IN THE CONSUMER DISPUTES REDRESSAL FORUM, PATHANAMTHITTA,

Dated this the 27^th day of July, 2010.

Present : Sri. Jacob Stephen (President).

Smt. C. Lathika Bhai (Member)

N. Premkumar (Member)

C.C. No.52/10 ( Filed on 26.03.2010)

Between:

Reji Mathew,

Ettickal House,

Cheenkalthadom P.O.,

Pathanamthitta.                                                           ....  Complainant.

And:

1.     The Managing Director,

Medi Assist India Pvt. Ltd.,

Team Reliance Wealth + Health

Bangalore – 560078.

2.     The Branch Manager,

Medi Assist India Pvt. Ltd.,

Ist Floor, Trinity complex,

T.K. Road, Pathanamthitta.                              ....  Opposite parties.

ORDER

Sri. Jacob Stephen (President):

                   The complainant has filed this complaint against the opposite parties for getting a relief from the Forum.

                   2. The complainant’s case is that he is a policy holder of the opposite parties vide policy No.11562086 under Reliance Life Insurance Wealth + Health Plan Scheme.  According to the complainant, as per the terms and conditions of the policy, the policy holder and his dependents are entitled to get treatment expenses and allied expenses for 10 years from 26.02.2008.  While so, during the validity of the policy, the complainant’s wife was hospitalised from 25.06.2009 to 02.07.2009 at Pushpagiri Medical College Hospital, Thiruvalla for the evaluation and treatment of post hysterectomy and pain abdomen under the consultation of Dr. Rajalekshmi.  She had undergone various medical treatments and consumed medicines as an inpatient for 7 consecutive days at the hospital.  The complainant had incurred altogether Rs.12,679/- as medical bills and other expenses in connection with the said treatment.  The complainant has claimed a cash reimbursement claim No.RLIC 1303/09 from the opposite parties on 01.08.2009 with all necessary documents.  But they have not allowed the complainant’s claim for the reimbursement even after issuing a lawyer notice on 03.11.2009.  The above said acts of the opposite parties is a clear deficiency in service and the opposite parties are liable to the complainant for the same.  Hence this complaint for the realisation of Rs.22,679/- under various heads along with cost of this proceedings.

                   3. In this case, the opposite parties were exparte.

                   4. On the basis of the complaint, the only point to be considered is whether this complaint can be allowed?

                   5. The evidence of the complainant consists of his proof affidavit and Exts.A1 to A5.  After closure of evidence, the complainant was heard.

                   6. The point:  In order to prove the complainant’s case, the complainant had filed proof affidavit in lieu of chief examination along with 5 documents.  On the basis of the proof affidavit, the documents produced by the complainant were marked as Exts.A1 to A5.  Ext.A1 is the photocopy of the premium collection receipt dated 20.02.2009 for Rs.10,000/- issued in the name of the complainant by the opposite parties.  Ext.A2 is the photocopy of the claim form dated 01.08.2009 submitted by the complainant before the opposite parties.  Ext.A3 is the photocopy of the discharge summary dated 02.07.2009 issued from Pushpagiri Medical College Hospital, Thiruvalla in the name of Elizabeth Reji.  Ext.A4 series (Exts.A4 to A4(j) are the medical bills issued from Pushpagiri Medical College Hospital, Thiruvalla in the name of Elizabeth Reji.  Ext.A5 is the office copy of the Advocate Notice dated 03.10.2009 issued for the complainant in the name of the first opposite party.

                   7. On a perusal of the materials on record, it is seen that the complainant is a policy holder of the opposite parties and his wife had undergone treatment at Pushpagiri Medical College Hospital from 25.06.2009 to 02.07.2009 and he had spent money for the said treatment.  The complainant’s allegation is that though he had filed a claim form as per the terms and conditions of the policy, the opposite parties denied the complainant’s claim for reimbursement.  Since the opposite parties are exparte, the complainant’s allegation against the opposite parties stands proved as unchallenged.  The denial of the complainant’s claim by the opposite parties is a clear deficiency in service and the opposite parties are liable to the complainant for the above said deficiency.  Hence this complaint is allowable as prayed for in the complaint.

                   8. In the result, this complaint is allowed, thereby the opposite parties are directed to pay Rs.22,679/- (Rupees Twenty two thousand six hundred and seventy nine only) as the expenses for the treatment and compensation for the deficiency of service along with cost of Rs.1,000/- (Rupees One thousand only) to the complainant within one month from the date of receipt of this order, failing which the complainant is allowed to realise the above said amounts with 9% interest per annum from today till the whole realisation.

                   Pronounced in the Open Forum on this the 27^th day of July, 2010.    

                                                                                             (Sd/-)

                                                                                                Jacob Stephen,

                                                                                                    (President)

Smt. C. Lathika Bhai (Member)     :         (Sd/-)

Sri. N. Premkumar (Member)       :         (Sd/-)

Appendix:

Witness examined on the side of the complainant : Nil.

Exhibits marked on the side of the complainant:

A1     :         Photocopy of the premium collection receipt dated 20.02.2009  

                    for Rs.10,000/- issued in the name of the complainant.

A2     :         Photocopy of the claim form dated 01.08.2009 submitted by the

                     complainant before the opposite parties.

A3     :         Photocopy of the discharge summary dated 02.07.2009 issued

                    from Pushpagiri Medical College Hospital, Thiruvalla in the

                    name of Elizabeth Reji.

A4  to A4(j) :Medical bills issued from Pushpagiri Medical College

                    Hospital, Thiruvalla in the name of Elizabeth Reji.

A5     :         Photocopy of the Advocate Notice dated 03.10.2009 issued for   

                     the complainant in the name of the first opposite party.

Witness examined on the side of the opposite parties : Nil.

Exhibits marked on the side of the opposite parties : Nil.

                                                                                                (By Order)

Senior Superintendent.

Copy to:  (1)  Reji Mathew, Ettickal House, Cheenkalthadom P.O.,

                        Pathanamthitta.                                                               

(2)  The Managing Director, Medi Assist India Pvt. Ltd.,

             Team Reliance Wealth + Health Bangalore – 560078.

(3)  The Branch Manager, Medi Assist India Pvt. Ltd.,

              Ist Floor, Trinity complex, T.K. Road, Pathanamthitta.

       (4)   The stock file.