Before Sir. expert/ Mohamed Isaac Mohamed Khan,

An explanatory memorandum for defense

In the lawsuit no 70 / 2017 (plenary commercial)

Presented by:

The defender: The New India Insurance Company LLt.

Legally represented by advocate: Mohamed Mahmoud Al Marzooqi.

Versus;

The plaintiff: Ras Al Khima Hospital

Legally represented by advocate: Al Naemi Law Firm

Facts brief.........

The incidents of this case is briefed as shown in its file, so no need to repeat the same in order to save the time and effort of this honorable court

The defense .........

Whereas it was proved by reviewing the attached claim statement and the documents presented by the plaintiff was of any correct facts, without any proof and violates the law, so it became worthy of refusal because of several grounds as follows:

Firstly;

The defender adheres to no covering the accident by its insurance policy, and that the physician caused the accident was not included in the insurance coverage. The proof; the schedule of doctors included by the insurance coverage by virtue of the insurance policy didn't contain the name of the mentioned doctor ( Ola Mahmoud Al Tokhy )

We kindly present the attached document no (1) the insurance policy with its translated copy, also the attached document no (2) schedule of doctors included by the insurance coverage, which proves that the doctor caused the accident ( Ola Mahmoud Al Tokhy) was not included therein, and her name is not stated in schedules of employees included by the insurance coverage.

Whereas the policy coverage was limited to doctors, nurses and employees included by the insurance coverage, Who are strictly nominated by the attached schedules.

Whereas the name of doctor ( Ola Mahmoud Al Tokhy) wasn't stated in the above-mentioned schedules, hence she is not included in the insurance coverage. So the claim totally worthy of refusal.

Secondly;

In addition to our adhesion to bring the doctor caused the accident (Ola Mahmoud Al Tokhy) is not included in the insurance coverage and that her name is not stated in schedules of employees included by the insurance coverage, the plaintiff alleged in its statement of claim that during the period of applying the insurance policy, an error occurred by one of its doctor during a delivery process which arranged responsibility to the plaintiff. But, by reviewing the case documents and evidences, we find that the plaintiff didn't present any proof or evidence to prove the essence of the accident or medical malpractice, and what are the procedures taken in concern, and what are the lawsuits or reports processed in concern.

Whereas the plaintiff didn't present any proof or evidence to prove the incidents and what strictly happened, and what is the essence of its responsibility or compensations alleged therein.

Hence, this lawsuit became totally worthy of refusal because of not proving.

Thirdly;

In addition to our adhering to the fact that the doctor claimed causing the incident (Ola Mahmoud Al Tokhy) is not included in the insurance coverage and her name is not stated in schedules of employees included by the insurance coverage, the plaintiff alleged in its statement of claim that as a result of the alleged malpractice, a lawsuit has been recorded against it by the damaged person before the civil court on 10/11/2014 , in which the court issued enforceable judgment obligating it to settle the compensation to the damaged. But in truth, the plaintiff didn't present any proof or evidence to prove such fake allegation.

Also, the plaintiff didn't present judicial verdicts supporting its claims.

Whereas such allegation was naked of its proof and without any evidence, hence this lawsuit became totally worthy of refusal.

Fourthly;

The defender adheres to refusing the claim because of violating conditions and terms of the insurance policy by the plaintiff. As the policy stipulated that the insured Hospital must immediately notify the New India insurance company once receiving any announcements for claims or lawsuits, and when knowing any party that may be a reason for any

 claims. But the proved in the documents is that the plaintiff hospital didn't notify the New India insurance company regarding anything in relation till a judicial verdict has been issued against the hospital.

(Kindly review the document submitted in the portfolio of documents (doc. no 1).

And after a final judgment was issued against the hospital, they came to claim against the New India insurance company, but their claim is worthy of refusal because they violated an essential clause for entitling the claim, which is the immediate notification for any claims.

Fifthly;

The insurance policy explicitly stipulated that undertaking the hospital for notification for any claims during applying the insurance policy within maximum of 90 days of the expiry date, and that was supported by the fact that the hospital have no insurance during such above mentioned ninety days.

(Kindly, review the portfolio of documents (doc. no 1)

But after reviewing the documents and instruments of the lawsuit, it becomes clear that the hospital didn't notify the company of the claim at issue till the date of 20/03/2016, although the accident subject matter of this claim had occurred in October of 2013.

That confirms violating clauses of the insurance policy by the plaintiff, so this claim is worthy of refusal.

In witness whereof the above-mentioned, and what the honorable court may see of comprehensive reasons and grounds;

Accordingly:...

The defender (New India insurance) solicits refusing the claim for the following reasons:

The doctor who caused the accident (Ola Mahmoud Al Tokhy) is not included by the insurance coverage.

The plaintiff didn't present any proof or evidence regarding the ancient and what strictly happened, and don't prove the essence of its responsibility or obligation to pay the claimed compensations.

The plaintiff didn't present any judicial verdicts supporting its claim.

The plaintiff hospital didn't notify the New India insurance company regarding the claim when occurred till a judicial verdict has been issued.

The plaintiff hospital didn't notify the New India insurance company regarding the claim during the period of applying the insurance policy.

Yours sincerely,

Acting for the defender company:

Advocate: Mohamed Mahmoud Al Marzooqi (signature).