{"id":41400,"date":"2011-08-01T00:00:00","date_gmt":"2011-07-31T18:30:00","guid":{"rendered":"https:\/\/www.legalindia.com\/judgments\/m-manivasagam-vs-the-branch-manager-on-1-august-2011"},"modified":"2014-07-05T09:20:25","modified_gmt":"2014-07-05T03:50:25","slug":"m-manivasagam-vs-the-branch-manager-on-1-august-2011","status":"publish","type":"post","link":"https:\/\/www.legalindia.com\/judgments\/m-manivasagam-vs-the-branch-manager-on-1-august-2011","title":{"rendered":"M. Manivasagam vs The Branch Manager on 1 August, 2011"},"content":{"rendered":"<div class=\"docsource_main\">Madras High Court<\/div>\n<div class=\"doc_title\">M. Manivasagam vs The Branch Manager on 1 August, 2011<\/div>\n<pre>       \n\n  \n\n  \n\n \n \n BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT\n\nDated: 01\/08\/2011\n\nCoram\nTHE HONOURABLE  MR. JUSTICE VINOD K. SHARMA\n\nWrit Petition (MD) No.5254 of 2008\nand M.P.(MD)No.1 of 2008\n\nM. Manivasagam,\nS\/o. Maruthanayagam,\nOld No.A-100\/2, New No.45,\nKamala Lakshmi Illam,\nSundarar Street,\nAlagappa Nagar, Madurai.\t\t\t...... Petitioner\n\nVs\n\n1. The Branch Manager,\n     National Insurance Company Ltd.,\n     Branch Office - 1,\n     6, West Masi Street,\n     Madurai - 625 001.\n\n2. The Chief Executive Officer \/\n     The Authorized Officer,\n     Medi Assist India Private Ltd.,\n     No.797, Annapoorna, 10th Main,\n     4th Block, Jaya Nagar,\n     Bangalore - 560 011. \t\t\t...... Respondents\n\n\t\tWrit Petition filed under Article 226 of the Constitution of India\npraying for issuance of a Writ of Certiorarified Mandamus to call for the\nrecords relating to the impugned order passed by the second respondent in his\nproceeding dated 25.04.2008 and quash the same, consequently direct the\nrespondents to pay a sum of Rs.1,41,406\/- as per the Medi Claim Policy.\n\n!For Petitioner\t... Mr. D. Saravanan\n^For Respondents... Mr. S.  Ramachandran\n- - - - - - - -\n:ORDER\n<\/pre>\n<p>\t\tThe petitioner has approached this Court, with a prayer for issuance<br \/>\nof a Writ, in the nature of Certiorari, for quashing the order dated 25.04.2008,<br \/>\nvide which the medical claim of the petitioner under the Insurance Policy stands<br \/>\nrepudiated by the respondent company.\n<\/p>\n<p>\t\t2. The petitioner was insured under the Scheme of Medical Claim<br \/>\nPolicy in the year 2001, and the policy was subsequently renewed regularly. The<br \/>\npolicy was in force from 01.12.2008 to 30.01.2009.\n<\/p>\n<p>\t\t3. The policy taken out by the petitioner was to cover unexpected<br \/>\nhospital expenses, sudden illness, injury, disease and other domiciliary<br \/>\nhospitalization.\n<\/p>\n<p>\t\t4. It is the case of the petitioner, that the petitioner felt Chest<br \/>\npain on 03.08.2007, and accordingly, approached his family Doctor, who advised<br \/>\nthe petitioner to undergo a test of Coronary Angiogram. As per the result of the<br \/>\nAngiogram, the petitioner was advised to undergo a bye-pass surgery. The<br \/>\npetitioner was in the very serious state at that time.\n<\/p>\n<p>\t\t5. The case of the petitioner, is that it was only after<br \/>\nhospitalization, that he had come to know that he had pre-existing disease<br \/>\ncalled &#8220;Diabetic Mellitus&#8221;. The petitioner, after undergoing surgery, filed the<br \/>\nclaim with the Insurance Company.