BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANGALORE

Dated this the 29^th FEBRUARY 2016

PRESENT

  SMT. ASHA SHETTY             :   HON’BLE PRESIDENT

                  SMT.LAVANYA M. RAI       :   HON’BLE MEMBER

COMPLAINT NO.393/2015

(Admitted on 21.11.2015)

 BETWEEN

K.B. Shridhar

S/o. K. Bhaskar Bhat,

R/at. Sapthagiri House,

Alankar Post & Village,

Puttur Taluk. D.K. District                        …….. COMPLAINANT

(Advocate for Complainant: Sri. Sanjaya D)

          VERSUS

1. S.M.C. Office,

Regional Office,

E.S.I. Corporation No. 10

Binnypet, Binny Fields,

Bangalore.

2. Superintendent,

ESI Hospital Kadri,

Shivabagh,

Mangalore.-02.

3. Medical Officer,

ESI Corporation,

Bolwar, Puttur.                           ……OPPOSITE PARTIES

(Opposite party No. 1 to 3 Ex-parte)

ORDER DELIVERED BY HON’BLE PRESIDENT

SMT. ASHA SHETTY:

I.       1. This complaint is filed under Section 12 of the Consumer Protection Act alleging deficiency in service as against the Opposite Parties claiming certain reliefs.

  The brief facts of the case are as under:

 The complainant was the employee of compco chocolate factory Puttur and member of Opposite Party’s medical insurance as per ID No. 17601884.  The complainant was paid premium per month and his family is also covered under the medical insurance.

When the matter stood thus, complainant father K. Bhaskar Bhat admitted to KMC hospital for omitting, headache and LOC, after examination admitted as an in-patient and undergone operation, spent Rs. 4,56,437/-. After the treatment, the claim was submitted to the second Opposite Party, but the complainant received Rs. 2,83,623/- instead of Rs. 4,56,437.  Thereafter the complainant addressed a letter but the Opposite Party not reimbursed the full medical expenses. Hence the above complaint filed U/sec 12 of the Consumer Protection Act 1986 (herein after referred to as ‘the Act’) seeking direction from this Forum to the Opposite Party to pay a sum of Rs.1,72,814/- including 12% interest from 05.02.2014 till payment along with compensation and cost of the proceedings.

II.     1. Version notice served to the opposite parties No. 1 to 3 by R.P.A.D receiving version notice neither appeared nor contested the case before this FORA, Hence we have proceeded ex-parte as against the opposite party No. 1 to 3.  The acknowledgment marked as court Document No. 1 to 3.

III.     1.  In support of the complaint, Sri K.B. Shridhar (CW1) – Complainant filed affidavit reiterating what has been stated in the complaint and answered the interrogatories served on her and produced Ex. C1 to C13. 

        In view of the above said facts, the points now that arise for our consideration in this case are as under:

1. Whether the Complainant proves that the Opposite Parties have committed deficiency in service?

2. If so, whether the Complainant is entitled for the reliefs claimed?

3. What order?

                We have considered the notes/oral arguments submitted by the learned counsels and also considered the materials that was placed before this Forum and answer the points are as follows:

                              Point No.(i): Affirmative.

                              Point No.(ii) & (iii): As per the final order. 

REASONS

IV.    1.  POINTS NO. (i) TO (iii):

In order to substantiate the averments made in complaint. That the complainant i.e. CW-1 filed affidavit and produced exhibits C1 to C13.  However the document produced by complainant it is proved beyond doubt that the complainant and his family insured with Opposite Party’s as per ID No. 17601884 and the discharge summary issued by KMC hospital i.e. Ex C-6 shows that the complainant father K. Bhaskar Bhat admitted with the complaint of omitting, headache and LOC. Thereafter undergone operation and discharged on 05.02.2014. The medical bills produced by complainant reveals that the complainant has spent Rs. 4,56,437.89/- out of the said amount Rs.2,86,623/- is paid but rest of the amount i.e. 1,72,814.89/- not paid. That the reasons for non-settlement of entire amount is not known, the entire material evidence placed by the complainant was to contradicted nor controverted by the opposite parties.  The entire evidence unrebutted by the Opposite Party. We noted that, in-spite of receiving version notice the Opposite Parties are not appeared not contested the case.  It shows their sheer negligence on the part of the Opposite Party.  Therefore we hold that complainant is entitled full amount of medical expenses and opposite parties committed deficiency in service without honoring the entire amount.  

 By considering the above aspect, we hereby directed the Opposite Parties  are jointly and severally to pay entire amount of Rs. 4,56,437.89 (-) 2,86,623/- = 1,72,814.89/- along with interest @ 10% p.a. from date of complainant till the date of payment and also pay  Rs. 3,000/- as cost of the litigation expenses to the complainant.  Payment shall be made within 30 days from the date of this order.

In the present case, interest considered by this Forum itself is compensation and therefore, no separate amount for compensation is awarded.

          In the result, we pass the following:        

ORDER

The complaint is allowed.  The Opposite Parties are jointly and severally shall pay entire amount of Rs. 4,56,437.89 (-) 2,86,623/- =  1,72,814.89/- along with interest @ 10% p.a. from date of complainant till the date of payment and also pay  Rs. 3,000/- as cost of the litigation expenses.  Payment shall be made within 30 days from the date of this order.

Copy of this order as per statutory requirements, be forward to the parties and file shall be consigned to record room.

(Page No.1 to 5 dictated to the Stenographer typed by him, revised and pronounced in the open court on this the 29^th day of FEBRUARY 2016).

PRESIDENT                               MEMBER

 (SMT. ASHA SHETTY)                (SMT. LAVANYA M.RAI)

D.K. District Consumer Forum         D.K. District Consumer Forum

     Mangalore.                                   Mangalore.                              

ANNEXURE

Witnesses examined on behalf of the Complainant:

CW1 – K.B. Shridhar       –      Complainant.

Documents produced on behalf of the Complainant:

Ex C1:                      : Copy of the I.D. Card. 

EX C2:03.04.2014   : O/c of the claim latter.

EX C3:05.08.2015   : Letter addressed by 2^nd O.P for sanction.

EX C4:16.07.2014   : O/c of the letter address by the

  complainant to 1^st O.P.

EX C5: 23.05.2015  : O/c of the letter address by the

  complainant to 1^st O.P.

EX C6: 04.04.2014  : Certificate issued by KMC Hospital

  Mangalore.

EX C7: 02.07.2015  : O/c of the letter address by the

  complainant 1^st O.P.

EX C8: 27.04.2015  : Copy of the Cheque issued to

  the complainant.

EX C9: 05.02.2014  : True copy of the Final Bill.

EXC10:01.09.2015  : O/c. of the regd. Lawyers notice.

EXC11:04.09.2015  : Postal Acknowledgment of

  2^nd Opposite Party.

EXC12:     .09.2015 : Postal Acknowledgment of

  1^st Opposite Party.

EXC13:11.09.2015  : Reply of the 3^rd Opposite Party.   

Witnesses examined on behalf of the Opposite Parties:

       Nil

Documents produced on behalf of the Opposite Parties:    

    Nil

Dated:29-02-2016                          PRESIDENT