O R D E R

Sri. P. Satheesh Chandran Nair (President):

                        The complainant filed this complaint u/s.12 of the C.P. Act 1986 for getting a relief against the opposite parties.

                        2. The case of the complainant is stated as follows:  The 1^st petitioner is the mother of the 2^nd petitioner.  One Balakrishna Panicker is the husband of the 1^st petitioner and father of 2^nd petitioner and he who died on 04.01.2014 due to Chronic Liver Disease.  According to 1^st petitioner, she took a policy with the 1^st opposite party during 2010 for a period of one year.  The said policy was having coverage to the 1^st petitioner and her husband the above said Balakrishna Panicker.  The 2^nd opposite party is the person who settle the claim and the 3^rd opposite party is promoting the marketing of the policy of the 1^st opposite party.  The 1^st petitioner was a customer of 3^rd opposite party and due to the instigation and compulsion of the said 3^rd opposite party she had taken the above said policy with 1^st opposite party.  The 1^st petitioner again contended that her husband was admitted in Pushpagiri Medical College Hospital, Thiruvalla and subsequently at Amrutha Institute of Medical Sciences, Kochi then she referred medical claim for the hospital expenses of her husband.  But the 1^st opposite party rejected all the claims.  Aggrieved by the decision of 1^st and 2^nd opposite party, she preferred various representations but at last on 08.05.2014 the 1^st and 2^nd opposite party sent an intimation to the petitioner revealing their inability to consider the claim. The 1^st petitioner submitted that she is a widow and nobody to assist her in such a needy occasion hence she file this petition before this Forum for the redressal of her grievances.  According to the 1^st petitioner, there is no uniformity in the averments made in both the intimation sent by the 2^nd opposite party.  As per the complainant, the intimation dated 02.04.2014 says ‘since the ailment is a pre-existing disease and not after 3 claim free years, the claim is medically repudiated’.  The complainant stated that the deceased was unaware of the existence of any diseases at the time of taking the policy.  The opposite parties are not made any demand with respect to the existence of any pre existing disease at the time of taking the policy.  The petitioner again contended that she has not violated any policy conditions as alleged by the 2^nd opposite party.  According to her, due to the irresponsibility of the opposite party the petitioners were compelled to arrange amount from others to meet the treatment expenses of the diseased.  As a result of the approach of the opposite parties, the petitioners suffered much mental strain, inconvenience and mental agony and all these cannot be compensated by way of money.  According to the petitioners she is eligible for compensation of Rs. 2,50,000/-, and otherwise it will give adverse message to the society.  The opposite parties are jointly and severally liable to pay the compensation stated above.  The cause of action of this case arised on 2010 1^st month on that date the 1^st policy was taken by the petitioner.  The complainant is requested to allow an amount of Rs.2,14,435/- as the claim amount and an amount of Rs.2,50,000/- as compensation of this case.  The complainant filed this case along with certain documents before the Forum.  This Forum peruse the complaint and document produced at the time of filing the complaint ordered to issue notice to the opposite parties and all the opposite parties except 2^nd opposite party entered appearance and 1^st and 3^rd opposite party filed separate versions in this case.  On 22.09.2014 the 2^nd opposite party declared exparte.