\n<\/p>\n<p>\t\t6. As the petitioner was denied cash less hospitalization, the<br \/>\npetitioner filed W.P.No.8331 of 2007. On notice, the Insurance Company took a<br \/>\nstand, that the petitioner had approached this Court, without raising claim with<br \/>\nthe Insurance Company. In the counter affidavit, the respondents had undertaken<br \/>\nto consider the claim of the petitioner when submitted. The petitioner, was<br \/>\ndirected to submit his claim by supporting documents to the Insurance Company,<br \/>\nwithin a period of one week of the receipt of a copy of the order, with a<br \/>\ndirection to be considered it in the terms of Medical Claim Policy taken out by<br \/>\nthe petitioner.\n<\/p>\n<p>\t\t7. The petitioner accordingly filed the claim, vide the impugned<br \/>\norder, the claim of the petitioner stands rejected.\n<\/p>\n<p>\t\t8. The impugned order reads as under:-\n<\/p>\n<p>\t\t&#8220;Dear Insured,<br \/>\n\t\t\tSubject: Liability Under Your Policy<br \/>\n\t\tWe confirm receipt of your claim as per the reference given above.<br \/>\nWe state our inability to admit liability due to the following:<br \/>\nClause<br \/>\nDescription<br \/>\n4.1<br \/>\nAll diseases \/ injuries which are pre-existing when the cover incepts for the<br \/>\nfirst time. For the purpose of applying this condition, the date of inception of<br \/>\nthe initial mediclaim policy taken from any of the Indian insurance Companies<br \/>\nshall be taken, provided the renewals have been continuous and without any<br \/>\nbreak.\n<\/p>\n<p>\tThe insurance policy was taken for the first time on 06.11.2011, in 2003<br \/>\nthe policy was renewed on 01.12.2003 with a break, hence this policy is to be<br \/>\nconsidered as fresh policy and continuous policy coverage is taken from this<br \/>\ndate only as per Insurance rule. The Diabetes Mellitus of over six years has a<br \/>\ndefinite bearing to this claim as hypertension and diabetes mellitus are<br \/>\nconsidered to have damaging effects especially on the blood vessels of the vital<br \/>\norgan like heart, Kidney and eyes. Diabetes Mellitus being pre-existing and a<br \/>\nmajor life-long ailment related to damage of the coronaries is a complication of<br \/>\nthe pre-existing ailment as per the Insurance Policy clause 4.1. Therefore, we<br \/>\nexpress our inability to admit this liability under this claim as the claims<br \/>\nfalls under clause 4.1 of the policy (pre-existing ailment with related<br \/>\ncomplicates) and the non-disclosure clause of the policy.<br \/>\n\tIn case you have further facts or information to substantiate your claim,<br \/>\nplease forward the same to us.&#8221;\n<\/p>\n<p>\t\t9. The petitioner challenged the impugned order on the ground that<br \/>\nthe stand taken by the Insurance Company, is contrary to the earlier stand taken<br \/>\nbefore this Court, as at that time, the eligibility was not disputed.\n<\/p>\n<p>\t\t10. The contention of the learned counsel for the petitioner is,<br \/>\nthat the stand of the respondents now is an attempt to deny the claim of the<br \/>\npetitioner under the Medical Claim Policy.\n<\/p>\n<p>\t\t11. It is also the contention of the learned counsel for the<br \/>\npetitioner, that the reasons recorded, are wrong, as the petitioner did not<br \/>\nsuppress any material from the Insurance Company, while taking out the Medical<br \/>\nClaim Policy.\n<\/p>\n<p>\t\t12. The case of the petitioner, is that in Column 17, it was<br \/>\ncategorically mentioned that petitioner suffers from &#8220;Diabetus Meletus&#8221;, which<br \/>\nat the time of renewal, was again reasserted.\n<\/p>\n<p>\t\t13. Learned counsel for the petitioner placed reliance on the<br \/>\nJudgment of the Hon&#8217;ble Supreme Court in the case of LIFE INSURANCE CORPORATION<br \/>\nOF INDIA AND OTHERS ..VS.. ASHA GOEL (SMT) AND ANOTHER (2001 (2) S.C.C. 160) to<br \/>\ncontend that the writ petition against the Insurance Company was competent.