Telangana

Warangal

3/06

B.Venkat Reddy and another - Complainant(s)

Versus

Andhra Bank rep by its Branch Manager and another - Opp.Party(s)

E.Satyanaryana Reddy

08 Sep 2006

ORDER


District Consumer Forum, Warangal
District Consumer Forum, Balasamudram,Hanmakonda
consumer case(CC) No. 3/06

B.Venkat Reddy and another
B.Venkat Reddy and another		 ...........Appellant(s)

Vs.

Andhra Bank rep by its Branch Manager and another
Andhra Bank rep by its Branch Manager and another 		...........Respondent(s)


BEFORE:


Complainant(s)/Appellant(s):


OppositeParty/Respondent(s):


OppositeParty/Respondent(s):


OppositeParty/Respondent(s):




ORDER

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BEFORE THE DISTRICT CONSUMER FORUM : WARANGAL

 

Present:       Sri D.Chiranjeevi Babu

                                                President.

                                               Sri N.J.Mohan Rao,

                                               Member.

                                      AND

                                                Smt. V.J. Praveena,

                                                Member.

 

Friday the 30th May, 2008.

 

CONSUMER DISPUTE NO. 03/2006

Between:

 

1. B.Venkat Reddy,

    S/o.Ranga Reddy,

    Age: 54 yrs., Occu.:Contractor,

    R/o.Burgampahad (V),

    Chilukodu (Post),

    Dornakal (Mandal),

    Warangal District.

 

2. B.Rukminamma,

    W/o.B.Venkat Reddy,

    Age; 52 yrs., occu.:Housewife,

    R/o.Burgampahad (Village),

    Chilukodu (Post),

    Dornakal (Mandal),

    Warangal District.

… Complainants

 

A N D

1. Andhra Bank,

    Rep.by its Branch Manager,

    103-Dornakal (Village & Mandal),

    Warangal District.

 

2. United India Insurance Company Limited,

    Rep.by its Divisional Manager,

    Divisional Office – 4, 2nd Floor,

    Possenette Bhavan,

    Tilak Road,

    Hyderabad.

… Opposite Parties

 

Counsel for the Complainants         : Sri. A.Venkateshwar Rao, Advocate

Counsel for the Opposite Parties     : Sri. A.Ravindra Sarvabhouma, Advocate

 

This complaint coming for final hearing before this Forum, the Forum pronounced the following Order.

 

                                               ::  ORDER  ::

     Sri D.Chiranjeevi Babu President

 

 

The brief averments contained in the complaint filed by the complainant are as follows:

 

01.     In this case the complainant No.2 is the wife of the complainant No.1.  The complainants were taken policy A.B.Arogyadaan Group Mediclaim Insurance Policy of opposite party No.2 and the opposite party No.2 and the any Branch of Andhra Bank are related with each other and with any Andhra Bank can get the information and renew the Policy.  The complainants are the policy holders of Policy No.1. 050400/48/05/00551 and UHID number is FHAU-00 00184053 and 2. 050400/48/05/00551 and UHID number is FHAU-00 00184057 respectively.  This is a Family Health Plan Limited scheme and both the complainants are the Policy holders of A.B.Arogyadaan Mediclaim Policy of Opposite Party No.2 during the year 2004-2005.  The complainants averments are that they paid the renewal charges on 03-06-2005 for renewal of the policy of A.B.Arogyadaan Group Mediclaim Insurance Policy for second year 2005-2006 within stipulated i.e. 08-06-2005 at Andhra Bank but the opposite party No.2 repudiated to give the claim. 

 

Opposite Parties filed the Written Version contending in brief as follows:

 

 

02.     The counsel for the opposite party No.1 argued elaborately stating that, the opposite parties 1 & 2 we are with some understandings and opened the Andhra Bank Arogyadaan Group Mediclaim Insurance Policy  with the opposite party No.2 and he argued that on 03-06-2005 the complainants paid the renewal fees and usually they will sent some amount for remittance on the last date of the month i.e. 30th or 31st, so the insurance company is liable to pay the compensation to the complainants as per the arguments of the opposite party No.1.

 

 

03.     The complainant in support of his claim filed his Affidavit in the form of chief examination and marked Exs.A-01 to A-26.  On behalf of opposite party Sri A.Ravindra Sarvabhouma filed his Affidavit in the form of chief examination and marked Ex.B-1.

 

04.     Now the point for consideration whether the complainants 1 & 2 are entitled to get the compensation amount of Rs.75,000/- for causing mental agony and also entitled to get medical expenses at about Rs.15,000/- and also they are entitled to get an amount of Rs.5,000/- towards costs.