                        3. The version of 1^st opposite party in this case is as follows:  According to 1^st opposite party, the complaint is not maintainable either in law or on facts.  As per the 1^st opposite party in Para 6 of the complaint, there is no uniformity in the averments made in both the intimations sent by the 2^nd opposite party is false and hence denied.  It is stated that 1^st opposite party had intimated by letter dated 02.04.2014 the ailment is a pre existing disease, and the letter dated 08.05.2014 it is stated that claim was repudiated on the ground of non revealing of previous ailment.  Anyway, according to 1^st opposite party the claim was repudiated on the ground of pre existing disease.  According to 1^st opposite party, this policy is for a minimum of 36 months, and if anybody having pre existing disease opposite party is not liable to compensate for the pre existing disease.  According to this opposite party, the complainant’s husband was having CLD as a pre existing disease and this was suppressed by the insured at the time of taking the policy.  Moreover, the deceased was also having type II diabetic mellitus and dyslipidemia at the time of taking the policy.  It is stated that insurance is a contract of uberimmae fidei and parties are bound observe utmost good faith.  The policy of the complainant was based on misrepresentation of true state of facts and hence the contract has become void ab initio.  The complainant had answered in the negative of the question relating to pre existing diseases in the proposal form and on the basis on which the policy was issued.  The deceased and the complainant have not disclosed the true state of facts and there has been suppression on their part.  According to this opposite party, there has been no irresponsibility arised on the part of them and there is no cause of actionalso arised against this opposite party as alleged by the complainant.  According to this opposite party, the liability if any is subject the terms, conditions and limitation of the policy.  There has been no deficiency in service or unfair trade practice on the part of this opposite parties.  Hence the 1^st opposite party prayed that the complaint may be dismissed with the cost of this opposite party.

                        4. The 3^rd opposite party filed separate version which is stated as follows:  According to 3^rd opposite party, the petition of the petitioners are not sustainable either in law or on facts.  It is admitted that the 1^st petitioner is a customer of 3^rd opposite party bank.  The 3^rd opposite party is always intract with the customers on the basis of the banking laws and regulations for the transaction of customers.  The bank is always helping these customers for their banking transactions only.  According to the 3^rd opposite party, the bank never persuaded the petitioner to join with the opposite parties as alleged in the petition.  The petitioners has no right to realize any amount from the 3^rd opposite party or this opposite party has not liable to pay any amount to the petitioners as alleged in the petition.  Hence the 3^rd opposite party prayed that this complaint may be dismissed with the cost of that complainant. 

                        5. We peruse the complaint, versions filed by opposite parties 1 and 3 and the records on both sides, we raise the following issues for consideration:

1. Whether the complaint is maintainable before the Forum?
2. If the complaint is maintainable, whether the complainant is succeed to prove the deficiency in service of the opposite parties?
3. Regarding relief and cost?

                      6. On the side of the complainant, PWs.1 to 3 were examined.  Complainant filed proof affidavit in lieu of chief examination and she is examined as PW1 and marked Ext.A1 to A9 and through this PW1 at the time of cross-examination Exts.B1 and B2 also marked.  In order to prove the case of the complainant, she herself adduced evidence as PW1 and marked Exts.A1 to A9 and Ext.A11.  Ext.A1 is the photocopy of Card issued by 1^st opposite party in the name of the complainant’s deceased husband. Ext.A2 is the photocopy of claim form issued by Pushpagiri Medical College Hospital, Thiruvalla.  Ext.A3 is the photocopy of rejection letter dated 06.12.2013 sent by opposite party to Pushpagiri Medical College, Thiruvalla.  Ext.A4 is the photocopy of claim form dated 07.01.2014 issued by 2^nd opposite party in the name of the complainant’s deceased husband.  Ext.A5 is the photocopy of certificate from Pushpagiri Medical College Hospital dated 01.02.2014.  Ext.A6 is the photocopy of letter dated 03.02.2014 send by the 1^st petitioner to 2^nd opposite party.  Ext.A7 is the photocopy of claim form dated 05.02.2014 send by 2^nd opposite party in the name of the complainant’s deceased husband.  Ext.A8 is the photocopy of intimation letter dated 02.04.2014 send by 2^nd opposite party to the complainant.  Ext.A9 is the photocopy of intimation letter dated 08.05.2014 send by 2^nd opposite party to the complainant.  Ext.A10 is the photocopy of certificate dated 01.02.2014 issued by

Dr. Pradeep Kumar, MD, DM, VSM Hospital, Thattarambalam in the name of the deceased Balakrishna Panicker.  Ext.A11 is the policy certificate of Universal Sampo General Insurance Co. Ltd.

