Andhra Pradesh

Visakhapatnam-II

CC/316/2014

Shankar Saran - Complainant(s)

Versus

Chairman-cum-Managing Director - Opp.Party(s)

Shankar Saran (In Person)

08 Jul 2015

ORDER

  Reg. of the Complaint:30-09-2014                                                                                                                              Date of Order:08-07-2015

BEFORE THE DISTRICT CONSUMERS FORUM-II

AT VISAKHAPATNAM2 

                   Present:

1.Sri H.ANANDA RAO, M.A., L.L.B.,

       President

2.Sri C.V.RAO, M.A., B.L.,

                                             Male Member

3.Smt.K.SAROJA, M.A., B.L.,

       Lady Member

                                            

 

WEDNESDAY, THE 08^TH DAY OF JULY, 2015

CONSUMER CASE NO.316/2014

 

BETWEEN:

SHANKAR SARAN S/O ANIL BEHARI SARAN,

HINDU, AGED 67 YEARS, FLAT NO.201,

DWARAKA MURALI APARTMENTS,

MURALINGAR, VISAKHAPATNAM-530007.

…Complainant

AND:

1.CHAIRMAN CUM MANAGING DIRECTOR,
VISAKHAPATNAM STEEL PLANT,

VISAKHAPATNAM-530031.

 

2.CHIEF MANAGER, NEW INDIA ASSURANCE COMPANY,

49-9-152, 2^ND FLOOR, AKKAYYAPALEM MAIN ROAD,

T.S.N.COLONY, DONDAPARTHY,

AKKAYYAPALEM, VISAKHAPATNAM-530 016.

…Opposite Parties

This case coming on 23-06-2015 for final hearing before us in the presence of      SRI S.SARAN, the Complainant-appearing in person, and of M/s SAI BABA AND SRINIVAS, Advocate for the 1^st Opposite Party, and 2^nd OP absent and having stood over till this date for consideration, this Forum made the following.

 

ORDER

 (As per SMT.K.SAROJA, Honourable Lady Member on behalf of the Bench)

1. The case of the complainant in brief is that the complainant is the retired General Manger of 1^st Opposite Party. The 1^st OP is providing Group Medi claim Insurance Scheme, for which the complainant had paid an amount of Rs.2,600/- through D.D.No.571862 dated 4-3-2014 of Indian Overseas Bank Towards enrolement fee for himself and his spouse for the period from 01-04-2014 to 31-03-2015. The 1^st OP paid an amount of Rs.56,465/- to the 2^nd OP on 27-03-2014 towards Medical Insurance premium for coverage under Group Medical Insurance Scheme. The OPs did not give Policy Copy and  Identity Card to the complainant in spite of many requests made by the complainant, the OPs did not issue the same to the complainant. Hence, this complaint.

1. To deliver the full insurance policy to the complainant by speed post within 7 days of receipt of this complaint;
2. To pay Rs.5,000/- to the complainant towards exemplary compensation for causing mental untold financial, mental and physical torture and withholding his right to claim reimbursement of the heavy medical treatment expenses already incurred by him since April 2014; and
3. To pay Rs.1,500/- to the complainant towards the cost of this complaint.

2. The 2^nd Opposite Party did not appear before this Forum and hence it is called absent.
3. The 1^st Opposite Party strongly resisted the claim of the complainant, by contending, as can be seen from their counter, the 1^st OP came to know that Vidal Health Service TPA Pvt. Ltd., a service provider of the 2^nd OP has sent the policy and identity cards of the complainant and his wife to his residential address located at MIG 65 Sector-I, MVP colony, Visakhapatnam through first flight couriers, but they were returned unserved. The 1^st OP informed Vidal Health TPA Pvt. Ltd., to issue duplicate copy of policy and ID Card to the complainant. So, this OP has no role in distributing the policy and ID of the enrolled members. 
4. At the time of enquiry, both parties filed affdiavits as well as the written arguments to support their contentions. Exhibit A1 to A10 were marked for the complainant. Exhibit B1 to B4 were marked for the OPs. Heard both sdies.

