IN THE HIGH COURT OF KERALA AT ERNAKULAM PRESENT : THE HONOURABLE MR. JUSTICE ANTONY DOMINIC TUESDAY, THE 9TH NOVEMBER 2010 / 18TH KARTHIKA 1932 WP(C).No. 33846 of 2010(E) ------------------------- PETITIONER : ------------------ SAPNA K.P. KULAPARAMBATHU HOUSE, KODIYURA PO, KALLACHI, KOZHIKODE DISTRICT-673 507. BY ADV. SRI. C.R. SIVAKUMAR RESPONDENT(S): ------------------------- 1. UNITED INDIA INSURANCE CO.LTD., REP.BY ITS GENERAL MANAGER, REGD & HEAD OFFICE, 24, WHITES ROAD, CHENNAI-600014. 2. THE BRANCH MANAGER, THE UNITED INDIA INSURANCE CO.LTD., P.B.NO.17, CITY COMPLEX, NEAR OLD BUS STAND, MAIN ROAD, VADAKARA, KOZHIKODE DISTRICT, PIN-673 101. 3. THE BRANCH MANAGER, T.T.K.HEALTH CARE TPA PVT.LTD., 39-4130, MAREENA BUILDING, M.G.ROAD, ERNAKULAM, COCHIN-682 016. BY THIS WRIT PETITION (CIVIL) HAVING COME UP FOR ADMISSION ON 09/11/2010, THE COURT ON THE SAME DAY DELIVERED THE FOLLOWING: Mn ANTONY DOMINIC, J. ``````````````````````````````````````````````````````` W.P.(C) No. 33846 of 2010 E ``````````````````````````````````````````````````````` Dated this the 9th day of November, 2010 J U D G M E N T Petitioner had subscribed a mediclaim policy with the respondents. Petitioner underwent ASD Closure Surgery in a private hospital. Thereupon, she made an application for medical reimbursement of the expenses. By Ext.P8, the third respondent, who is stated to be an agent of respondents 1 and 2, informed the petitioner that the case papers from the hospital prior to her admission showed diagnosis as congenital heart disease and that such ailments are not excluded under clause 4.1 of the policy. It is on receipt of Ext.P8, this writ petition has been filed, seeking to direct the respondents to process Ext.P5 claim of the petitioner and give her the benefit of the policy. 2. As already seen, reason for rejection of her claim is that it was excluded by Clause 4.1 of Ext.P1 policy. Clause 4.1 of Ext.P1 policy shows that all congenital diseases W.P.(C) No.33846/10 : 2 : (internal and external) are excluded from the purview of the policy. Therefore, if the records show that the disease of the petitioner was a congenital disease, the respondents cannot be faulted for the view they have taken. 3. On the other hand, counsel for the petitioner contended that the said conclusion is incorrect and that the disease of the petitioner was not a congenital disease. It is his contention that if it was a congenital disease, the petitioner would not have lived so long. This is a matter which cannot be pronounced in a writ petition. If as claimed by the petitioner, the disease is not a congenital disease, it will have to be established by the petitioner based on facts and evidences which exercise is not possible in a writ petition. Therefore, the relief sought for cannot be granted in this writ petition. Writ petition fails and it is dismissed. Sd/- (ANTONY DOMINIC, JUDGE) aks