            7. On the other hand, opposite parties marked Exts.B1 to B6. Ext.B1 is the Photocopy of medical certificate dated 20.12.2013 issued by Pushpagiri Medical College Hospital, Thiruvalla.  Ext.B2 is the photocopy of the discharge summary of Amrita Institute of Medical Science & Research Centre, Kochi.  Ext.B3 is the photocopy of the policy Schedule (IOB Health Care Plus).  Ext.B4 and B5 are the photocopies of the policy schedule of PW1 dated 02.03.2011 and 01.03.2012 respectively.  Ext.B6 is the photocopy of IOB Health Care Plus proposal form dated 28.02.2011.  

           8. PW2 is an eye witness who witnessed PW1 and 3^rd opposite party at the time of taking the above said policy.  PW3 is a doctor who treated the PW1’s husband for CLD and Ext.A10 is marked through this witness.  Ext.A10 is the medical certificate issued by PW3 in favour of PW1.  Though 1^st opposite party filed version in this case, no oral evidence adduced on their side.  But on 03.06.2015, counsel for 1^st opposite party filed the policy certificate and condition of the said policy certificate and this documents are marked as Ext.B3 series and on 17.06.2015 the counsel produced 3 document for 1^st opposite party that is also marked as Exts.B4 to B6.  After the closing of evidence, complainant and 1^st opposite party filed argument note before the Forum.

            9. Point Nos. 1 to 3:- For the sake of convenience we are considering all the issues together.  It is seen that through PW3 Ext.A10 medical certificate is marked.  As discussed earlier Ext.A11 is the policy certificate of Universal Sampo General Insurance Co. Ltd., (IOB Health Care Plus Policy Schedule) which was issued on 05.03.2013 and the Policy No.2817/51242620/01/B00.  It is also evident to see that 3^rd opposite party the Indian Overseas Bank is the intermediary of this policy.  As per Ext.A11, we come to a conclusion that the complainant is a subscriber of 1^st opposite party’s policy scheme.  If so the complainant is covered under the definition Clause of C.P. Act Sec.2(b) and (d).  Hence Point No.1 found in favour of the complainant.  Ext.A1 is the photocopy of the card issued in favour of the deceased husband of the complainant and it is valid from 28.02.2011.  Ext.A2 shows that the PW1 filed a request for cashless hospitalization as per the medical insurance policy for the treatment charges incurred at Pushpagiri Medical College Hospital, Thiruvalla.  Ext.A3 is the rejection letter dated 06.12.2013 of 1^st opposite party.  It is to see that the reason for the rejection is for ‘alcohol substance abuse and its related complications is not payable by insurance.  Hence cashless access is denied’.  This Ext.A3 is the reply to Ext.A2 request.  Ext.A4 is also a claim form for an amount of Rs.36,103/- along with a copy of the certificate issued on 20.12.2013 by one Dr. Abraham Varghese attached to Pushpagiri Hospital.  Ext.A5 shows that PW1’s husband was admitted in Pushpagiri Medical College Hospital and treated for Cryptogenic Cirrhosis-CLD and for Type 2 DM/DLP/Massiv GI bleed.  This certificate is issued by Dr. Reema Susan Korah attached to Pushpagiri Medical College on 01.02.2014.  Through this Ext.A5 it can be seen that the deceased was not a drunkard and diabetic for 8 years and it is specifically stated that the deceased has not a history of alcoholism.  It is to see that through Ext.A6, this PW1 has written a letter to the 1^st opposite party for condoning the delay of submission of claim in time.  The delay of submission of claim is not at all a matter to be disputed by the other side hence there is no need of considering Ext.A6 for the decision in this case.  As per Ext.A7, it is evident to see that PW1 has preferred a claim form against this opposite party 1 and 2 for an amount of Rs.2,14,435/- on 05.02.2014 for the expenses incurred by her at Amrutha Hospital, Kochi.  The concerned doctor one G. Rajesh also filed a medical certificate to that effect.  Ext.A8 is a letter dated 02.04.2014 to PW1 issued by the authorized person of 1^st opposite party rejecting the claim as per Ext.A7.  It is seen that the claim of PW1 was rejected due to her husband’s CLD with portal hyper tension acute GI bleed/Type 2 DM.  Though it is stated that since 8 years the patient is a known case of type of DM and CLD for 4 years, but there is no convincing evidence produced to see that the statement was true or not.  It is the definite case of PW1 that at the time of joining the said scheme, the deceased husband or the complainant was suffered any kind of chronic diseases as alleged 1^st opposite party.  When we consider the rejection letter, i.e. Ext.A3, the reason stated as “alcohol substance abuse and its related complication was not payable by insurance.  Hence, cashless access was denied”.  When we compare the rejection letter of Ext.A3 and Ext.A8 it is to see that the opposite party has no concrete opinion regarding the rejection of the claim.  It is interesting to see that the Ext.A3 and A8 are self contradictory and the contention of PW1 can be considered as more probable.  Ext.A9 dated 08.05.2014 is also an intimation of rejection of claim due to the reason more or less stated in Ext.A8.

