Kerala High Court
New India Assurance Co.Ltd vs Jayasree K.G on 5 March, 2025
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W.P.(C) No.29393 of 2019
2025:KER:18713
IN THE HIGH COURT OF KERALA AT ERNAKULAM
PRESENT
THE HONOURABLE MR. JUSTICE HARISANKAR V. MENON
WEDNESDAY, THE 5TH DAY OF MARCH 2025 / 14TH PHALGUNA, 1946
WP(C) NO. 29393 OF 2019
PETITIONER:
NEW INDIA ASSURANCE CO.LTD.
KALAMASSERY BRANCH, REPRESENTED BY ITS ASSISTANT
MANAGER, REGIONAL OFFICE, M.G.ROAD, ERNAKULAM.
BY ADVS.
GEORGE CHERIAN (SR.)
K.S.SANTHI
ALEXY AUGUSTINE
LATHA SUSAN CHERIAN
RESPONDENT:
JAYASREE K.G.
MULLAPILLY HOUSE, KORATTY SOUTH P.O.,
PIN-680 308, REPRESENTING HER DAUGHTER
LAKSHMIPRIYA.
BY ADVS.
SRI.T.K.KOSHY
SMT.V.V.RISANI
THIS WRIT PETITION (CIVIL) HAVING BEEN FINALLY HEARD ON
05.03.2025, THE COURT ON THE SAME DAY DELIVERED THE
FOLLOWING:
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W.P.(C) No.29393 of 2019
2025:KER:18713
JUDGMENT
The petitioner, an insurance company, has filed the captioned writ petition, challenging the findings contained in Ext.P6 order issued by the Permanent Lok Adalth, in a claim filed by the sole respondent herein.
2. The respondent herein has filed Ext.P1 petition before the Permanent Lok Adalath, with reference to the provisions of Section 22 of the Legal Service Authorities Act, 1987, pointing out that her minor daughter was having recurrent attacks of severe headache/eye pain as well as vomiting since December, 2017, that she was under treatment with the L.F. Hospital, and that she was directed to consult an expert Ayurvedic Physician, on account of which, her daughter was admitted to "Sreedhareeyam Eye Hospital, Koothattukulam" for treatment. It is on the basis of the treatment carried out from 11.08.2018 to 24.08.2018, the claim was presented before the petitioner herein, which stood repudiated on the basis of Ext.P5, placing reliance on Clause 4.4.2 of the Insurance Policy. The Lok Adalath, by Ext.P6 Award, found favour with the respondent herein and decided the issue in favour of the respondent.
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2025:KER:18713
3. It is in such circumstances that the captioned writ petition is filed by the petitioner, challenging Ext.P6 issued by the Permanent Lok Adalath.
4. I have heard Sri.George Cherian, the learned Senior Counsel for the petitioner and the learned counsel for the respondent herein.
5. The short issue arising for consideration in this writ petition is with reference to the findings contained in Ext.P6.
6. The facts are not in dispute. The respondent claimed the benefit of the insurance policy obtained from the petitioner herein, with respect to the treatment carried out for her daughter with an Ayurvedic Hospital. It may straightaway be noticed that the respondent admits that her daughter was originally treated at L.F. Hospital, and later on, on the basis of the expert advice, she was admitted and treated at Sreedhareeyam Eye Hospital. The claim was presented on the basis of Ext.P3 filled by the Hospital wherein the treatment was carried out. The details of the ailment diagnosed and the treatment carried out in the Hospital were with reference to "Myopic Astigmatism/Hruswadrushti". It is on the basis of the afore treatment, the respondent claims that the 4 W.P.(C) No.29393 of 2019 2025:KER:18713 petitioner was bound to honour the insurance policy.
7. At this juncture, a reference to Clause No.4.4.2 of the insurance policy would be relevant, and the same reads as under;
"a. Circumcision unless necessary for treatment of an illness not excluded hereunder or as may be necessitated due to an accident b. Change of life or cosmetic or aesthetic treatment of any description such as correction of eyesight, etc. c. Plastic Surgery other than as may be necessitated due to an accident or as a part of any illness."
A reference to the afore insurance policy, which has not been disputed by the respondent also, shows that certain types of treatment for illness are excluded from the purview of the claim. Clause (b) of the afore shows that treatment carried out for "change of life/cosmetic/aesthetic" descriptions such as correction of eyesight etc. is not entitled for the benefit of the insurance claim. The learned counsel for the respondent would contend that the term "correction of eyesight" is to be read along with the terms "cosmetic or aesthetic", and insofar as the correction of eyesight, even if admitted, was not with reference to any cosmetic or aesthetic treatment, the respondent was entitled for the insurance claim. True, at the first blush, the afore contention appears to be 5 W.P.(C) No.29393 of 2019 2025:KER:18713 attractive. However, I notice that, apart from cosmetic/aesthetic treatment, treatments which are in the nature of "change of life"
are also covered by Clause No.4.4.2 relied on by the petitioner. In such circumstances, the correction of eyesight has to be only regarded as one making changes in the life of the respondent's daughter.
8. In such circumstances, the claim made by the respondent, as seen described in Ext.P3, would show that the treatment carried out is with respect to Myopic Astigmatism/ Hruswadrushti. This can only be considered as one making changes to the life of the patient concerned. In such circumstances, the exclusion Clause No.4.4.2 referred to above would certainly apply.
9. In this connection, I take note of the contention raised by the learned counsel on the basis of Ext.P4 certificate issued by the Hospital dated 23.10.2018. The afore certificate makes reference to the details of the treatments carried out and the symptoms which were treated as above.
10. However, the claim was on the basis of Ext.P3 and Ext.P4 can only be considered as supplementing the claim on the 6 W.P.(C) No.29393 of 2019 2025:KER:18713 basis of Ext.P3. On a reading of Ext.P4 also, I am of the opinion that the treatment carried out with respect to the respondent's daughter was for correction of eyesight and would ultimately change the life of the patient concerned.
11. In such circumstances, I am of the opinion that the respondent herein was not entitled for the claim on the basis of Clause No.4.4.2 relied on by the petitioner herein.
12. Resultantly, the findings in Ext.P6 in favour of the respondent cannot be sustained.
Therefore, the writ petition would stand allowed, setting aside Ext.P6.
Sd/-
HARISANKAR V. MENON JUDGE anm 7 W.P.(C) No.29393 of 2019 2025:KER:18713 APPENDIX OF WP(C) 29393/2019 PETITIONER'S EXHIBITS EXHIBIT P1 TRUE COPY OF THE PETITION O.P.NO.69/19 SUBMITTED BY PETITIONER.
EXHIBIT P2 TRUE COPY OF THE WRITTEN STATEMENT FILED BY THE PETITIONER IN O.P.NO.69/19.
EXHIBIT P3 TRUE COPY OF THE CLAIM FORM SUBMITTED BY THE PETITIONER.
EXHIBIT P4 TRUE COPY OF THE CERTIFICATE ISSUED BY SREEDHARIYAM HOSPITAL DATED 23.10.18.
EXHIBIT P5 TRUE COPY OF THE LETTER DATED 24.9.18. EXHIBIT P6 TRUE COY OF THE ORDER OF PERMANENT LOK ADALATH DATED 9.10.2019.