F.A.No.839/2010 against  C.C.No.759/2009, District Forum-1,Hyderabad .

Between

Reliance General Insurance Co. Ltd.,

6-4-8/1, 1^st Floor , Vijetha Sunjeevini

Apartments, Opp.Gandhi Hospital,

Hyderabad.                                                         …Appellant/

                                                                           Opp.party no.1

          And

1.Surya Bhaskara Rama Rao

   S/o.Venkat Rao, Aged : 46 years,

   Occ: Private Service, R/o. Flat No.F8,

   Block No.21, HIG –II, A.P.B.H.,

   Manasa Enclave , Baghlingampally,

    Hyderabad – 500 044.                                      … Respondent/

                                                                           Complainant

2. Manager, Medi Assist India Pvt. Ltd.,

    1-10-104/47/2A, Plot No:356,

    Manikanta Nilayam , Opp.Church , Beside,

    Pantaloon, Begumpet,

    Hyderabad – 500 016.                                      … Respondent/

                                                                           Opp.party no.2

Counsel for the Appellant            :   Mr. Ramachandra Reddy Gadi       

Counsel for the respondents        :  Mr.N. Mukund Reddy-R1.

                                                 R2 present in person.

QUORUM:THE HON’BLE JUSTICE SRI D.APPA RAO, PRESIDENT

     AND

SMT.M.SHREESHA, HON’BLE   MEMBER.

         THURSDAY, THE SIXTEENTH DAY OF FEBRUARY,

TWO THOUSAND TWELVE

         (Typed to dictation of   Smt.M.Shreesha, Hon’ble Member)

                                        ****

        Aggrieved by the order in C.C.No.759/2009  on the file of District Forum-1, Hyderabad, the opposite party no.1  preferred  this appeal. 

         The brief facts as set  out in the complaint are that the complainant took a health policy from the opposite parties and paid Rs.4,400/-  covering   for a sum of Rs.1 lakh  for a period of two years i.e. from 21.12.2007  to 20.12.2009  for his family members  i.e. himself, his wife and two sons.  When the policy was in force  the complainant’s younger son underwent  ‘Fistulotomy’  on 17.12.2008  in Mediciti Hospitals.The complainant made a claim on 15.12.2008  requesting Medi Assist India Pvt. Ltd  which is the third party administrator  of opposite party no.1 for   cashless hospitalization  but the same was rejected stating that  he has to submit the bills for reimbursement. The complainant paid the hospital bills for Rs.24,102/-  and submitted the same to opposite party no.2 and once again submitted the split bills  on 5.6.2009  but did not  receive any response. Hence the complaint seeking direction to the opposite parties  to pay Rs.24,102/-  with interest at 18% p.a.  from 21.7.2007  together  with  compensation of Rs.10,000/-  and costs of Rs.5000/-.

        Opposite parties  1 and 2 remained exparte.

        The District Forum based on the evidence adduced i.e. Exs.A1 to A11   and pleadings put forward  allowed the complaint directing the   opp.parties  to pay Rs.24,102/- with interest at 12% p.a. from 21.12.2007  till the date of payment and also to pay the compensation of Rs.5000/-  and costs of Rs.2000/-.

         Aggrieved by the said order opposite party no.1 preferred this appeal.

          The facts not in dispute are that the issuance of the  Reliance Health- Wise policy to the complainant for a sum  of Rs.1 lakh, the period of coverage being 21.12.2007  to 20.12.2009  as evidenced under  Exs.A1 and A2.  Ex.A3 is the claim made by the complainant  stating that  his son had undergone  Fistulotomy  operation at Mediciti Hospital but the cashless facility was denied and he was  asked to submit the bills for reimbursement.  Ex.A6  is the Discharge Summary evidencing that the Fistulotomy  was done on   M.Prithvi, the complainant’s son.  Ex.A7 is the  In-patient Discharge Bill  amounting to Rs.24,102/-  which clearly evidences that the complainant’s son had incurred this amount towards hospitalization  expenses which  he is entitled  as per the terms and conditions of Ex.A9 policy.  It is not in dispute that the complainant has also given split  wise details as evidenced under Ex.A11. 

        The main point for  consideration here is whether the complainant is entitled to  interest from 20.12.2008 instead of 21.12.2007 ?

The complainant has already withdrawn Rs.24,102/-  which was  deposited  before this Commission.   The learned  counsel for the appellant/opp.party no.1 in his grounds stated that the patient was admitted on 17.12.2008 and  was discharged on 20.12.2008  and the complaint  was filed on 14.10.2009  whereas the District Forum has awarded interest from 21.12.2007.  We observe from the  record that  Ex.A6   which is the Discharge Summary  evidences that the complainant’s son M.Prithvi  was admitted on 17.12.2008  and Fistulotomy  was done on the same day and he was discharged on 20.12.2008 .  The bill evidenced under Es.A7 is dt.20.12.2008 .  The District Forum has awarded the amount with interest  from the  date of policy instead of the date  on which the amounts were  paid. We are of the considered view that while the complainant is entitled to Rs.24,102/-  with interest at 12% p.a., this interest  ought to have been awarded from 20.12.2008 which is the bill date evidenced under   Ex.A7.  We confirm the rest of the order of the District Forum with respect to the compensation and costs  as the opposite parties have failed  to reimburse the complainant till the complainant  chose to seek redressal before the District Forum. 

        In the result this appeal is allowed in part and order of the District Forum is modified with respect to date of interest only i.e. 12% p.a. from 20.12.2008  instead of 21.12.2007  while we confirm the rest of the order of the District Forum.  No further costs. Time for compliance four weeks.     

                                                                        PRESIDENT

                                                                        MEMBER

Pm*                                                                  Dt.16.2.2012