbursement for all the treatment and test the deceased has undergone as he was covered under the above insurance policy.  O.P is bound to honour the terms and conditions of the policy and respect the claim. Deliberately and intentionally, without any reason, the O.P remained silent for over a period of 15 months. This shows the careless attitude and the conduct is breach of trust placed by the deceased. O.P has resorted to cheap practice which is unbecoming on it. O.P has practiced unfair trade practice and has failed to honour the terms of the policy and deliberately tried to find out one or the other frivolous ground to repudiate the claim. The O.P has got a huge premium of Rs.70,000/- from the deceased and complainant No.2 and failed to provide any service and to honour its commitments. If O.P had no intention of passing any claim of Type I diabetes patient, suffering from diseases unrelated to diabetes, then O.P ought not to have floated such a scheme.  The conduct of O.P shows its dubious method of luring gullible consumers to pay higher premium only to be informed late that their claims cannot be honoured.  Apart from not honouring the claim, O.p has also denied renewal of the said insurance in respect of complainant No.2 for further years. She is entitled to for the renewal being poor applicant which amounts to unfair trade practice.

7.     It is further contended that, the act of O.P in not allowing cash less admission to the hospital at the time deceased was admitted, resulted in huge mental stress and agony in the mind of the deceased and to the complainants. Complainants have come from a middle class family and paid Rs.2,00,000/- and odd within a period two to three weeks to the hospital not being sure as to how much the hospital charges would be, has resulted in shock, uncertainty, mental agony and frustration of the family members along with the  deceased who was fighting for life. The act of O.P requires strong condemnation and they have to be penalized with exemplary damages/compensation. They are entitle to a compensation of Rs.2,00,000/-. The cause for the complaint arose the day on which the deceased and complainant No.1 availed health insurance from O.P, the day on which O.P refused to allow cash less treatment, the day on which deceased admitted to the hospital, the day on which he died and subsequently the day on which the claim was made in Bengaluru where the deceased was residing and took treatment in the hospital and died and also where the O.P is carrying on its business and pray to allow the complaint.

8.     Upon the service of notice O.P appeared before the forum through its advocate, filed its version and contended that the complainant is liable to be dismissed in limine as complainant has mislead the forum and not entitle for the claim made.  It has denied the averments made in the complaint parawise. Further it has taken up the contention that complainant, and the deceased obtained the policy and the same was issued subject to the terms and conditions against the premium and the risk assumed excluding pre-existing ailments.  While executing the proposal form the deceased has not stated the ailments which he was suffering. Only on good faith, the proposal was accepted believing that he had no pre-existing ailments. When he was hospitalized for the first time and got discharged on 3.11.2014, the medical records revealed that he had acute exacerbation of ILD.  Hence cashless facility was not allowed and the claim of the complainant was repudiated for non-disclosures of pre-existing ailment. Both the claims were repudiated for non-disclosure of the preexisting ailment after scrutinizing the claim.   It is found that the deceased was having symptomatic ILD with symptoms of shortness of breath PFT shows moderate restriction which confirms the ILD was present prior to the inception of the medical insurance policy. Further the son of the deceased in his letter dated 31.03.2015 has informed that deceased had CVA during August 1995 which is prior to the policy coming into effect. The insurer had not disclosed the above facts at the time obtaining the policy and  by misrepresenting the fact and by not disclosing the material fact has obtained the insurance. There is misrepresentation and non-disclosure of material facts and hence under condition No.14 of the policy, they have repudiated the claim and refunded the premium amount.