 

05.     After arguments of the both side counsels, we are of the opinion that the opposite party No.2 is not liable to pay anything to the complainants.  In this case the complainant No.2 is the wife of the complainant No.1.  The complainants were taken policy A.B.Arogyadaan Group Mediclaim Insurance Policy of opposite party No.2 and the opposite party No.2 and the any Branch of Andhra Bank are related with each other and with any Andhra Bank can get the information and renew the Policy.  The complainants are the policy holders of Policy No.1. 050400/48/05/00551 and UHID number is FHAU-00 00184053 and 2. 050400/48/05/00551 and UHID number is FHAU-00 00184057 respectively.  This is a Family Health Plan Limited scheme and both the complainants are the Policy holders of A.B.Arogyadaan Mediclaim Policy of Opposite Party No.2 during the year 2004-2005.  The complainant No.1 received a letter from opposite party No.2 and Andhra Bank Head Office, Hyderabad for renewal of the above policy “by paying the premium at Andhra Bank on or before 08-06-2005 for only showing the renewal letter to the Branch Manager, Andhra Bank and the renewal coverage starts from   09-06-2005 to 08-06-2006.  As per the instructions of the opposite party No.2 for renewal of the policy for the second year the complainant No.1 paid the premium of Rs.2,043/- at Andhra bank, 103-Dornakal of Warangal – Opposite party No.1 on 03-06-2005.  Then the complainants are the beneficiaries of renewal and as per the terms and conditions of the policy, complainants are entitled to enjoy the  “cashless facility for taking the treatment in the net work Hospitals listed in the TPA’s member guide book” from the date of renewal of the Policy, by remitting the renewal premium at Andhra bank, Dornakal on 03-06-2005 within the stipulated time.  The complainant No.2 suffered from severe Anemia and she approached the Cure Hospital, Balaji Nagar, Khammam, which is one of the net work Hospitals listed in the TPA’s member guide book and she was examined opposite party by assessing approximate expenditure of Rs.15,000/- for the treatment.  The opposite party No.2 sent a letter bearing No.P.A.7128, dated 28-07-2005 to the Cure Hospital,  Khammam  stating that,  they  are  giving  guarantee  for payment of Rs.10,000/- to the Cure Hospital, Khammam.   The  complainant No.2 has taken treatment in that hospital no amount of Rs.10,000/- paid by the opposite party No.2 and sent a letter dated 15-09-2005 to the complainant No.1 and the Cure Hospital, Khammam stating that the claim falls under the “30 days waiting period” clause of the given medi claim policy the above reason claim is repudiated.  The complainant No.1 is also eye problem and he approached the L.V.Prasad Eye Institute, Hyderabad one of the net work hospitals listed in the TPA’s member guide book.  The complainant No.1 needs treatment for his eyes due to the ailment of “gradual painless programme decrease in vision in both eyes” and mentioned in the Admission Request Note and also assessed approximate expenses of Rs.21,000/-.  But to the utter surprise of the complainant No.1 the concerned department of the opposite party No.2 sent a letter of denial on 18-08-2005 to L.V.Prasad Eye Institute stated as “cashless facility is denied.  The complainants averments are that they paid the renewal charges on 03-06-2005 for renewal of the policy of A.B.Arogyadaan Group Mediclaim Insurance Policy for second year 2005-2006 within stipulated i.e. 08-06-2005 at Andhra Bank but the opposite party No.2 repudiated to give the claim. 

 

06.       The opposite party No.1 Advocate argued elaborately stating that, the opposite parties 1 & 2 we are with some understandings and opened the Andhra Bank Arogyadaan Group Mediclaim Insurance Policy  with the opposite party No.2 and he argued that on 03-06-2005 the complainants paid the renewal fees and usually they will sent some amount for remittance on the last date of the month i.e. 30th or 31st, so the insurance company is liable to pay the compensation to the complainants as per the arguments of the opposite party No.1, for this our answer is that we are disagreeing with the arguments of complainants as well as opposite party No.1 counsel because it is true that the complainants 1 & 2 paid renewal fees towards A.B.Arogyadaan Group Mediclaim Insurance Policy on 03-06-2005 in opposite party No.1 branch, when the complainants already paid the same on 30-06-2005 itself, it is the duty of the opposite party No.1 to send the same and remitted the same in opposite party No.2 immediately on the same date itself, but surprisingly the opposite party No.1 sent the same amount for remittance to the opposite party No.2 on 03-06-2005, so after 27 days the opposite party No.1 sent the amount to the opposite party No.2 for remittance to the premium paid for taking policy so next time after lapse of 22 days from the date of expiring  of the previous policy.  Hence the fresh policy has been issued, which is coming from the period 30-06-2005 to 29-06-2006 only.  The reasons what ever as alleged by the complainants and the opposite party No.1 for causing delay in remittance of premium for the next time, are not binding up opposite party No.2 to accept the policy issued as renewed to have the risk coverage continuously from the date of expiry of the first policy, when it is a clear lapse of 22 days in between first policy and next policy shall be treated as fresh policy and the terms and conditions will applies to the policy holders as fresh policy holders and cannot be termed as renewed policy holders.  Hence they are not entitled to claim benefits as if the renewed policy holders, so the opposite party rightly repudiated the claims of the complainant No.2 for the treatment taken Cure Hospital as contended in the para No.2 of the complaint above, so also this opposite party has rightly repudiated the claim of the complainant No.1 regarding treatment undergoing eye operation at L.V.Prasad Eye Hospital pay expenditure sum of Rs.25,000/- since the said diseased is false under one year execution because the policy when it is issued as fresh policy the said diseased  filing within one (1) year exclusion as per terms, for which the opposite party No.1 is not liable to consider the risk assured by the opposite party No.2 and accordingly they have repudiated, so what ever the opposite party No.2  did it is a correct manner and opposite party No.2 is not liable to pay anything to the complainants.