                        10. The complainant examined one Dr. Pradeep Kumar, MD, DM attached to VSM Hospital, Thattarambalam and through him Ext.A10 is marked.  According to him, the deceased was admitted in his hospital with a complaint of Jaundice on 02.01.2014 and also it is evident that the deceased was previously treated in Amrutha Hospital for the same disease.  When PW3 examined in chief examination, he deposed that “ടി രോഗിയുടെ അസുഖം non-alcoholic ആയിരുന്നു.  എൻറെ hospital ല് വച്ച് ടിയാൻ  04.01.2014- ല് മരണപ്പെട്ടു  പോയിട്ടുള്ളതാണ്.  Fatty liver പൊതുവെ കണ്ടുവരുന്ന ഒരു symptom ആണ്  Fatty liver symptom ഉള്ള രോഗി ഒരിക്കലും CLD ആകണമെന്നില്ല.  Fatty liver ബാധിച്ച ആള്ക്ക്  initial stageþÂ symptoms ഒന്നും ഉണ്ടാകാറില്ല.  ESMO എന്ന മരുന്ന് Fatty liverþന് ഉപയോഗിക്കുന്ന മരുന്നല്ല”. Even though 1^st opposite party cross-examined this PW3 nothing brought out to believe the case of 1^st opposite party.  There is no suggestion from 1^st opposite party to see that when this CLD and Type 2 diabetic started in the person of the deceased.  If 1^st and 2^nd opposite party has a definite case regarding the suppression of the above said diseases at the time of filing the proposal for the said insurance scheme, it is to be noted that what prevented them to ask the details regarding the previous alleged diseases through this competent witness.  At the same time, the 1^st and 3^rd opposite parties in this case cross-examined PW1 but nothing brought out to disbelieve her version in the proof affidavit before us or there is no material contradiction brought out as a result of the cross-examination of 1^st and 3^rd opposite parties.  It is interesting to say that though 3^rd opposite party is an active person who involved for the issuance of this insurance certificate to PW1 but through his version and the style of cross-examination this 3^rd opposite party has taken an approach of evading from the responsibilities.  It is already stated above that through Ext.A11 the presence and involvement of the 3^rd opposite party is proved there is no need of believing the stand taken by 3^rd opposite party in this regard.  We do admit that the 1^st opposite party has a definite case that the PW1 has purposefully with ill motive suppressed the chronic diseases of her husband at the time of issuance of Ext.A11 insurance policy.  But at the same time 1^st opposite party has not succeed to prove that this PW1 suppressed the alleged diseases at the time of issuance of Ext.A11.  It is to be noted that Ext.A11 is issued on 06.03.2013 as per Ext.A11 series.  There is no document produced on the side of 1^st opposite party to see that the deceased was under treatment for the said diseases at any hospitals prayer to the issuance of this policy certificate.