9.     It is further contended that since there is suppression and non-disclosing of material particulars at the time of obtaining the policy, and filling-up of proposal, they have repudiated the claim since the insurance business stands on good faith. They accepted the premium by relying on the particulars furnished by the proposal.  When the deceased got admitted for treatment, the true facts about the pre existing health condition came to light. Hence they have repudiated the claim.  Further the first consultation was on 20.08.2014 which falls on 26^th day of policy.  The admission case sheet of Apollo hospital dated 20.08.2014 discloses that patient has shortness of breath since two months i.e. since June 2014 which falls prior to the inception of the policy and the doctor in the first page of admission has noted on 22.07.2014 HBTLC, platelet count, ESR indicates that insured was evaluated before policy inception i.e. 26.07.2014. Admission note of the hospital dated 28.10.2014, mentions as the chief complaint is cough since six month and known case of stroke with left hemiplegia. Further son of the deceased on 30.3.2015 in his letter has admitted that his father has suffered CVA/old stroke during July-August 1995. Though the present ailment was related to the previous ailment, the insured had not disclosed the same at the time of inception of the policy which amounts to non-disclosure of material facts.  And further the insurance is a contract based on utmost good faith and the insured to be truthful and transparent in the proposal to enable the insurer to take and make a conscious decision to underwrite the risk or not. Failure on the part of the insured in this regard vitiates the very contract of insurance. Due to the suppression, non-disclosure of the material facts particularly, pre existing disease, the claim is repudiated and it cannot be held as deficiency in service and hence the complainant is not a consumer under provisions of Consumer Protection Act. This forum has no jurisdiction to adjudicate the complaint. There is no cause of action to the complaint. The allegations are frivolous and baseless.

10.   Further contended that without prejudice to the parawise denial of the complaint allegations, it is further contended that, if at all there was no suppression of material fact, the obligation of the O.P is only to the extent of Rs.2,00,000/-  and hence the claim over and above is not payable and on these grounds prayed the forum to dismiss the complaint.

11.      In order to substantiate their respective cases, the complainants and O.P have filed their affidavit evidence and documents. Heard the arguments. The following points arise for our consideration:-

                   (1)   Whether the complainants have proved the

                        deficiency in service and unfair trade practice

                        by Op?

(2)  Whether the complainants are entitled to

                       the relief prayed for in the complaint?

12.   Our answers to the above points are:-

POINT 1:    In the Affirmative.

POINT 2:    Partly in the Affirmative

                   for the following:

REASONS

POINT No.1:-

13.   Upon perusing the rival contention and the evidence adduced, it becomes clear that the complainant No.1 and the deceased obtained insurance policy from the O.P by disclosing that they have hypertension and diabetes. O.P has collected a premium of Rs.69,798/- and the insurance cover for a sum of Rs.5,00,000/- and policy period is from 26.7.2014 to 25.7.2015.

14.   The fact of issuing the policy, receiving the premium, admission of the deceased to the hospital for diagnose and at a later date for treatment and death of the deceased in the hospital, the claim at the first instance for cashless treatment , its rejection, claim made by the complainants for reimbursement, seeking clarification from the complainant, complainant furnishing the details and repudiation of the claim after long time is not at dispute. 

15.   The only contention of the O.P for repudiation of the claim of the complainants is that, complainants and the deceased have suppressed material facts that the deceased suffered stroke and that he was having ILD prior to obtaining the insurance policy as per the notes made by the doctor who treated the deceased and the same is violation of the suppression and non-disclosure of the material facts which is in violation of the principle of Uberrima fides (utmost good faith).

16.   On the other hand, it is the contention of the complainant that at the time of obtaining the policy, though suffering of stroke was intimated to the agent of the O.P, the agent informed them that since the said stroke is a very old one, the same need not be mentioned.  It is further contention of the complainant that though the deceased suffered stroke on his left hand, that was in the year 1995 for which he took treatment for three months and afterwards he served in the judiciary without any break till his retirement and there was no intention for them to not to disclose the same whereas, the same was informed to the agent who informed them that it is not a material fact to be informed as it has taken place in the year 1995.

17.   Further  it is contended by the complainant that the deceased and the complainant were not at all knowing that the deceased was having ILD and it was only detected when the deceased was admitted to the hospital on 20.08.2014 as he was having difficulty in breathing and the frequency of cough increased on that day pursuant to which he was taken to the Apollo  hospital, Jayanagar wherein after the test such as X-ray, CT scan, lung function test were made which was detected that the deceased was having interestial lung disease ILD.  As per the direction of the doctor he had to go for consultation after two weeks.  Even if the deceased was having the ILD prior to the proposal for the policy, it was only detected after the above examination on 20.08.2014 and it was not within the knowledge of the deceased that he was having ILD to inform the O.P. Hence it is the contention of the complainant that repudiation of the policy and denying reimbursement of the medical expenses made by the complainant is illegal, amounts to deficiency in service in terms of the policy conditions and further amounts to unfair trade practice for having received hefty premium in respect of the floater policy. 