\n<\/p>\n<p>\t\t14. It is also the contention of the learned counsel for the<br \/>\npetitioner, that suppression by policy holder must be fraudulent, and mere<br \/>\ninaccuracy or falsity cannot be a ground to deny the benefit under the policy.<br \/>\nIt is thus contended that the impugned order cannot be sustained.\n<\/p>\n<p>\t\t15. The learned counsel for the petitioner placed reliance on the<br \/>\nJudgment of the Hon&#8217;ble Supreme Court in BIMAN KRISHNA BOSE ..VS.. UNITED INDIA<br \/>\nINSURANCE CO., LTD., AND ANOTHER (2001 (6) S.C.C. 477) wherein the action of the<br \/>\nInsurance Company, refusing to renew the policy was held to be bad in law.\n<\/p>\n<p>\t\t16. It is the contention of the learned counsel for the petitioner,<br \/>\nthat the Insurance Company is State, within the meaning of Article 12 of the<br \/>\nConstitution of India, thus amenable to Writ jurisdiction.\n<\/p>\n<p>\t\t17. This writ petition is opposed by the learned counsel for the<br \/>\nrespondents, by contending that disputed question of facts have been raised<br \/>\nregarding the suppression of material facts while taking out the policy.\n<\/p>\n<p>\t\t18. It is also the contention of the learned counsel for the<br \/>\nrespondents, that contrary stand has been taken by the petitioner, as one side<br \/>\nit is stated that the petitioner came to know about the factum of suffering from<br \/>\n&#8220;Diabetic Mellitus&#8221; only after hospitalization, whereas now the stand is that<br \/>\nthe factum was not suppressed.\n<\/p>\n<p>\t\t19. On consideration, I find that the writ petition is not competent<br \/>\nbefore this Court. It cannot be disputed that the Insurance Company is &#8220;STATE&#8221;<br \/>\nwithin the meaning of Article 12 of the Constitution of India, therefore,<br \/>\namenable to writ jurisdiction, but at the same time, the disputed question of<br \/>\nfacts cannot be gone into in the writ petition, as the remedy with the<br \/>\npetitioner is to take out appropriate proceedings before the Consumer Court,<br \/>\nregarding the deficiency in service or appropriate Civil remedy, in accordance<br \/>\nwith law, where disputed question of facts can be gone into.\n<\/p>\n<p>\t\t20. This Court, in exercise of writ jurisdiction cannot adjudicate<br \/>\nthe disputed question of facts.\n<\/p>\n<p>\t\t21. Consequently, this writ petition is dismissed as not<br \/>\nmaintainable. The liberty is granted to the petitioner to avail his alternative<br \/>\nlegal remedy, in accordance with law.\n<\/p>\n<p>\t\t22. The petitioner has been prosecuting his remedy before this Court<br \/>\nbonafide since 2008. In case, the petitioner chooses to avail alternative<br \/>\nremedy, he shall be entitled to the benefit of Section 14 of the Limitation Act,<br \/>\nin those proceedings.\n<\/p>\n<p>\t\tNo costs. Consequently, the connected M.P.(MD)No.1 of 2008 is<br \/>\nclosed.\n<\/p>\n<p>Dpn\/-<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Madras High Court M. Manivasagam vs The Branch Manager on 1 August, 2011 BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT Dated: 01\/08\/2011 Coram THE HONOURABLE MR. JUSTICE VINOD K. SHARMA Writ Petition (MD) No.5254 of 2008 and M.P.(MD)No.1 of 2008 M. Manivasagam, S\/o. Maruthanayagam, Old No.A-100\/2, New No.45, Kamala Lakshmi Illam, Sundarar Street, Alagappa [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[8,13],"tags":[],"class_list":["post-41400","post","type-post","status-publish","format-standard","hentry","category-high-court","category-madras-high-court"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>M. 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