PRESENT

                   Complainant by Advocate Shri.Gucchiya 

                   Opponent by Adv.Smt Bhavana Bhat.                  

ORDER

(Per- Mr. S. D. MADAKE, Hon’ble President

1.The a company incorporated as per Indian Companies Act 1956 having office at (W) Mumbai. The opposite party is a company registered as per Companies Act office at Andheri(E),Mumbai.

2.The Complainant had taken “Employees Group Policy No. HWT-00003175-000.00 for a period between 1.10.2009 to 30.09.2010 from opposite party covering 939 staff members and 1452 dependants.

3.The complainant states that one of the employee namely Kumar Singh’s son Singh born on 23.09.2009 was admitted in the hospital due to pneumonia and heavy fever for period between 02.08.2010 to 09.08.2010.The employee paid charges of Rs.35/- for treatment as per law, complainant is entitle for the amount as per terms and conditions of the Insurance Contract.

4. claimed the amount from opposite party by submitting application supported by documents, however evoked no response opponent . It is prayed opposite party be directed to pay sum of Rs.35/- with interest at the rate of 18% p.a. from the date of filing complaint.

5.The opposite party filed written statement on 15.04.2013 and resisted the allegations made in the is contended that complainant failed to provide the correct particulars of the person to be added that too without identifying and mentioning the employees ID for inclusion of his dependant which is apparent on the face of record.

6.The opposite party stated that dispute is about non-inclusion of employee dependant which arose on 15.10.2009 and the complaint is filed two years from the said date of cause of is alleged that the complaint is frivolous and vexatious and this forum has no jurisdiction to entertain the complaint.

7.The oppositeparty stated that the claim was not payable as master Singh was not covered neither proposed nor accepted hence there no question of any is prayed complaint be dismissed with cost.

8.We have perused complaint written of evidence ,written notes of argument and list of names of employees as well as their dependants ,as well as documents relating to treatment .

9.Admittedly complainant has taken Insurance policy in respect of Employees group medicals policy for 939 employees and 1452 complainant has paid premium on We have perused the list of dependants and found that name of Singh is included in the list.

10.We have perused the certificate of municipal corporation Mira- shows that was born on 23.09.2009 at Shree Hospital the name of father is Singh who is employee of name is at Sr.No.638

11 We have perused discharge card dated 09.08.10 which indicate that Singh was admitted in the hospital during 02.08.10 09.08.10 .We have perused medical bill issued by Aryan Child Health Care Centre & Nursing home dated 09.08.2010 for Rs.31,405/- and bills issued by Medical etc. The opposite party has not disputed the amount in written statement.

12.The complainant has proved that opposite party failed to consider the legitimate claim supported by documentary opposite party is justified to state that policy is void for want of consideration.

13.The complainant is entitle to receive amount of Rs.35,640/-(Rs. Thirty five thousand six hundred forty ) with interest at 9% from the date i.e.09.08.2010.The complainant is entitle for cost of Rs.10,000/- .We do not want to award compensation for mental we awarded reasonable interest on the amount.

14.In the result, pass the following order.

                          ORDER

1.         RBT  Consumer Complaint No. 343/2012  is partly allowed.

2.         The opposite party is directed to pary Rs.35,640/- to complainant with interest at 9% p.a. from 09.08.2010 till realisation of 

            amount.

3          The  opposite party is directed to pay cost of Rs.10,000/- to complainant.

4.        Copy of this order be sent to the both parties.