                   11.. At the same time, it is to be considered that the opposite party marked Ext.B1 and B2 through the PW1.  In Ext.B1 medical certificate a separate column is there.  In that column the past history is stated as “the deceased was CLD for 4 years, and Type 2 DM and dyslipidemia”.  It is to be noted that except the recording of this diseases through Ext.B1 no sufficient evidence produced from the side of 1^st opposite party to establish his case or to disbelieve PW1’s version in respect of the proposal form for this scheme.  Moreover, the counsel for the petitioner argued that there is every chance of stating the history by the bystanders or any other person before the concerned doctor at the time of admission in hospital. The said probabilities also has to be considered when considering this case.  Ext.B3 series and Ext.A11 series are more or less one and same.  Through this Ext.B3, it is to see that health floater sum insured and personal accident floater sum insured are Rs. 1 lakh each.  Ext.B4 and B5 are policy schedule of PW1 dated 02.03.2011 and 01.03.2012 respectively.  Ext.B6 is the IOB Health Care Plus Proposal Form dated 28.02.2011, through this Ext.B6 the complainant PW1 and the deceased husband Balakrishna Panicker became the insured under the above said policy and 2^nd complainant the daughter of the said insured Surya Balakrishnan is the nominee of this IOB Health Care Plus Proposal Form, i.e. Ext.B6.  When PW2 is examined before this Forum, it is to see that the 3^rd opposite party is only cross-examined this witness and the evidence adduced through this PW2 is unchallengeable against 1^st opposite party.  In PW2’s chief examination, “അന്നുതന്നെ Manager policy documents ഒപ്പിടുവിക്കുന്നത് ഞാൻ നേരില് കണ്ടു.  Manager അസുഖങ്ങള് വല്ലതും ഉണ്ടെങ്കില് അതിൻറെ documents വേണമെന്ന് ആവശ്യപ്പെട്ടില്ല. ഞാൻ 1999 മുതല്  hospitalല് work ചെയ്യുന്ന ആളാണ്”.  The said portion of the testimony of PW1 is unchallengeable against 1^st opposite party and it is also brought out in evidence that the manager not asked any document regarding the diseases at the time of preparing the proposal form.  It is come out in evidence that 3^rd opposite party is a promoter of this policy and if 1^st opposite party has a definite case of previous history of any diseases at the time of joining the policy, what prevented 3^rd opposite party to enquire about it?  The inference in respect of this fact is also comes in favour of PW1.

                   12. The learned counsel appearing for 1^st opposite party filed argument note and the said argument note referred the decision of the Hon’ble National Commission reported in CPJ 2006 Page 239 in Prema Vs. Life Insurance Corporation of India Ltd.  The nut shell of the decision is that the state of health of the insured in the proposal form and the personal statement were the basis of the contract between the parties.  When considering the evidence and circumstances of this case, the 1^st opposite party has not succeed to prove the suppression of health factor at the time of filing the proposal form.  So the decision has no application in this case.  The learned counsel also referred SCC 160 2001(2) the decision of our Hon’ble Supreme Court regarding the same fact.  We found that the Hon’ble Supreme Court decision has not applicable when we consider the nature and circumstances of this case.  On the basis of the finding of the suppression of the pre diseases at the time of taking the policy, we have to find that the citation in SCC 316 2009(8) of our Hon’ble Supreme Court and the decision of Hon’ble National Commission in Life Insurance Corporation of India Vs. Kuldipsingh decided on 03.06.2015 and the other decisions stated in the argument note in Para 14, 15, 16 and 20 are also not applicable when considering the evidence and nature of this case.  It is to be noted that regarding the terms and condition of the policy there is no disputes between the parties. The only dispute is whether the complainant suppressed certain material facts regarding the pre disease of the deceased at the time of taking the said policy.  We do admit that the liability of the policy is limited to Rs. 1 lakh as per Ext.A11.  At the same time, we have to consider whether the opposite party is justified to repudiate the Ext.A3 and A8, i.e. medical benefit proposals.  We find that the opposite party 1 and 2 has committed deficiency in service by repudiating the genuine claim of the complainant.  We have to borne in mind that a policy holder is taking this kind of policy for meeting the expenses of medical treatment etc.  The very name of this policy is, ‘IOB Health Care Plus Policy Schedule’.  So it is the paramount duty of the insurer to give sufficient coverage for meeting the medical expenses for the hospital treatment etc.  The complainant is being a widow and leading a miserable life her grievances has to be considered seriously when deciding her case. As per Ext.A7, the claim is for Rs.2,14,435/-.  The same is accompanied by a certificate issued by the doctor named Dr. G. Suresh, MD of Amrutha Hospital, Kochi.  Either opposite party 1 and 3 did not challenge the genuineness of the Ext.A7 amount at the time of cross-examining the PW1.  Hence the hospital expenses incurred by PW1 as per Ext.A7 is reliable and it can be admitted in evidence. 

