Present :       Sri. C.T. Sabu, President

                                                            Smt. Sreeja. S., Member

                                                            Sri. Ram Mohan R, Member

31^stday of October 2022

CC 413/21 filed on 09/11/21

Complainant            :           Dayana Davis, Poovathinkal House,

                                                P.O.Viyyur, Thrissur.

                                                (By Adv. A.D.Benny, Thrissur)

Opposite Party        :           Manager, IFFCO Tokio General Insurance Co.Ltd,

                                                Kings way Towers, 30/228/8(A), 3^rd Floor,

                                                C.Achuthamenon Road, Punkunnam, Thrissur.

                                                (Ex-parte)    

O R D E R

By Smt. Sreeja S. Member:

1) The complainant availed an insurance policy issued by opposite party named “Corona Rakshak” with policy No. H0519550, and Member ID H0519550. The policy was valid during the period from 13/11/2020 to 24/08/2021. The complainant undergone medical treatment at Amala Multi Specialty Hospital, Thrissur from 29/04/21 to 05/05/21. She preferred a claim for the same amounting to Rs.2,50,000/-. The opposite party denied the payment eligible under the policy and same amounts to deficiency in service. So a lawyer notice dated 05/10/21 was sent which yielded no result. Hence this complaint.

            2) On receiving complaint, notice was properly sent to the opposite party. Opposite party not appeared before this Commission and called absent set ex-parte.

            3) Complainant appeared before this Commission and filed proof affidavit in which he has affirmed and explained all the averments stated in the complaint in detail. He produced six documents which are marked as Exts. A1 to A6. Ext. A1 is the copy of Insurance Policy; Ext.A2 is the copy of claim rejected letter; Ext.A3 is the copy of discharge summary; Ext. A4 is the copy of lawyer notice; Ext.A5 is the acknowledgement card and Ext.A6 is the mailed copy of insurance policy details.

            4) We have  gone through the pleadings and documents produced by the complainant. The complainant admitted in Amala Medical College on 29/04/21 due to covid positive and same is proved by Ext.A3. The opposite party issued Corona Rakshak policy proved by Ext.A1. Ext. A1 to A6 documents prove the case of the complainant. Also there is no contra evidence available before us. Hence we are inclined to allow this complaint.

            In the result, complaint is allowed and hereby direct the opposite party to pay Rs.2,50,000/- with 9% interest  from the date of claim and also directed to pay compensation of Rs.5000/- and Rs.2500/- towards cost, to complainant, within one month from the date of receipt of copy of this order.

            Dictated to the Confidential Assistant, transcribed by her, corrected by me and pronounced in the open Commission this the 31^stday of October 2022.

    Sd/-                                                        Sd/-                                                             Sd/-

Sreeja S                                             Ram Mohan R                                             C.T. Sabu

Member                                            Member                                                        President

Appendix

Complainant’s Exhibits :

Ext. A1 is the copy of Insurance Policy.

Ext.A2 is the copy of claim rejected letter.

Ext.A3 is the copy of discharge summary.

Ext. A4 is the copy of lawyer notice.

Ext.A5 is the acknowledgement card.

Ext.A6 is the mailed copy of insurance policy details.

                                                                                                                        Id/-

Member