Exhibit A1 is the is the Debt of Rs.2,600/- in Pass Book, Exhibit A2 is the E-mail sent, Exhibit A3 is the e-mail, Exhibit A4 is the Detailed Track, Exhibit A5 is the Statement of IOB, Exhibit A6 is the Application, Exhibit A7 is the Letter, dated 25-04-2014, Exhibit A8 is the e-mail, dated 26-05-2015, Exhibit A9 is the Policy Letter and Exhibit A10 is the Enrolement form.

Exhibit B1 is the Group Mediclaim Insurance Policy, Exhibit B2 is the Group Mediclaim Premium Computation report for the month of April, 2014, Exhibit B3 is the List of Employees from April, 2014 to October, 2014 and Exhibit B4 is the online payment.

6.       The fact shown from Exhibit B1 reveals that the 1^st OP is the insurer and insurance amount was sent to the 2^nd OP.  Exhibit B2 and B3 reveals that the 1^st OP has sent list of employees from April, 2014 from October, 2014 with ID numbers.

7.       The point that would arise for determination is:

Whether there is any deficiency of service on the part of the OPs? If so, Whether the Complainant is entitled to the reliefs asked for?

8.       After careful perusal of the case record, this forum finds that the complainant and his wife obtained insurance policy through Steel Plant i.e., the 1^st OP. on 16-12-2014 after filing of this complant, a duplicate Mediclaim Policy and ID Cards were received by the complainant. So, the complainant stated in his affidavit and written arguments that the first relief is fulfilled. So, he is not claiming the same.  The 1^st OP is only a facilitator  who sends his employees’  mediclaim amount to the Insurance Company i.e., the 2^nd OP. It is the obligation of the Insurance Company to sent Insurance Policy and ID cards to the policy holders. In our opinion, the 1^st OP is not liable beause it was only a facilitator who sent insurance amount to the insurance company only. It is the duty of the 2^nd OP after receiving of the insurance amount from the 1^st OP, issued insurance policy and ID cards to its members  who were obtained the policy from the insurance company. But the 2^nd OP failes to issue insurance policy and ID Cards to the complainant and his wife.  Without the Insurance Policy and ID Cards, the complainant and his wife cannot reimburse their medical claim. We are of the opinion that there is deficiency in service on the part of the 2^nd OP. Hence, the complainant is entitled to Rs.5,000/- towards compensation and Rs.1,500/- towards costs.

 

9.       In the result, this complainant is allowed, directing the 2^nd Opposite Party to pay a compensation of Rs.5,000/- (Rupees five thousand only) and costs of Rs.1,500/- (Rupees one thousand and five hundred only) to the complainant. Time for compliance, one month.  However, the case against the 1^st OP is dismissed.

Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open Forum, on this the 08^th day of July, 2015.                                         

         

Sd/-                                          Sd/-                                                   Sd/-  

MALE MEMBER                                 PRESIDENT                                                  LADY MEMBER

APPENDIX OF EVIDENCE

Exhibits Marked for the Complainant:                                                                        

Exhibits	Date	Description	Remarks
A-1		Debt of Rs.2,600/- in Pass Book	Photocopy
A-2		E-mail	Photocopy
A-3		E-mail	Photocopy
A-4		Detailed Tract	Photocopy
A-5		Statement of IOB	Photocopy
A-6		Application	Photocopy
A-7	25-04-2014	Letter	Photocopy
A-8	26-05-2015	E-mail	Photocopy
A-9		Policy Letter	Photocopy
A-10		Enrolement Form	Photocopy

 

Exhibits Marked on behalf of the OPs:    

Exhibits	Date	Description	Remarks
B-1		Group Mediclaim Insurance Policy	Photocopy
B-2		Group Mediclaim Premium Computation report for the month of April, 2014	Print Out
B-3		List of Employees from April, 2014 to October, 2014	Print Out
B-4		Exhibit B4 is the online payment	Print Out

 

   Sd/-                                                Sd/-                                                   Sd/-  

MALE MEMBER                                 PRESIDENT                                                  LADY MEMBER