                        13. As per Ext.A11, the policy issued on 06.03.2013, and the period of insurance coverage is from 28.02.2013 to 27.02.2014.  The sum assured as per the policy is Rs. 1 lakh and the insured persons are the petitioners (PW1 and her husband deceased Balakrishna Panicker).  As per Ext.A7, the date of admission of the deceased is from 06.12.2013 to 02.01.2014.  Hence it is find that the policy certificate is valid and the deceased admitted in the hospital within the time limit of the policy.  The Ext.A11also explains that what pre-existing condition is ‘any condition ailment or injury or related conditions for which you had signs/symptoms or were diagnosed and or received medical advice/treatment within 36 months prior to your first policy with us’.  It is very clear from the available evidence that the deceased was not treated at any hospital for any kind of diseases stated in the pre-existed condition prior to avail this policy.  If 1^st opposite party has a strong case regarding this aspect, it is the duty of the 1^st opposite party to point out where and whom examined this deceased for any pre-existing disease as alleged.  Another important issue is that if a policy holder suppressed any material fact, it is the duty of the insurer to cancel the policy as per Clause 6 of Ext.A11, “We may cancel this policy sending 15 days notice in writing by recorded delivery to you at your last known address.  However this clause shall not be exercised except on grounds of fraud, moral hazard, misrepresentation, or suppression of any material fact either at the time of taking the policy or any time during the currency of the policy”.

                        14. Though Clause 6 is a mandatory provision it has not complied by the 1^st opposite party.  Here also inference can be taken in favour of the complainant.  When the opposite party failed to prove the pre-existing disease of the deceased then the question to be considered is whether the repudiation of the claim is justifiable or not.  In Clause 11 of Ext.A11, “Pre-Hospitalization and Post Hospitalization expenses will also be reimbursed along with the aforesaid Hospitalization expenses subject to the overall Sum Insured limit of the Insured Person(s).  Any Nursing expenses during pre and post hospitalization will be considered only if Qualified Nurse is employed on the advice of the attending Medical Practitioner for the duration specified”.

                        15.  On the basis of the above discussions and findings, we find that the complainant is deserve to get a reasonable compensation from these opposite parties.  We do admit that 3^rd opposite party is a scheduled bank, functioning as per the provisions of Reserve Bank of India Act.  But at the same time, it is proved that 3^rd opposite party is an active part for enrolling this complainant in this insurance policy.  The 3^rd opposite party is the only person instigated the complainant and as a banker, a layman like this, the complainant totally believe him and join this insurance scheme and he is also liable for the loss and mental injury caused to the complainant.  Hence Point No.2 and 3 also found in favour of the complainant.

           16.  In these circumstances, the complainant is not only eligible for the medical expenses as per this policy but also eligible for a reasonable compensation.  Though the complainant is treated her husband at two important hospital, i.e. Pushpagiri Hospital, Thiruvalla and Amrutha Hospital, Kochi,  he died and lakhs of amount is spent for his survival.  We think that it is the duty of the Forum to consider the pain and sorrows suffered by the petitioner in this case and that grievances has to be properly compensated.

