KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION  VAZHUTHACADU  THIRUVANANTHAPURAM

                                  APPEAL  NO: 378/2007

      JUDGMENT DATED: 20-12-2010

  PRESENT

JUSTICE SHRI.K.R. UDAYABHANU               : PRESIDENT

SHRI. S. CHANDRAMOHAN NAIR                  : MEMBER

The Chairman,

Health India Educational & Charitable Trust,

Lourde Centre, Annex Building,                        : APPELLANT

Sub Jail Road, Aluva.

(By Adv.Sri.G.S.Kalkura)

          Vs.

1.      Archana.A,

Mattachil Veli, North Aryad,

Valiya Kalavoor, Alappuzha-688542.

(By Adv:Sri.S.R.Arun)

2.      K.Reghunathan Nair,

Rareeram House, North Aryad.P.O,

Alappuzha.

(By Adv.Sri.G.S.Rajeev)

                                                                   : RESPONDENTS

3.      The Manager,

United India Insurance Co. Ltd.,

Eloor Road, Kalamassery.

(By Adv:Sri.Lakshmanan.T.J)

4.      Chandran Pillai,

Chandramangalam,

Cherthala South.P.O,

Areeparampath.

(By Adv.Sri.G.S.Rajeev)

                                                JUDGMENT

SHRI. S. CHANDRAMOHAN NAIR : MEMBER

This appeal is preferred by the 1^st opposite party in OP.4/05 of CDRF, Alappuzha.  By the impugned order dated:7/9/2007, the 1^st, 2^nd and 4^th opposite parties under directions to pay to the complainant a sum of Rs.42,208/- with interest at 9% per annum from 3/1/2005 till the date of payment.

2.      The case of the complainant before the Forum was that she had joined in the medi claim insurance policy offered by the 1^st opposite party and suggested by the 2^nd and 4^th opposite parties and that though she had paid a sum of Rs.1100/- for joining the medi claim policy on 28/10/2003 and though an accident had occurred to her on 19/11/2003, the 3^rd opposite party had repudiated the claim on the ground that there was no valid insurance policy at the time of accident.

3.      The opposite parties filed versions.  The 1^st and 3^rd opposite parties contended that the Forum had no jurisdiction and that the 1^st opposite party was not a joint venture of the 1^st and 2^nd opposite parties.  It was also submitted that they are not liable for the settlement of accidental death and other insurance claims and that as per the terms and conditions of the policy, the complainant was not entitled to any insurance claim.

4.      The 3^rd opposite party submitted that though a policy was issued including the claim of the complainant it had the coverage only from 21/11/2003 to 20/11/2004 and that as the accident had occurred on 19/11/2003 there was no coverage at the time of accident and as such they are not liable for any claims made by the complainant.  It was also submitted that the 3^rd opposite party was not liable for any receipt issued by the 1^st opposite party and as such there was no deficiency of service on their part.

5.      The evidence adduced consisted of the oral testimony of the complainant as PW1 and Exts.A1 to A8 on the side of the complainant.  The opposite parties produced 4 documents which were marked as Exts.B1 to B4.

6.      Heard the appellant and 1^st respondent.

7.      Learned counsel for the appellant vehemently argued before us that the Forum had no jurisdiction to try the complaint and it was beyond the jurisdiction that the complaint was allowed by the Forum below.  It is also his case that the Forum had ordered for the actual amount paid by the complainant which is against the terms and conditions even if the complainant had a policy at the time of accident.  It was also submitted that there were discrepancies in the treatment records of the complainant such as the complainant had stated at one point that she had sustained injury to the left knee where as at some other point she had a case that she had sustained injury to the right knee.  It is also the case of the learned counsel that the Forum below had not adverted to the said discrepancies while passing the order.

8.      On the other hand, the learned counsel for the 1^st respondent supported the findings and conclusions of the Forum below and submitted before us that the complainant had joined in the scheme by paying the required amount on 28/10/2003 and it was due to the deficiency of service of the 1^st 2nd and 4^th opposite parties that they did not forward the amount and necessary papers to the 3^rd opposite party on time.  It is also his case that the 1^st opposite party had delayed the payment to the 3^rd opposite party and the policy could be issued for the period from 21/11/2003 to 20/11/2004 because of the lapse of the 1^st opposite party and hence the order of the Forum below directing the 1^st 2nd and 4^th opposite parties to pay the amount is just proper and liable to be paid by the said opposite parties.

9.      On hearing the learned counsel for the appellant, the 1^st respondent and also on perusing the records we find that the complainant had joined the policy by paying the sum of Rs.1100/- on 28/10/2003.  Nobody has a case that the payment was not made on 28/10/2003 and it was the duty of the 1^st opposite party to forward the amount and necessary papers to the 3^rd opposite party in order to enable the complainant to get the benefit of the group insurance policy in which she was included.  It is noted that no intimation was given to the complainant with regard to any of the papers to be produced by her for joining the group insurance policy.  It seems that the 1^st opposite party had taken the effort to enjoin the complainant in  the policy only from 21/11/2003.  We find that it was without any reason that the payment was delayed by the 1^st opposite party to the 3^rd opposite party.  Though the appellant/1^st opposite party would argue that the treatment regarding the accident cannot be believed even the opposite parties have no case that no accident had happened on 19/11/2003 and the complainant had sustained injuries.  The treatment bills produced by the complainant would also support the case of the complainant that she had sustained injuries and had undergone treatment.  However it is also found that the Forum below had ordered for the compensation of the entire amount of Rs.42,208/- to be paid by the 1^st, 2^nd and 4^th opposite parties.  It seems that the 1^st, 2^nd and 4^th opposite parties were deficient in their service in delaying the matter of taking the policy though the complainant had paid the amount on 28/10/2003.  The Forum below had found deficiency of service on the part of the 1^st, 2^nd and 4^th opposite parties which are upheld by this commission also.  However only compensation can be ordered in a case were only deficiency of service is found out.  The 3^rd opposite party is excluded from the liability since there was no valid policy at the time of accident that happened to the complainant/1^st respondent.  The said situation arose for the reason that the 1^st, 2^nd and 4^th opposite parties   were not diligent in following up the matter especially a medi claim group insurance policy which would have enabled the complainant to get the treatment expenses reimbursed in case of accident and subsequent treatments.  Thus, we find that the 1^st, 2^nd and 4^th opposite parties had committed deficiency of service and in the facts and circumstances of the case it is just and proper that a compensation of Rs.25,000/- is awarded to the complainant with 9% interest from 3/1/2005.  The opposite parties including the appellant are directed to pay the amount within one month from the date of receipt of this order failing which the amount so arrived at shall carry interest at 12% per annum from the date of default till payment.  In the nature and circumstances of the present appeal, the parties are directed to suffer their respective costs.

S. CHANDRAMOHAN NAIR: MEMBER

JUSTICE K.R. UDAYABHANU: PRESIDENT

VL.