Sandeep Mehta, J.- Through this writ petition under Articles 226/227 of the Constitution of India, the petitioner insurance company has approached this court for assailing the judgment dated 04.01.2018 passed by the Permanent Lok Adalat, Jodhpur in Case No.2/2016, whereby, while accepting the application filed by the respondent Mr. Narendra Mehta under Section 22-B of the Legal Services Authorities Act, 1987, whereby the petitioner insurance company was directed to honour the medical reimbursement claim submitted by the respondent against the mediclaim insurance policy.
2. Mr. Jagdish Vyas, learned counsel representing the petitioner insurance company, vehemently urged that the respondent was suffering from hypertension and had not completed the waiting period of two years in terms of the condition No.4.2 of the insurance policy and as such, his claim was rightly repudiated. He, thus, urges this court to exercise its extraordinary/supervisory writ jurisdiction and quash the impugned order as being grossly bad in the eye of law.
3. Per contra, Mr. Anil Bhandari, Advocate, representing the respondent, submits that the respondent had taken the mediclaim insurance policy, during currency whereof, he suffered severe Angina pain, whereafter, he was taken to the Surana Hospital and Research Center, Mumbai, and was subject to Coronary Artery Bypass Graft (CABG) surgery. He contends that the cause of CABG surgery was not directly related to hypertension being suffered by the respondent, which is simply a lifestyle disease. He further submits that the claim filed by the respondent was not for the expenses borne for the treatment of hypertension, hence, could not have been repudiated.
4. I have given my thoughtful consideration to the arguments advanced at bar and gone through the impugned award and the original record and more particularly, the conditions of the mediclaim insurance policy issued by the petitioner.
5. Clause No.4.2 of the insurance policy, on which much reliance was placed by Mr. Vyas, postulates that the expenses on treatment of ailments/diseases/surgeries mentioned thereafter would not be payable for the specified period, if such disease is contracted or manifested during currency of the policy. CABG surgery is not amongst the list of diseases included in clause 4.2 of the mediclaim insurance policy. Hypertension has been included in the said schedule and waiting period thereof has been mentioned as two years. This court is of the firm opinion that exclusion of the CABG from the schedule appended to clause 4.2 is a conscious decision of the insurance company because there is no such medical protocol that a person ahving hypertension would invariably be required to undergo CABG surgery. This surgery is required when symptoms of coronary artery blockage are manifested in a patient. Hypertension may be one of the factors leading of Angina followed by CABG surgery, but cannot be considered to be a conclusive. There is no reason to believe that hypertension alone can be the sole contributory factor requiring such treatment. Manifestly, the bills provided to the petitioner insurance company, for which reimbursement was sought by the respondent, only pertain to the bypass procedure undertaken by the respondent at the Surana Hospital and Research Center. As CABG is not amongst the list of exclusions mentioned in clause 4.2, manifestly, the claim filed by the respondent for such surgical procedure could not have been repudiated. The Permanent Lok Adalat exercised the jurisdiction vested in it in a perfectly just and legal fashion while passing the impugned judgment dated 04.01.2018, which does not suffer from any illegality, irregularity or perversity warranting interference in exercise of supervisory writ jurisdiction of this court.
6. Hence, the writ petition as well as the stay petition are dismissed as being devoid of merit.
7. The record be returned to the court concerned forthwith.
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