18.   On the other hand, it is the specific case of the O.P that though the deceased had stroke, the same was not informed at the time of proposal and further it was within the knowledge of the deceased and the complainant that he was having ILD.  O.P derives its knowledge from the notes of the doctor who treated the deceased that the deceased had shortness of breath since two months i.e. since June 2014 and as per the O.P it falls prior to the inception of the policy. On perusing the documents filed by the O.P the said document which O.P relies regarding the case sheet donot reveal that he was having short of breath prior to two months from 20.08.2014. As per the letter written by the treating doctor, it is made clear that once deceased was evaluated in emergency department on 20.08.2014 with history of breathlessness, dry cough increased in intensity since from 19.08.2014. This was his first consultation in Apollo hospital. He was advised CT test for further evaluation. (2) CT test was done on 22.08.2014 which showed features of ILD (not classical ) UIP pattern,(3) There is no past history ILD before 22.08.2014, (4) CT reports and consultation reports are enclosed (5) History of old stroke/CVA is unrelated and has no association with his present condition and hospitalization.  When this is taken in to consideration, there is no basis for O.P to say that the deceased was having ILD prior to the inception of the policy and it also clear from the report of the doctor that old stroke/CVA is unrelated to and has no association with the present condition and hospitalization.

19.   It is to be borne in mind that, on the request of the O.P only, the 2^nd Complainant informed to the O.P that his father had a stroke in the year 1995 and took treatment for about three months for the same and after words he served the judiciary and retired. From then onwards, he did not take any treatment for the same.  In view of the disclosure by the 2^nd complainant, O.P has come to know that deceased had a stroke.  In the proposal form there is an answer of no for the question “Have you or any member of your family proposed to be insured, suffered or suffering from any disease/ailment/adverse medical condition of any kind especially heart/stroke/cancer/renal disorder. Alzamire disease or parkinsons disease – Yes * No i.e. answer is ‘No’ ”. It is this answer that which is one of the reason for the O.P to repudiate the policy.  As already stated, though it is informed as per the contention of the complainants to the agent, as per his say that it is not material to be disclosed since it has occurred in 1995 the  same was not mentioned in the proposal form.  Though it can be considered as non-disclosure, it cannot be considered as non-disclosure of material facts which is directly affecting to the medical condition of the deceased at the time of taking the treatment. In this connection the Hon’ble Supreme Court of India in Civil Appeal No.5322/2007 it has held that there are three conditions for application for 2^nd part of Section 45 of the Insurance Act which are:

(a) The statement must be on a material matter             or must suppress facts which it was material to disclose.

(b) The suppression must be fraudulently made    by the policy holder and

(c) The policy holder must have known making the statement that it was false or that it suppressed fact which it was material to disclose.

20.   When the above conditions are made applicable to the present facts of the case, since in the year 1995 the deceased had suffered a stroke which is in no way connected to the medical condition of the deceased at the time of making a proposal to obtain the policy cannot be termed as suppressing the facts which it was material to disclose and, no fraudulent intention can be fastened too and that since the agent who has initiated the deceased to obtain policy was sure that when the same if disclosed, the proposal for the insurance would be rejected and thereby the company would loose hefty premium and inturn he would loose the commission has omitted to mention the same and same cannot be termed as false statement and suppressed facts which it was material to disclose .

21.   Further the Hon’ble High Court of Delhi heldin“RFA 610/2016 and CM No.45832/2017 in United India Insurance Co. Vs Jayaprakash Tayal held that exclusionary clause arising from genetic disorders in the policy is violative of Article 14 of the constitution.  As per the directions given, IRDAI has issued directions to all the health companies offering contracts of health insurance that no claim in respect of any existing insurance policy should be rejected based on the exclusion of genetic disorders.  It has also asked insurance companies not to include genetic disorders under the list of exclusion  in respect of policies issued are to be launched in future.

B.4. The fact that there are different types of genetic disorders and even common diseases like diabetes and cardiac diseases could be included in the broad definition, and makes the exclusion vulnerable. In effect, it would mean that large swathes of population would be excluded from availing health insurance which could have a negative impact on the health of a country.

47. It is, therefore, the settled law that if a contract or a clause in a contract is found unreasonable or unfair or irrational, one must look to the relative bargaining power of the contracting parties. In dotted line contracts there would be no occasion for a weaker party to bargain or to assume to have equal bargaining power. He has either to accept or leave the services or goods in terms of the dotted line contract. His option would be either to accept the unreasonable or unfair terms or forego the service for ever. With a view to have the services of the goods, the party enters into a contract with unreasonable or unfair terms contained therein and he would be left with no option but to sign the contract.

