KERALA STATE CONSUMENR DISPUES REDRESSAL COMMISSION VAZUTHACAUD, THIRUVANANTHAPURAM APPEAL NO.191/04 JUDGMENT DATED 05.07.08 PRESENT:- JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT SMT.VALSALA SARANGADHARAN : MEMBER SRI.M.K.ABDULLA SONA : MEMBER Great India Service Club, Regency Centre Calvary road, : APPELLANT Thrissur – 680 004. (By Adv.P.Rajmohan & A.Y.Khalid) Vs 1.Branch Manager, National Insurance Co Ltd., Ambika Arcade, M.G.Road, Thrissur-680 004. (By Adv.S.Rajeev) : RESPONDENTS 2. P.D.Bernadu, S/o.Devasya, Puthumana House, Thodupuzha, Idukki District. JUDGMENT SMT.VALSALA SARANGADHARAN : MEMBER The above appeal is directed against the order dated.27.1.04 in OP.No.222/03 of CDRF, Idukki, directing the appellant/first opposite party to pay Rs.10,000/- as compensation to the complainant. 2. The case of the complainant is that he joined in a medical insurance scheme sponsored by the first opposite party with the assistance of the second opposite party on payment of Rs.200/- as first premium to the first opposite party. The complainant sustained fracture to his back bone in a fall and was treated as inpatient for 11 days from 8.3.02 and had to spend an amount of Rs.6000/-. A claim form along with necessary documents were entrusted to the opposite parties. But the insured amount was not paid. Hence he filed the complaint before the Forum alleging deficiency in service and claimed Rs.19,300/- by way of compensation. 3. It is the case of the first opposite party that they are only a Master policy holder, issued by the second opposite party. Thereby the members of the Ist opposite party, Great India Service Club joined in the insurance scheme of the second opposite party. It is also contended that the insurance certificates to the insured were issued and if any claim is made by the insured, it is the duty of the second opposite party to indemnify the insured. The first opposite party further contended that they have no role in sanctioning the claim. 4. The second opposite party/insurer in their version contended that the first opposite party is not an authorized agent of the second opposite party and without policy No. they are unable to trace out the policy if any is issued to the complainant. Moreover, neither the complainant nor the first opposite party informed the second opposite party about any treatment claim made by the complainant. No claim was submitted. But the second opposite party showed their willingness to settle the claim if the complainant produces the details of policy issued to him. ie; duly filled claim form with respect to complainant’s claim, treatment certificates and medical bills subject to the terms and conditions of the policy. As the complainant did not make any claim with relevant documents, there is no deficiency of service on their part and that they are not liable to pay any compensation to the complainant. 5. The evidence consisted of the testimony of the PW1 and Exts.P1 to P6. 6. We heard the counsel for the appellant and first respondent/insurance company and perused the available records. Both parties reiterated the respective stands taken before the forum. 7. The point to be considered is whether there is any deficiency of service on the part of the opposite parties. The first opposite party had issued a receipt of Rs.200/- for enrolling the complainant in a Medical Insurance Scheme. It is the case of the complainant that he submitted the claim form and all treatment records to the first opposite party. There is nothing to show that the complainant had submitted the claim form or relevant documents to the second opposite party. The complainant is not in a position to give policy number to the second opposite party and alleges that he had already submitted the claim form to the first opposite party. Without policy number the second opposite party could not trace out the policy if any and they could not entertain the claim without claim form and other relevant documents. So, the second opposite party cannot be held liable. It is to be noted that there is nothing on record to show that the complainant insured with the 2nd opposite party. The complainant could not produce any documents to show that he had insurance coverage under the so called Master Policy issued by the 2nd opposite party. The facts, circumstances and the available records would show that there was no deficiency in service on the part of the second opposite party. 8. The first opposite party who received Rs.200/- as first premium for the policy from the complainant has a bounden duty to see that a policy is issued in the name of the complainant or that his name is also included in the Mater Policy. The 1st opposite party had to submit claim form and relevant documents to the second opposite party, which were handed over to them by the complainant. The first opposite party has not adduced any evidence to establish their case. They have not even cross examined the complainant. After having received the amount from the complainant it is not fair on the part of the 1st opposite party to shift the burden to the second opposite party. The forum below has rightly held that there was deficiency of service on the part of the first opposite party. We are of the view that there is deficiency of service on the part of the first opposite party and for that first opposite party is liable to compensate the complainant/second respondent. In the result the appeal is dismissed and the impugned order dated.27.1.04 passed by the CDRF, Idukki in OP.No.222/03 is confirmed. As far as the present appeal is concerned. There shall be no order as to costs. SMT.VALSALA SARANGADHARAN : MEMBER JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT SRI.M.K.ABDULLA SONA : MEMBER R.AV
......................JUSTICE SHRI.K.R.UDAYABHANU
......................SMT.VALSALA SARNGADHARAN
......................SRI.M.A.ABDULLA SONA | | 
