KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM APPEAL NO.422/02 JUDGMENT DATED.22.07.08 PRESENT:- JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT SMT.VALSALA SARANGADHARAN : MEMBER SRI.S.CHANDRA MOHAN NAIR : MEMBER The Branch Manager, National Insurance Company Ltd., P.B.No.89, M.G.Road, : APPELLANT Thrissur-680001. (By Adv.Rajan P.Kaliyath) Vs 1. Antony, Kumpalamthanathu, Pazhayarikandam Post, Idukki District. 2. The General Secretary, Nirmal Gram Vanitha Dairy : RESPONDENTS Central Society, Alankar Towers, Kothamangalam – 686691. 3. The Secretary, Nirmal Gram Vanitha Dairy Central Society, Erunnuraker, Mannamkandam Post, Idukki District PIN – 685561. (By Adv.M.C.Jose for R2 & R3) JUDGMENT SRI.S.CHANDRA MOHAN NAIR: MEMBER By the order dated.6.5.02 the first opposite party in OP.No.74/01 of CDRF, Idukki are under orders to pay to the complainant an amount of Rs.4307/- with 12% interest from 5.3.01 till the date of payment with Rs.5000/- as compensation and Rs.750/- as costs. 2. The case of the complainant before the Forum was that he had joined in an accident health insurance scheme jointly proposed by the first opposite party and opposite parties 2 and 3. He had joined for the first time on 12.8.99 and subsequently on 27.3.2000. He fell ill on 10.7.2000 and an amount of Rs.4307/- was spent by him towards treatment charges. It is his case that though he made an application for the reimbursement of the amount, the insurance company /first opposite party repudiated the claim on the ground that he had contracted the disease within one month from the date of commencement of the policy. Alleging deficiency of service the complaint was filed praying for directions to the opposite party to pay the amount of Rs.4307/- with interest and compensation of Rs.5000/- and costs. 3. The first opposite party filed the version contending that the complaint is not maintainable and that the complainant had not joined in the scheme on 12.8.99 and that the company was not liable to indemnify the loss sustained by the complainant. It was also submitted that there was no deficiency in service in repudiating the claim and the complainant had approached the Forum for some undue enrichment and as such it was prayed that the complaint was to be dismissed with costs. The second and third opposite parties filed their objection stating that they were not unnecessary parties to the complaint and they also prayed for the dismissal of the complaint with costs. 4. The evidence consisted of the oral testimony of the complainant as PW1 and Exts.P1 to P3. On the side of the opposite parties Exts.R1 to R3 were marked and it is based on the said evidence and documents that the Forum passed the impugned order. 5. We heard the learned counsel for the appellants and the respondent. 6. It is the admitted case of both the parties that the complainant had joined a Group Mediclaim Policy valid from 31.3.2000 to 30.3.01. It is also admitted that the complainant fell ill on 10.7.2000 and had spent Rs.4307/-. It is to be seen that as per Ext.R2 and R3 the doctor had issued a certificate that the complainant was having illness for three months prior to his admission in the hospital on 10.7.2000 and as such the opposite party’s action in repudiating the claim is perfectly justified due to the fact that the complainant had contracted the disease within 30 days from the date of commencement of the policy. It is also his case that the complainant had mistakenly submitted before the Forum that he had joined the policy on 12.8.1999. The learned counsel further submitted before us that the Forum had gone wrong in allowing Rs.5000/- also as compensation since 12% interest from the date of the filing of the complaint was awarded with costs. Raising the above contentions he prayed for the dismissal of the complaint in toto. 7. On the other hand, the learned counsel for the respondent submitted his arguments supporting the findings and conclusions of the Forum below. He submitted that the complainant had joined in the Group Mediclaim Policy from 12.8.1999 which is evident from Ext.P1. He has also argued that the opposite parties have committed grave deficiency of service in repudiating the claim and in fact the Forum has awarded only reasonable amounts for the agony endured by the complainant even when he was eligible to get the amount. 8. On hearing the learned counsel for the appellants and the respondent we find that there is no evidence to prove that the complainant had the disease three months prior to the admission on 10.7.2000. Even though in Ext.R2 it is stated that the complainant was having the disease for three months and he was aware of the said disease, it is to be noted that apart from producing the medical certificate the opposite parties had not taken any steps to prove the same by examining the doctor who had issued the said certificate. In such a circumstance it is our considered view that the appellants ought not have repudiated the claim. However as interest at 12% from the date of filing the complaint was ordered there was no necessity to award another sum of Rs.5000/- as compensation, since it can be treated that the interest amount would compensate the complainant for the injury and loss suffered by him. In the result the appeal is allowed in part, modifying the order dated.6.5.02 in OP.No.74/01 of CDRF, Idukki thereby the appellant/opposite party is directed to pay Rs.4307/- with 12% from 5.3.01 till the date of payment along with the cost of Rs.750/-. However in the nature and circumstance of the present appeal the parties are directed to suffer their respective costs. S.CHANDRA MOHAN NAIR : MEMBER JUSTICE K.R.UDAYABHANU : PRESIDENT VALSALA SARANGADHARAN : MEMBER R.AV
......................JUSTICE SHRI.K.R.UDAYABHANU
......................SMT.VALSALA SARNGADHARAN
......................SRI.S.CHANDRAMOHAN NAIR | | 