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

1. The opposite parties 1 and 2 are directed to pay an amount of Rs. 1 lakh (Rupees One Lakh only) to the complainants as the insurance amount for the medical treatment of PW1’s husband with 10% interest from the date of filing of this petition within one month of date of receipt of this order.

2. The opposite parties 1 and 2 are also directed to pay a compensation of Rs.50,000/- (Rupees Fifty Thousand only) to the complainants with an interest of 10% from the date of order till the realization.

3. The 3^rd opposite party is also liable to pay an amount of Rs.25,000/- (Rupees Twenty Five Thousand only) as compensation to the complainants from the date of order till its realization with an interest of 10% per annum.

4. A cost of Rs.3,000/- (Rupees Three Thousand only) is allowed to the complainants from opposite party 1 to 3 with an interest of 10% per annum from the date of order till its realization.  (If the opposite parties 1 to 3 pay the above amount within one month of the date of receipt of this order there shall be no interest for the relief 2, 3 and 4).

                   Declared in the Open Forum on this the 06^th day of August, 2015.

                                                                                             (Sd/-)

                                                                            P. Satheesh Chandran Nair,                                                                  

                                                                                                               (President)

Smt. K.P. Padmasree (Member – I)           :   (Sd/-)

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

Appendix:

Witness examined on the side of the complainant:

PW1  :  Sobha Balakrishnan

PW2  :  Jayaraj. S

PW3  :  Pradeep Kumar. P

Exhibits marked on the side of the complainant:

A1  :  Photocopy of the card No.CHE-US-IBOI-000-0048744-B

A2  :  Photocopy of claim form from Pushpagiri Medical College Hospital,    

         Thiruvalla. 

A3  :  Photocopy of the rejection letter dated 06.12.2013 of 1^st opposite party.  A4  :  Photocopy of the claim form dated 07.01.2014 for an amount of  

         Rs.36,103/-. 

A5  :  Photocopy of the certificate dated 01.02.2014 from Pushpagiri Medical  

         College Hospital, Thiruvalla. 

A6  :  Photocopy of letter dated 03.02.2014 send by the petitioner to

         2^nd opposite party.

A7  :  Photocopy of claim form dated 05.02.2014.

A8  :  Photocopy of intimation letter dated 02.04.2014

A9  :  Photocopy of intimation letter dated 08.05.2014

A10 :  Photocopy of certificate dated 01.02.2014 issued by Dr. Dr. Pradeep Kumar, 

          MD, DM, VSM Hospital, Thattarambalam.

A11 :  Policy certificate of Universal Sambo General Insurance Co. Ltd.

Witness examined on the side of the opposite parties:  Nil.

Exhibits marked on the side of the opposite parties:

B1  : Photocopy of medical certificate dated 20.12.2013 issued by Pushpagiri Medical  

        College Hospital, Thiruvalla. 

B2  :  Photocopy of the discharge summary of Amrita Institute of Medical Science &  

         Research Centre, Kochi. 

B3 :  Photocopy of the policy Schedule (IOB Health Care Plus).

B4 & B5  :  Photocopy of the policy schedule dated 02.03.2011 and 01.03.2012

B6 :  Photocopy of IOB Health Care Plus proposal form dated 28.02.2011.

                                                                                                                     (By Order)

                                                                                                   (Sd/-)

                                                                                    Senior Superintendent.

Copy to:- (1) Sobha Balakrishnan, Sobha Nivas, Parumala Muri,

          Kadapra Village.

2. Manager, Universal Sompo General Insu. Co. Ltd.

         A-201 Crystal Plaza, 2^nd Floor, Opp. Infiniti Mall, Link Road,

         Andheri West, Mumbai – 400 058.

3. Manager, TTK Health Care Service Pvt. Ltd.,

         Anmol Palani, 2^nd Floor, 88, G.N. Chetty Road, T. Nagar, Chennai.

               (4) Branch Manager, Indian Overseas Bank, Branch Valanjavattom,

                    Pulikeezhu, Kadapra.

               (5) The Stock File.