Date of Filing:18.03.2008<br /> Date of Order:31.07.2008<br /> <br /> <br /> <br /> BEFORE THE II ADDITIONAL DISTRICT CONSUMER DISPUTES REDRESSAL FORUM SESHADRIPURAM BANGALORE-20<br /> <br /> Dated: 31ST DAY OF JULY 2008<br /> PRESENT<br /> <br /> <br /> <br /> Sri. S.S. NAGARALE, B.A, LL.B. (SPL.), President.<br /> Smt. D. LEELAVATHI, M.A.LL.B, Member.<br /> Sri. BALAKRISHNA. V. MASALI, B.A, LL.B. (SPL.), Member.<br /> <br /> <br /> <br /> <br /> COMPLAINT NO: 729 OF 2008<br /> <br /> Rajendra C. Kalakamb<br /> S/o. Chennappa<br /> R/at No. 41, Opp. MMET School<br /> R.S. Palya, Kammanahalli Road<br /> Bangalore Complainant<br /> <br /> V/S<br /> <br /> 1. FIRSTSOURCE SOLUTION LTD.<br /> 6TH Floor, Peninsula Chambers<br /> Ganapatrao Kadam Marg<br /> Lower Parel, Mumbai 400 018<br /> Maharashtra<br /> Represented by its Managing Director<br /> <br /> 2. PARAMOUNT HEALTH SERVICES P. LTD.<br /> No. 10/1, I Floor (Near Institute of Agriculture<br /> Technologies), Queens Road<br /> Bangalore 560 052<br /> Represented by its Managing Director Opposite Parties<br /> <br /> <br /> ORDER<br /> By the President Sri. S.S. Nagarale<br /> <br /> <br /> This is a complaint filed under section 12 of the Consumer Protection Act claiming Rs. 23,316/- with interest.<br /> The facts of the case are that the complainant was admitted to the Bellandur Clinic with history of giddiness, abnormal behaviour and subsequently referred to Apollo Hospital on 11.08.2007. He under went various tests and investigations. He discharged on 14.08.2007. Complainant had paid total amount of Rs. 23,316/- vide bill dated 11.08.2007 and 14.08.2007. Complainant had taken employees hospitalization and domiciliary hospitalization benefits policy from the opposite parties. Complainant made claim of Rs. 23,316/- from the opposite parties. Complainant is entitled for reimbursement of afore said amount. The claim of the complainant was not accepted. Complainant submitted that repudiation of the claim is baseless. Therefore, he filed present complaint<br /> 2. Notice issued to opposite parties. Opposite party No. 1 appeared through advocate and defence version filed. Opposite party No. 2 though served with notice not appeared before this forum and defence version not filed. Opposite party No. 2 was placed as ex-parte.<br /> 3. Complainant has filed his affidavit and documents. Arguments are heard. <br /> REASONS <br /> 4. Opposite party No. 2 rejected the claim of the complainant relying on Clause 3 (viii) of the policy which states that the intentional self-injury whether arising from an attempt to suicide or otherwise and use of intoxicating drugs or alcohol and the claim was treated as NO claim. The opposite party No. 2 has not appeared and contested the matter before the forum inspite of service of notice by registered post. The opposite party No. 2 has failed to file defence version. The defence taken by the opposite party No. 2 while repudiating the claim has not been substantiated by the opposite party No. 2. In the absence of any defence version or proof it may not be said or accepted that the complainant’s claim is barred under clause 3(viii) of policy. There is no proof or evidence to show that there was intentional self injury arising from an attempt to suicide or otherwise and use of intoxicating drugs or alcohol. The complainant has produced Apollo Hospital discharge summary. This discharge summary disclose suspected drug over dosage and had also disclose there is no history of alcohol or drug abuse in the past. The Doctors opine that only suspected drug over dosage. There is no mention in the summary sheet that the complainant used intoxicating drugs or alcohol. As per the hospital final bill sum of Rs. 22,645/- was paid. Out of this Rs. 5,500/- was paid towards room rent and rest of the amount was towards laboratory, doctor fee and others. The complainant may not be entitled for room rent. Out of Rs. 22,645/- the net amount comes to Rs. 17,145/-. The opposite party No. 2 M/s. Paramount Health Services Pvt. Ltd. shall be directed to pay Rs. 17,145/- to the complainant. In the result I proceed to pass the following:<br /> ORDER<br /> <br /> 5. The Complaint is partly allowed. The opposite party No. 2 is directed to pay Rs. 17,145/- to the complainant towards medi claim within 30 days from the date of this order.<br /> 6. Send the copy of this Order to both the parties free of costs immediately. <br /> 7. Pronounced in the Open Forum on this 31ST DAY OF JULY 2008. <br /> Order accordingly,<br /> <br /> PRESIDENT<br /> We concur the above findings. <br /> <br /> MEMBER MEMBER<br />