BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM,
ERNAKULAM.
Date of filing : 19/10/2010
Date of Order : 29/07/2011
Present :-
Shri. A. Rajesh, President.
Shri. Paul Gomez, Member.
Smt. C.K. Lekhamma, Member.
C.C. No. 554/2010
Between
M.E. Meerakutty, | :: | Complainant |
Mundangamattathil House, Pezhakkappilly. P.O., Muvattupuzha. |
| (By party-in-person) |
And
Manager, | :: | Opposite party |
M/s. National Insurance Company Ltd., Divisional Office, Urumbath Building, Pump Junction, Aluva. |
| (By Adv. C.M. Rasheed, Rex Building, Railway Station Road, Alwaye) |
O R D E R
A. Rajesh, President.
1. The case of the complainant is as follows :
The complainant is the beneficiary of the Life India Health Care membership taken by his son Faizal Meerakutty. As per the health care scheme launched by M/s. Life India, all the beneficiaries were given mediclaim coverage by the opposite party. While so, the complainant was treated for swelling on his right leg and he was subjected for a surgery for the disease. He was treated as inpatient for 17 days and spent Rs. 29,000/- towards treatment expenses. But as per the policy conditions, the complainant is eligible for Rs. 10,500/- only. However, the opposite party issued a cheque only for Rs. 5,000/-. The said act of the opposite party amount to deficiency of service. The complainant is entitled for Rs. 5,500/- which was deducted from the eligible amount of Rs. 10,500/- along with interest at the rate of 12% p.a. from the date of claim till realisation. Hence this complaint.
2. Version of the opposite party :
During the processing of the claim application, the opposite party had investigated the claim and found that the medical certificate was unauthorisedly corrected by the complainant and that the illness was a pre-existing one. That fact was intimated to the complainant. Then, the complainant came up with a clarification. On humanitarian consideration, the opposite party decided to settle the claim on non-standard basis and offered Rs. 5,000/-. The complainant accepted the offer in full and final satisfaction of the claim. No objection was raised at that time except for the same in the complaint. The complainant is not entitled to get further insurance claim from the opposite party.
3. No oral evidence was adduced by the parties. Exts. A1 and A2 and B1 were marked on the side of the complainant and the opposite party respectively. Heard both sides.
4. The only point that arose for consideration is whether the complainant is entitled to get further insurance claim from the opposite party or not?
5. Admittedly, the opposite party has possessed the claim application of the complainant and allowed a sum of Rs. 5,000/- to him by way of insurance claim. Ext. B1 the receipt issued by the complainant goes to show that he has accepted the above sum in full and final settlement of his claim without demur. The complainant does not have a case that he has executed Ext. B1 receipt under the influence of the vitiating elements of contract such as coercion, undue influence, fraud, misrepresentation or mistake. In the above circumstances, we are only to hold that the complainant is not entitled to get any further insurance claim from the opposite party.
6. Accordingly, we dismiss the complaint.
Pronounced in open Forum on this the 29th day of July 2011.
