WP(C) NO. 27088 OF 2022 1 2025:KER:25853 IN THE HIGH COURT OF KERALA AT ERNAKULAM PRESENT THE HONOURABLE MR. JUSTICE D. K. SINGH TUESDAY, THE 25TH DAY OF MARCH 2025 / 4TH CHAITHRA, 1947 WP(C) NO. 27088 OF 2022 PETITIONER: NEW INDIA ASSURANCE COMPANY LTD. REGIONAL OFFICE, 36/707, KANDAMKULATHY TOWERS, M.G.ROAD, ERNAKULAM DISTRICT - 682 011 REPRESENTED BY ITS ASSISTANT MANAGER. BY ADVS. GEORGE A.CHERIAN K.JACOB MATHEW RESPONDENTS: 1 NAZEER A.M. ALIAS NASEER MOIDU, S/O.LATE A.A.MOIDU, AMBAKATH HOUSE, MARAKKADAVU, MATTANCHERY P.O., ERNAKULAM DISTRICT - 682 002. 2 HON'BLE PERMANENT LOK ADALATH ERNAKULAM (FOR PUBLIC UTILITY SERVICES). BY ADVS. REJI GEORGE George R.P.SREENIVASAN(K/001068/2016) VARNA MANOJ(K/552/2016) SAISANKAR.S(K/002188/2021) THIS WRIT PETITION (CIVIL) HAVING COME UP FOR ADMISSION ON 25.03.2025, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING: WP(C) NO. 27088 OF 2022 2 2025:KER:25853 JUDGMENT Dated this the 25th day of March, 2025 The petitioner Insurance company has approached this Court under Article 226 of the Constitution of India impugning the award dated 21.07.2022 passed by the Permanent Lok Adalat at Ernakulam (for Public Utility Services) in O.P No.10558/2020 filed by the respondent. 2. The Permanent Lok Adalat in the impugned award has directed the petitioner insurance company to pay a sum of Rs.1,06,841/- towards full and final settlement of the claim of the respondent for medical reimbursement under the policy taken by the respondent within the period of two months from the date of receipt of a copy of the award, failing which the award amount should carry interest at the rate of 9% from the date of the petition till realization from the petitioner. 3. The learned counsel for the petitioner submits that the respondent had taken the medical policy from WP(C) NO. 27088 OF 2022 3 2025:KER:25853 the petitioner insurance company initially from 08.11.2016 to 07.11.2017. The said policy has some exclusion clauses in para 4.3.1, which states as under: “4.3.1. Unless the insured person has continuous coverage in excess of twenty-four months, expenses on treatment of the following illnesses are not payable. 1. All Internal and external benign tumours, cysts, polyps of any kind, including benigh breast lumps. 2. Benign ear, nose throat disorders. 3. Benign prostate hypertrophy 4. Cataract and age related eye ailments 5. Diabetes Mellitus 6. Gastric/Duodenal Ulcer 7. Gout and Rheumatism 8. Hernia of all types 9. Hydrocele 10. Hypertension 11. No Infective arthritis 12. Piles, Fissures and Fistula in anus 13. Pilonidal sinus, Sinusitis and related disorders 14. Prolapse inter Vertebral Disc and spinal Diseases unless arising from accident 15. Skin Disorders 16. Stone in Gall Bladder and Bile duct, excluding malignancy 17. Stones in Urinary system 18. Treatment for Menorrhagia/Fibromyoma, Myoma and Prolapsed uterus 19. Varicose Veins and Varicose Ulcers Note: Even after twenty four months of Continuous Coverage, the above illnesses will not be covered if they arise from a Pre- existing condition, until 48 months of Continuous Coverage have elapsed since inception of the first policy with the company.” 4. It is submitted that the respondent is suffering from Upper Airway Obstruction, and this disease is WP(C) NO. 27088 OF 2022 4 2025:KER:25853 exempted from reimbursement if it is detected and treatment is taken within 24 months of taking the policy. It is submitted that the respondent was diagnosed with the disease of Upper Airway Obstruction within 8 months of taking the policy, and therefore, he is not entitled for reimbursement of the amount of medical expenses incurred by him. 5. The Permanent Lok Adalat has held that the exclusion clause relied on by the petitioner company would not be applicable inasmuch as the respondent was never made aware of such a clause and the said terms and conditions were not supplied to him. 6. As the respondent was not made aware of the terms and conditions of the exclusion, the repudiation of the claim placing reliance on such an exclusion clause has been found to be illegal. The Permanent Lok Adalat further come to the conclusion that the respondent has preferred the claim within the period of three years from WP(C) NO. 27088 OF 2022 5 2025:KER:25853 the date of the cause of action ie., from the date of repudiation and therefore, the claim was well within the time. Thus, the Permanent Lok Adalat has allowed the claim petition and directed the petitioner company to pay a sum of Rs.1,06,841/- along with interest as mentioned above. 7. The learned counsel for the petitioner has placed reliance on the judgment of the Hon’ble Supreme Court in the Case of Export Credit Guarantee Corporation of India Limited v. GARG Sons International [(2014) 1 SC 686] which has no relevance. I have considered the submissions and gone through the impugned award passed by the Permanent Lok Adalat. This Court under Article 226 of the Constitution of India would not be required to re- appreciate evidence laid by the parties before the Permanent Lok Adalat. This Court is required to consider that whether there is any gross illegality committed or WP(C) NO. 27088 OF 2022 6 2025:KER:25853 the award is without jurisdiction. This Court does not find that the award passed by the Permanent Lok Adalat are such, which can be said to be perverse. The award is a well-reasoned award. Every aspect and contentions have been considered by the Permanent Lok Adalat in a detailed manner, and I do not find that the findings recorded by the Permanent Lok Adalat are such which can be said to be perverse. Thus, there is no scope to interfere with the well-reasoned award. The present writ petition is hereby dismissed, without cost. Sd/- D. K. SINGH JUDGE AP WP(C) NO. 27088 OF 2022 7 2025:KER:25853 APPENDIX OF WP(C) 27088/2022 PETITIONER EXHIBITS Exhibit P1 TRUE COPY OF O.P.NO.10558/2020 OF PERMANENT LOK ADALATH, ERNAKULAM. Exhibit P2 TRUE COPY OF THE WRITTEN STATEMENT DATED 5/8/2011 BEFORE THE PERMANENT LOK ADALATH, ERNAKULAM. Exhibit P3 TRUE COPY OF THE LETTER DATED 1/1/18 ISSUED BY THE PETITIONER COMPANY TO RESPONDENT. Exhibit P4 TRUE COPY OF THE POLICY WITH TERMS AND CONDITIONS. Exhibit P5 TRUE COPY OF THE AWARD DATED 21/7/22. RESPONDENT EXHIBITS Exhibit R1(a) The true copy of the deposition of the 1st Respondent dt. 10.01.2022 in O.P. No. 10558/2020 on the files of the 2nd Respondent Exhibit R1(b) The true copy of the proceedings dt. 18.02.2022 in O.P. No. 10558/2020 on the files of the 2nd Respondent Exhibit R1(c) A TRUE COPY OF PROOF AFFIDAVIT FILED IN LIEU OF THE CHIEF EXAMINATION AND AN ENGLISH TRANSLATION OF THE SAID EXT.R1 (A) DEPOSITION