E.15. Insurance documents are standard form contracts and usually the insured person signs on the dotted line. It would be extremely tenuous to expect a layman to read each and every clause of an insurance document before signing it. On most occasions, a person who intends to obtain insurance has no choice to say NO to a clause in an insurance policy. Medical insurance is primarily obtained for the purpose of unforeseen medical conditions which may affect a person and so long as there has been no fraud, concealment or suppression, at the time of obtaining insurance, policies ought to be honoured. It is usual to see claimants running from pillar to post in order to get medical reimbursement from insurance companies. This case is no different. In the insurance policy issued to the Plaintiff, no genetic testing was undertaken before hand. This obviously means that the exclusion of genetic disorder is being applied on the basis of family history and not on the basis of a specific test. Such application of exclusion lacks the foundation itself and is untenable. E.16. In every disease, there are four stages- i) prevention, ii) diagnosis & management, iii) cure iv) palliative care in non-curable diseases. Insurance would be required at every stage; diagnostic tests can begin with a simple lab report to complex diagnostic costing thousands of rupees. Management of a disease would include continuous administration of medicines for example in the case of diabetes and blood pressure or use of devices like a pacemaker and ICD in the case of a cardiac condition. Cure of a disease would include medicinal cures & surgical cures. In the case of diseases like cancer, the fourth stage of chemotherapy, medicinal administration and palliative care go hand in hand. To exclude any particular medical condition from availing insurance for any of the above steps in the journey of well- being could lead to loss of life. There could be different terms specified by the insurance company in the case of serious ailments, provided they stand the test of reasonableness and the differentiation is intelligible. E.17. A broad categorization and exclusion of genetic disorders of every and all kind would lead to enormous discretion in the hands of the insurance company to reject genuine claims. The ambiguity and the uncertainty of the precise definition of genetic disorders makes the exclusion too broad. Firstly, exclusion of genetic disorders by itself would be unconstitutional and the broad unqualified exclusion would not stand the test of non- arbitrariness and unreasonableness.

22.   In view of the above decision, the O.P has failed to show to this forum that the non-disclosure of the stroke with the deceased had in the year 1995 has direct nexus to the medical condition which the deceased was having at the time of obtaining the policy and also at the time of the deceased getting himself admitted to the hospital, earlier for checkup, and at a later date, for treatment for ILD. Even the treated doctor has given his clear opinion to the O.P that the CVA/Stroke of the deceased is unrelated to and has no association with deceased’s present condition and hospitalization. 

23.   It is also the case of the O.P that, the deceased was having ILD and he was knowing the same much prior to putting the proposal for insurance.  As already stated, there is no iota of evidence placed by O.P regarding the same.  OP could have got the deceased medically examined since he was having diabetes and hypertension at the time of issuing the policy or acceptance of proposal and  could have got known any other medical ailments and make itself sure that  except the above, there was no medical condition which renders the deceased and his spouse to get the medical Insurance and if there was any, could have rejected the proposal at the thresh hold.  Having accepted the hefty insurance amount of Rs.69,798/- and when the claim was made, O.P has come out with the untenable  reasons and repudiated the insurance which is according to us is highly illegal, improper  which amounts to unfair trade practice and also deficiency in service that too, when the deceased was in a severe deteriorating health condition regarding not allowing cash less admission to the hospital and after words denying the reimbursement of medical expenses.  Hence we answer Point No.1 in the Affirmative.

POINT No.2:

24.   In the result, the complainants are entitle for the amount claimed in the complaint regarding the reimbursement of the medical expenses since O.P has not at all raised any  dispute/objection regarding the amount mentioned therein along with interest at the rate of 12% per annum on the above from the date of claim till the date payment of full amount. It is quite clear for a middle class family whose earning member is under serious health condition admitted to a speciality hospital to arrange for the medical expenses. On one hand the earning member in the hospital and there is no income and on the other hand, though there was a insurance for cashless facility with the O.P, OP has rejected   the same which has put the family members in to great mental agony, tension , stress and to anxious moments in life..  In view of this, we are of the opinion that though the complainants have not quantified the same, which cannot be held that they have not at all undergone mental stress, tension and anxious movements and hence it is just and proper to award a sum of Rs.50,000/- towards the damages and Rs.10,000/- towards the litigation expenses.  The counsel for the O.P has relied on the four following decisions:

“1) MANU/SC/0702/1999 in the SUPREME COURT OF INDIA IN C.A. NO.8716/1997 – ORIENTAL INSURANCE CO. LTD., VS SAMAYANALLUR PRIMARY AGRICULTURAL CO-OP. BANK.