 

  Hence we answered this point accordingly in favour of the opposite party No.2 against the complainants and Opposite Party No.1.

 

POINT No.2  WHAT RELIEF:-

 

          The first point is decided in favour of the opposite party No.2 against the complainants and opposite party No.1, this point is also decided in favour of the opposite party No.2 against the complainants and opposite party No.1.

 

          In the result this complaint is dismissed but without costs.

 

(Dictated to the Stenographer transcribed by him corrected and pronounced by us in the open Forum today i.e.  30th May, 2008).

 

 

                                                                              Sd/-               Sd/-                Sd/-

       Member          Member          President,

       District Consumer Forum, Warangal.

 

APPENDIX OF EVIDNECE

WITNESSES EXAMINED

 

ON BEHALF OF COMPLAINANT                          ON BEHALF OF O.Ps.

Affidavit of Complainant                                     Affidavit of Opposite Parties

EXHIBITS MARKED

ON BEHALFOF COMPLAINANT

 

  1. Ex.A-1 is the Xerox copy of Mediclaim Insurance policy, dated 11-08-2005.
  2. Ex.A-2 is the Xerox copy of Certificate of Insurance AB-Arogyadaan Group mediclaim insurance policy and No.050400/4805/00551.
  3. Ex.A-3 is the Xerox copy of Denial of Cashless Service, dated 18-08-2005.
  4. Ex.A-4 is the Original Family Health plan of Admission Request Note.
  5. Ex.A-5 is the Xerox copy of Andhra Bank-103 Dornakal, dt.:23-08-2005.
  6. Ex.A-6 is the Xerox copy of details of premium collected.
  7. Ex.A-7 is the Xerox copy of Status of Insurance Claim, dated 15-09-2005.
  8. Ex.A-8 is the Xerox copy of Cure Emergency Hospital in Patient Name: B.Rukminamma, dated 15-08-2005.
  9. Ex.A-9 is the Xerox copy of Authorization Letter to the Hospital for the Treatment and Guarantee of payment, dated 28-07-2005.
  10. Ex.A-10 is the Xerox copy of Status of Your Insurance Claim, dated 15-09-2005.
  11. Ex.A-11 is the acknowledgement card and receipt.
  12. Ex.A-12 is the Xerox copy of Legal Notice, dated 25-11-2005.
  13. Ex.A-13 is the acknowledgement card and receipt
  14. Ex.A-14  is the Xerox copy of Legal Notice, dated 22-11-2005.
  15. Ex.A-15 is the Original Cash Receipt of Apurva Medical & General Stores, dated 28-06-2005.
  16. Ex.A-16 is the Original Bill of Sri Clinical Laboratory, dated 28-06-2005.
  17. Ex.A-17 is the Original Cash Bill of Himaja Medicals, dated 13-07-2005.
  18. Ex.A-18 is the Original Cash Bill of Cure Pharmacy, dated 20-10-2005.
  19. Ex.A-19 is the Original Cash Bill of Cure Pharmacy, dated 14-09-2005.
  20. Ex.A-20 is the Original Cash Bill of Cure Pharmacy, dated 13-08-2005.
  21. Ex.A-21 is the Original Cash Bill of Cure Pharmacy, dated 13-08-2005.
  22. Ex.A-22 is the Manasa Clinic, Khammam, dated 13-07-2005.
  23. Ex.A-23 is the original Quest Diagnostic Centre, dated 13-07-2005.
  24. Ex.A-24 is the Cure Hospital, dated 14-09-2005.
  25. Ex.A-25 is the Xerox copy of United India Insurance Co.Ltd., of Andhra Bank Head Office, Hyderabad of AB-Arogyadaan Mediclaim Policy.
  26. Ex.A-26 is the Original AB Arogyadaan Family Health Plan Limited of Identity Cards.

 

ON BEHALF OF Opposite partIES

  1. Ex.B-1 is the Xerox coy of United India Insurance Co.Ltd., regarding to Refund of Excess Premium of AB-Arogyhadaan mediclaim policy.

 

 

                                                                                                 Sd/-

        PRESIDENT.