IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Saturday, the 30th day of October, 2010
Filed on 28.03.2007
Present
1. Sri. Jimmy Korah (President)
2. Sri. K.Anirudhan (Member)
3. Smt. N. Shajitha Beevi (Member)
in
CC/No. 62/2007
between
Complainant:- Opposite parties:-
Sri. S.V. Senan 1. The General Manager
Munduparambil House ICICI Lombard General
Behind KSDP, North of Katadi Insurance Co. Ltd., ICICI Kalavoor P.O. Towers, Bandra-Kurla Complex
Alappuzha – 688 522 Bandra(E), Mumbai – 400 005
2. The Branch Manager
ICICI Lombard General
Insurance Co. Ltd., IIIrd Floor
Kannankeri Estate
Shanmughom Road
Ernakulam, Kochi – 682 031
(By Adv. R. Ajithkumar Varma –
Opposite parties 1 and 2)
O R D E R
SRI. JIMMY KORAH (PRESIDENT)
The case of the complainant in precise is as follows: - The complainant and his wife were the 'health care insurance policy' holders of the opposite parties. The proposal for the said policy had been laid by the complainant's son. For the purpose of the policy, an amount of Rs.1l,156/- (Rupees eleven thousand one hundred and fifty six only) was paid to the opposite parties. Meanwhile on 5th August 2005, while the policy was in force, the complainant was hospitalized. After a day of treatment, the complainant was discharged from the hospital. On 8th August 2005, the complainant preferred a claim for an amount of Rs.3,797/- (Rupees three thousand seven hundred and ninety seven only). To the complainant's surprise, the claim of the complainant was repudiated citing reason to the effect that the opposite parties haven't accepted the proposal, and as such no policy was issued. As a matter of fact, the opposite parties have issued policy to the complainant. The complainant approached the opposite party for the lawful claim amount vide several letters, reminders and otherwise. Notwithstanding the complainant's earnest efforts, the opposite parties were least inclined to disburse the claim amount to the complainant. The complainant sustained enormous loss of money. The complainant had to go through massive mental agony as well. Got aggrieved on this, the complainant approached this Forum for compensation and relief.
2. On notice being served, the opposite parties appeared,. and put in version. The crux of the contentions of the opposite parties is that the opposite parties have never accepted the proposal of the policy. With the result no policy was issued as well. Despite several requisitions, no proper proposal was laid before the opposite parties from the complainant's end. According to the opposite parties as no policy was in existence, the complainant's claim was not good enough to provide any amount. The opposite parties have refunded the amount the complainant remitted towards the policy vide a cheque. That apart, the complaint is not maintainable before this Forum. There is no deficiency on the part of the opposite parties. The complaint is only to be dismissed with cost to the opposite parties, the opposite parties fervently contend.
3. The evidence of the complainant consists of the testimony of the complainant himself, and the documents Exts.Al to A15 were marked. On the side of the opposite parties, the manager of the opposite parties put in proof affidavit.
4. Keeping in view the contentions of the parties, the issues that crop up before us
are:-
(1) Whether the opposite parties had issued policy to the complainant?
(2) Whether the complainant is entitled to any relief?
5. We meticulously perused the entire materials placed on record by the parties. The complainant contends that the opposite parties had issued health insurance policy. Thereafter, he was hospitalized. Pursuant to the same, the complainant preferred a claim before the opposite parties. The opposite parties repudiated the claim. Interestingly, the opposite party has not disputed the hospitalization and the like. According to the opposite party, even the proposal of the policy was not accepted. As a matter of fact no policy was in existence for and on behalf of the complainant at the material time, the opposite parties contend. In the backdrop of the said curious contention of the opposite parties, the immediate short question arises for consideration is whether the complainant was the holder of the policy at the material time. We anxiously perused the pleadings, affidavits,' particularly the Exts. put on record by the complainant. The complainant has drawn our attention to Exts.A2 and A3. We carefully went through the same. On a perusal of Exts.A2 & A3 we are not persuaded to accept the opposite parties' contention that the complainant was not issued any policy. Thus, going by the materials, we are of the strong view that a policy issued by the opposite party was existent at the material time. It is pertinent to note that the opposite parties have not raised any other serious contentions save the contention as to the jurisdiction of this Forum. Admittedly the opposite parties are having branches operation within the territorial jurisdiction of this Forum. We need hardly say this Forum has abundant jurisdiction to sit in judgment over the instant complaint. In the forgoing facts and circumstance, we have no hesitation to hold that the complainant is entitled to relief.
6. In view of the facts and findings herein above, the opposite parties are directed to pay the complainant an amount of Rs.11,156/- (Rupees eleven thousand one hundred and fifty six only) with 9% interest from the date of remittance of the said amount for the purpose of availing policy from the opposite parties till its recovery .. The opposite parties are further directed to pay to the complainant the claim amount of Rs.3797/-(Rupees three thousand seven hundred and ninety seven only) and an amount of Rs.5,000/- (Rupees five thousand only) as compensation and Rs.1,500/ -(Rupees one thousand and five hundred only) as cost of the proceedings. We further direct the opposite parties to comply with this order within 30 days from the date of receipt of this order.
Complaint stands disposed accordingly.
Pronounced in open Forum on this the 30th day of October, 2010.
Sd/- Sri. Jimmy Korah:
Sd/- Sri. K. Anirudhan:
Sd/- Smt. N. Shajitha Beevi:
Appendix:-
Evidence of the complainant:-
Ext.A1 - Authorization
Ext.A2 - Photo copy of the policy
Ext.A3 series - Photo copy of the cards (2 Nos.)
Ext.A4 - Photo copy of the letter dated 14.8.2005
Ext.A5 - Photo copy of the letter dated 12.4.2006
Ext.A6 - Photo copy of the letter dated 28.4.2006
Ext.A7 - Photo copy of the letter dated 10.7.2006
Ext.A8 - Photo copy of the letter dated 7.2.2006
Ext.A9 - Photo copy of the letter dated 22.2.2006
Ext.A10 - Photo copy of the letter dated 27.3.2006
Ext.A11 - Photo copy of the registered letter dated 14.10.2006
Ext.A12 - Photo copy of the form No.1 (4 pages)
Ext.A13 - Photo copy of the letter dated 14.4.2006
Ext.A14 - Photo copy of the letter dated 8.8.2005
Ext.A15 - Photo copy of the cheque for Rs.11,156/-
Evidence of the opposite parties:- Nil
// True Copy //
By Order
Senior Superintendent
To
Complainant/Opposite parties/S.F.
Typed by:- pr/-
Compared by:-
