KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM.

APPEAL NO.240/2013

JUDGMENT DATED:29.06.2013

           (Against the order in CC.74/12 on the file of CDRF, Palakkadu, dtd:16.02.13)

PRESENT:

JUSTICE SHRI. P.Q.BARKATH ALI              :  PRESIDENT

The Chairman,

Life India Education & Charitable Trust,

Surya Complex, Vellurkunnam,                       : APPELLANT

Muvattupuzha, Ernakulam.

(By Adv: Sri. Narayan.R)

          Vs.

A.C. Prasad,

S/o Kannan, Arayanparamb House,

Nagaripuram.P.O, Mannur,

Palakkad Taluk, Palakkad-678 642.

(By Adv: Sri. Baji Raveendran)

The Manager,

The National Insurance co. Ltd.,

Divisional Office, Urumbath Building,    : RESPONDENTS

Pump Junction, Aluva-683 101.

Administrator,

M/s TTK Health Care, TPA Private Limited,

1400 B, Mareena Building, M.G.Road,

Ernakulam, Cochin-682 016.

JUDGMENT

JUSTICE SHRI.P.Q. BARKATH ALI : PRESIDENT

This is an appeal filed by the 1^st opposite party in CC.74/12 on the file of CDRF, Palakkad challenging the order of the Forum dated, February 16, 2013.

2.      The case of the 1^st respondent/complainant as stated in the complaint before the Forum in brief is this:

First opposite party is the Chairman of Life India Education and Charitable Trust, Ernakulam.  Complainant is a member of the said trust.  The said trust used to insure all its members with the 2^nd respondent/National Insurance Company.  The complainant has taken a mediclaim policy from the 1^st opposite party on October 23, 2009 by paying an amount of Rs.2200/-.  After few months complainant experienced loss of hearing.    On the instructions of the first opposite party he got admitted in the West Fort Hospital, Thrissur and underwent surgery.  The complainant submitted all his documents and claimed reimbursement of the amount spent by him.  But 2^nd opposite party did not reimburse the same.  Complainant claimed Rs.26,698/- as expenses incurred by him for treatment and Rs.50,000/- as compensation and cost.

3.      The third opposite party M/s TTK Health Care Private Limited remained absent before the Forum.  The first opposite party in its version before the Forum contended that they have forwarded all the documents submitted by the complainant to the 2^nd opposite party, the Insurance Company and that therefore there is no deficiency in service on his part.

4.      The second opposite party, National Insurance Company represented by its Branch Manager, Aluva in his version contended thus:   The 3^rd opposite party who has to collect all the documents and forward the same to the Insurance Company did not do so.  Subsequently, the 2^nd opposite party received those documents which show that complainant was suffering from the disease even prior to taking the insurance policy.  Therefore 2^nd opposite party is not liable to pay any amount to the complainant.

5.      Complainant and opposite parties 1 and 2 filed proof affidavits before the Forum.  Exts.A1 to A7 were marked on the side of the complainant and Exts.B1 to B3 were marked on the side of the opposite parties 1 and 2.  On an appreciation of evidence the Forum awarded a compensation of Rs.4000/- and a cost of Rs.1000/-.  The 1^st opposite party has filed this appeal challenging the order of the Forum awarding compensation and cost against the 1^st opposite party.

6.      Heard the counsel for both sides.  First respondent/ complainant entered appearance and respondents 2 and 3 remained absent.

7.      The question which arises for consideration is:  Whether the Forum is justified in awarding compensation and cost against appellant?

8.      It is not disputed that the complainant took Ext.A1 Health Care membership certificate dated, October 23, 2009.  It is also not in dispute that he underwent treatment and surgery in West Fort Hospital, Thrissur for loss of hearing.  Ext.A2 and A3 are copies of the discharge certificate and medical certificate issued from the hospital.  The specific case of the complainant is that though he submitted claim form to the 1^st opposite party/appellant the amount was not disbursed by the 2^nd opposite party/Insurance Company.  The 1^st opposite party/appellant would say that they have forwarded the claim to the Insurance Company.  No evidence was adduced on the side of the 2^nd opposite party/Insurance Company to show that complainant was suffering from the said disease even prior to the issuance of Ext.A1 certificate.  Therefore they are bound to reimburse the expenses incurred by the complainant for treatment.  The counsel for the appellant had submitted that 2^nd opposite party had already paid entire treatment expenses to the complainant.  Therefore there is no deficiency of service on the part of the appellant/1^st opposite party.  That being so, first opposite party is not bound to pay compensation to the complainant.

In the result appeal is allowed in part.  The impugned order of the lower Forum in so far as it ordered compensation and cost against the 1^st opposite party is set aside.  Complainant can realize the compensation and cost awarded from the opposite parties 2 and 3.  No costs.

JUSTICE P.Q.BARKATH ALI:  PRESIDENT

VL.