2) MANU/SC/0495/1999 in the SUPREME COURT OF INDIA IN C.A. NO.4913/1997 – ORIENTAL INSURANCE CO. LTD., VS SONY CHERIYAN.

3) CIVIL APPEAL NO.2080 OF 2002 OF SUPREME COURT OF INDIA IN VIKRAM GREENTECH (I) Ltd. & Anr. Vs New India Assurance Co. Ltd.

4) CIVIL APPEAL NO. 6277/2004 OF UNITED INDIA INSURANCE CO. LTD VS. M/S HARCHAND RAI CHANDAN LAL

5) CIVIL APPEAL NO.5322/2007 IN SUPREME COURT OF INDIA OF P.C.CHACKO AND ANOR. S. CHAIRMAN, LIFE INSURANCE COPROPRATION OF INDIA AND ORS.”

25.   We have gone through the said decisions. The same are not applicable and helpful to the since the entire facts and circumstances of both cases are entirely different from the one on hand.  In the result we answer Point No.2 Partly in the Affirmative and pass the following:-

ORDER

1. The Complaint is hereby partly allowed along with cost.
2. The O.P i.e. Star Health and Allied Insurance Company Ltd., Represented by its authorized Signatory is hereby directed to pay a sum of Rs.2,23,248/- along with interest at the rate of 12% per annum from the date of submission of claims i.e., 31.3.2015 till the date of paying full amount to the complainant.
3. Further O.P is hereby directed to pay a sum of Rs.50,000/- towards damages and Rs.10,000/- towards costs of the proceedings.
4. O.P within 30 days from the date of receipt of this order, failing which to pay interest at 12% per annum on the said amount till the payment is made in full.
5.  Send a copy of this order to both parties free of cost.

(Dictated to the Stenographer over the computer, typed by him, corrected and then pronounced by us in the Open Forum on this 24^th Day of SEPTEMBER 2018)

MEMBER                        PRESIDENT

ANNEXURES

1. Witness examined on behalf of the Complainant/s by way of affidavit:

Copies of Documents produced on behalf of Complainant/s:

Doc.No.1: Copy of the health Insurance policy issued by O.P.

Doc.No.2:Copy of letter dated 30.10.2014 issued by the O.P.

Doc.No.3 : Copy of letter dated 30.10.2014 issued by Dr. Ravindra Mehta, Apollo Specialty Hospital, Bangalore.

Doc.No.4: Copy of Discharge Summary dated 03.11.2014 issued by Apollo Specialty Hospital, Bangalore.

Doc.No.5: Copy of the inpatient bill dated 03.11.2014 issued by Apollo Speciality Hospital. Bangalore.

Doc.No.6:Copy of Death summary dated 16.11.2014.

Doc.No.7: Copy of the inpatient bill dated 16.11.2014 issued by Apollo Specialty Hospital, Bangalore.

Doc.No.8: Copy of Death certificate dated 16.11.2014 issued by Chief Registrar of Birth and Death.

Doc.No.9: Copy of Insurance claim form.

Doc.No.10: Copy of Insurance claim Form.

Doc.No.11: Acknowledgment issued by O.P.

Doc.No.12: Acknowledgment issued by the O.P.

Doc.No.13: Letter dated 31.03.2015 issued by the complainant No.2 to the O.P.

2. Witness examined on behalf of the Opposite party/s by way of affidavit:

RW-1: G.Mahadevan, Deputy Manager/Authorized Signatory of O.P.

Copies of Documents produced on behalf of Opposite Party/s

Doc.No.1: Copy of claims rejection letter.

Doc.No.2:  Copy of policy copy with conditions.

Doc.No.3: Copy self declaration letter.

Doc.No.4: O.P sheet and admissions sheet 20.08.2014.

Doc.No.5: Copy of admission sheet dated 28.10.2014.

MEMBER                        PRESIDENT