BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM,
ERNAKULAM.
Date of filing : 14/02/2012
Date of Order : 29/09/2012
Present :-
Shri. A. Rajesh, President.
Shri. Paul Gomez, Member.
Smt. C.K. Lekhamma, Member.
C.C. No. 89/2012
Between
Asokan, | :: | Complainant |
Kollam Veettil, Aranagavu Temple Road, Chendamangalam. P.O., Pin – 683 512. |
| (Party-in-person) |
And
Branch Manager, United India Insurance Co. Ltd., | :: | Opposite Party |
Municipal Building, Main Road, North Paravur. P.O., North Paravur – 683 513. |
| (By Adv. C.M. Rasheed, Rex Building, Railway Station Road, Alwaye) |
O R D E R
A. Rajesh, President.
1. The case of the complainant is as follows :-
The complainant has been holding an insurance policy of the opposite party with sum assured of Rs. 50,000/-, since 03-11-2005. The last policy was for the period from 02-11-2011 to 02-11-2012 . The complainant underwent treatment at Santhi Hospital, Paravur from 23-08-2011 to 26-08-2011. The complainant had to expend Rs. 8,617/- towards treatment expenses. The opposite party allowed only Rs. 3,600/- against the claim of Rs. 8,617/-. The complainant is entitled to get the balance insurance claim of Rs. 5,017/- together with compensation of Rs. 5,000/- and interest to the tune of Rs. 600/-. This complaint hence.
2. The version of the opposite party is as follows :-
The claim of the complainant was fully and finally settled for an amount of Rs. 3,600/- by the opposite party and the complainant has received the said amount in full and final satisfaction of his claim without raising any protest. The present dispute is only with regard to the question of quantum of the amount paid by the opposite party. In that view of the matter, this Forum has no jurisdiction to entertain the complaint. Though the complainant has produced bills for a total amount of Rs. 8,617/-, he was eligible to get only Rs. 3,600/- as per the terms and condition of the policy. The complainant has no cause of action against the opposite party. The complainant is not entitled to get any of the reliefs as claimed for.
3. No oral evidence was adduced by the parties. Exts. A1 to A28 and B1 and B2 were marked on the part of the complainant and the opposite party respectively. Heard the complainant who appeared in person and the counsel for the opposite party.
4. The points that came up for consideration are as follows :-
Whether the complaint is maintainable in this Forum?
Whether the complainant is entitled to get the balance insurance claim with interest together with a compensation of Rs. 5,000/-?
5. Point No. i. :- Ext. A1 goes to show that the complainant has received a sum of Rs. 3,600/- from the opposite party towards full and final settlement of the insurance claim. It is to be noted that the complainant has received the amount as per the settlement without raising any protest.
6. By relying on the decision of the Hon'ble Apex court in United India Insurance Co. Ltd. Vs. Ajmer Singh Cotton and General Mills AIR 1999 3027 SC, the Hon'ble National Consumer Disputes Redressal Commission in National Insurance Co. Ltd. Vs. Krishna Rice Mills II (2008) CPJ 327 NC, held that “In the instant case, the discharge vouchers were admittedly executed voluntarily and the complainant had not alleged therein execution under fraud undue inference, misrepresentation or the like. In the absence of pleading and evidence, the Hon'ble State Commission was justified in dismissing their complaints.”
7. Relying on the observation of the Hon'ble National Consumer Disputes Redressal Commission, we are only to close the proceedings in this complaint. Held so.
Pronounced in the open Forum on this the 29th day of September 2012
Forwarded/By Order, Sd/- A. Rajesh, President.
Sd/- Paul Gomez, Member.
Sd/- C.K. Lekhamma, Member.
Senior Superintendent.
A P P E N D I X
Complainant's Exhibits :-
Exhibit A1 | :: | Copy of Medi Guard Policy |
“ A2 | :: | Copy of Medi Guard Policy |
“ A3 | :: | Copy of Medi Guard Policy |
“ A4 | :: | Copy of Medi Guard Policy |
“ A5 | :: | Copy of Health Insurance Policy Claim Form. |
“ A6 | :: | Copy of Medical certificate /attending doctor's certificate |
“ A7 | :: | Discharge card |
“ A8 | :: | Prescription of the doctor |
“ A9 | :: | Prescription of the doctor |
“ A10 | :: | OP bill dt. 04-08-2011 |
“ A11 | :: | Pharmacy cash bill dt. 04-08-2011 |
“ A12 | :: | Copy of the bill |
“ A13 | :: | Copy of the invoice No. 127646 |
“ A14 | :: | Copy of the invoice No. 123992 |
“ A15 | :: | Copy of the bill dt. 10-02-2011 |
“ A16 | :: | Copy of the bill dt. 23-08-2011 |
“ A17 | :: | Copy of the bill dt. 23-08-2011 |
“ A18 | :: | Copy of the bill dt. 24-08-2011 |
“ A19 | :: | Copy of the bill dt. 25-08-2011 |
“ A20 | :: | Copy of the bill dt. 26-08-2011 |
“ A21 | :: | Copy of the invoice dt. 26-08-2011 |
“ A22 | :: | Copy of the invoice dt. 26-08-2011 |
“ A23 | :: | Copy of the bill dt. 26-08-2011 |
“ A24 | :: | Copy of the bill dt. 03-09-2011 |
“ A25 | :: | Copy of the bill dt. 03-09-2011 |
“ A26 | :: | Copy of the prescription of the doctor dt. 03-08-2011 |
“ A27 | :: | Copy of Medical certificate /attending doctor's certificate |
“ A28 | :: | Copy of the certificate dt. 22-04-2010 |
Opposite party's Exhibits :-
Exhibit B1 | :: | Copy of the settlement intimation voucher issued by the op.pty. |
“ B2 | :: | Claim reimbursement voucher dt. 03-11-2011 |
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