This Complaint coming up before us for hearing on 29-11-11 in the presence of Sri B. Veeresh, advocate for the complainants and of Smt G. Sudha Madhuri, advocate for opposite parties 2 and 3,                      1^st opposite party remained absent and set exparte, upon perusing the material on record after hearing both sides and having stood over till this day for consideration this Forum made the following:-

O R D E R

Per Sri A. Hazarath Rao,  President:-

        The complainants filed this complaint under section 12 of the Consumer Protection Act seeking reimbursement of medical expenses of the complainants 2 and 3 together with interest in a sum of Rs.33,836/-; Rs.10,000/- towards mental agony; Rs.20,000/- towards compensation and Rs.5,000/- towards expenses.

2.   In brief the averments of the complaint are hereunder:

        The 3^rd complainant is daughter of the complainants 1 and 2.   The 1^st complainant on 04-02-10 for himself and his family obtained family insurance policy bearing No.2817/50430829/29/00/00 from M/s Universal Sompo General Insurance Company Limited a joint venture of M/s Allahabad Bank, Indian Overseas Bank, Karnataka Bank, Dabur Investment Corporation and Sompo Japan Insurance Inc. under IOB-Health care policy for the period from 01-02-10 to 31-01-11.   The 1^st complainant paid premium with the 3^rd opposite party towards the said insurance policy.   The 2^nd complainant took treatment in NRI General Hospital, China Kakani, Guntur district during 08-06-10 –                10-06-10 as inpatient for dengue fever and later in Life Hospital, Guntur during 13-06-10 – 16-06-10 for viral fever/malaria and incurred Rs.20,536/-.   The 2^nd complainant was discharged from M/s Life hospital on 16-06-10. Subsequently, the 3^rd complainant took treatment in M/s Sri Rama Chandra Children’s and Dental hospital, Guntur as inpatient from 04-09-10 to 08-09-10 and incurred Rs.7,115/-.    The complainants 2 and 3 are having health insurance cards.   As the above hospitals did not accept the health insurance cards issued by the opposite parties the complainant made payment.   The 1^st complainant brought the same to the notice of the opposite parties.   The 1^st opposite party informed the 1^st complainant to send the papers mentioned in it. The 1^st complainant sent those documents.   Inspite of submission of all documents the 1^st opposite party did not settle the claim.   The 1^st complainant got issued notice to the opposite parties demanding reimbursement of medical expenses.   As there was no proper response the complaint filed this claim before this Forum.    The complaint therefore be allowed.

3.    The 1^st opposite party remained exparte.  

4.    The 2^nd opposite party filed memo adopting the version filed by the 3^rd opposite party and their contention in brief is hereunder:

        The complainants have taken IOB health care plus from M/s Universal Sompo General Insurance Company Limited vide policy No. 2817/50430829/29/00/00 dated 04-02-10.     The 3^rd opposite party delivered health cards issued by M/s Universal Sompo General Insurance Company Limited to the complainants as it processed their application.    The 1^st opposite party by their letter asked the original receipts with official seal and sign in order to process the claim.   Thereafter there was no correspondence between the complainants and 1^st opposite party except issuance of legal notice.    The 1^st opposite party did not repudiate the claim and more over required original documents to settle the claim.   The complainants without sending those documents to the 1^st opposite party got issued legal notice in a haste manner and filed the present complaint without showing the insurance company.   The complaint is thus bad for non joinder of necessary parties and mis-joinder of unnecessary parties.   The complaint therefore be dismissed.

5.   Exs.A-1 to A-16 were marked on behalf of the complainant.   No documents were marked on behalf of the opposite parties 2 and 3.

6.    Now the points that arose for consideration in this complaint are:

        1. Whether the opposite parties committed deficiency of service?

        2. Whether the complainants are entitled to compensation?

        3. To what relief?

7.   POINTS 1 & 2:-   Exs.A-2 and A-3 were health cards in the name of the complainants 2 and 3 issued by M/s Universal Sompo General Insurance Company.   The opposite parties 2 and 3 are facilitators only as rightly contended by them.   The claim has to be settled by the               1^st opposite party as seen from Ex.A-7 dated 23-08-10. Under            Ex.A-7 the 1^st opposite party required the 1^st complainant to send the documents mentioned below within 7 days to process the claim.

a. Need claim form duly filled and signed, kindly clarify the total        amount claimed.

        b. Need detailed discharge summary with doctor’s seal and sign                  in original for DOA 08-06-10, 10-06-10 & 13-06-10 & 16-06-10.

        c. Need original proper numbered hospital main bill with                            complete breakup details in hospital letter head with seal                        and sign.

        d. Need original proper numbered payment receipt with receipt                 number seal and     sign.

        e. Need lab reports for all.

        f.  Need indoor case paper (ICP) sheets.

        g.  Need all first detection reports and doctor’s prescriptions for                         the same.

        h.  Need treating consultant to clarify the exact duration of the                  ailment and since when the patients suffering from the                        above said illness.

        i.  Need all previous treatment taken details with prescription                    and lab reports.

        j.  Need first consultation reports.

8.    The complainants in para 3 (e) of their complaint mentioned that the 1^st complainant sent all necessary papers to the 1^st opposite party.   The 1^st complainant filed affidavit also to the same affect.   Prior to filing the case the complainants got issued notice on 06-06-11 to the opposite parties. In that notice also the 1^st complainant did not mention the date when he sent the papers mentioned in Ex.A-7 to the 1st opposite party. The learned counsel for the complainants contended that the complainants did not keep anything with them due to innocence.   The copy of prescriptions along with medical bills did not contain the counter signature of the doctors of the said hospitals as required under Ex.A-7 by the 1^st opposite party.   Absence of date when the 1^st complainant sent the required documents to the 1^st opposite party the same cannot be accepted. Under those circumstances it cannot be said that the opposite parties committed deficiency of service and as such they are not entitled to any compensation.   For the above discussion we answer this point in favour of the opposite parties. 

9.   POINT No.3:   Instead of dismissing the claim disposing off the complaint with certain directions will meet ends of justice.   In the result the complaint is disposed off with the following directions:

1. The complainants are directed to submit documents to the              1^st opposite party as required under Ex.A-7 under acknowledgment within four weeks either directly or through the 3^rd opposite party.
2.  The 1^st opposite party is directed to process the claim within four weeks after receipt of relevant papers from the complainants.
3. Each party is directed to bear their own costs.

Typed to my dictation by Junior Stenographer, corrected by me and pronounced in the open Forum dated this the 30^th day of November, 2011.

MEMBER                                                           PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite parties:   NIL

PRESIDENT