DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD
DATED THIS THE 25TH DAY OF MARCH, 2024.
PRESENT : SRI VINAY MENON .V, PRESIDENT.
: SMT. VIDYA.A., MEMBER. : SRI. KRISHNANKUTTY N .K, MEMBER.
DATE OF FILING: 02.11.2023.
CC/298/2023
Praveen Kumar.K, - Complainant
S/o.Kandan, Souparnika,
Annakode, Pallassana,
Palakkad-678 505.
(By Adv. Sayooj.K.C)
Vs
Manappuram Finance Ltd., -Opposite Party
Pulikkottil Complex,
1st Floor, Opposite Karuna Gardens,
Chamdappura, Parali,
Palakkad-678 612.
(Ex-parte)
ORDER
BY SRI. KRISHNANKUTTY N .K, MEMBER.
1. Pleadings of the complainant.
The complainant and his wife availed medical insurance cover for Rs.5 lakhs each from M/s.Niva Bupa Health Insurance Co. Ltd. under the Group Master Policy in the name of the opposite party. The coverage was for the period from 08.01.2022 to 07.01.2023. The complainant remitted the renewal premium of Rs.8,865/- on 25.01.2023 ie within the grace period of 30 days from the expiry of the earlier policy. Instead of renewal policies, the complainant received by registered post, two separate policy documents for Rs.5,00,000/- in the name of the complainant and his wife issued by M/s.Liberty General Insurance for the period from 28.01.2023 to 27.01.2024 along with the insurance ID cards.
The complainant was admitted to M/s. Rajeev Gandhi Co-operative Hospital for treatment of heart related problems on 09.05.2023. As the insurance company refused to give pre authorisation for cashless facility, the complainant had to make the payment in cash at the time of discharge. When the complainant enquired about the denial, the insurance company sent him rejection letter stating that, as the policy was issued only on 28.01.2023, he is not eligible for the claim as per the terms of the policy.
According to the complainant, he had to suffer loss due to the deficiency in service or unfair trade practice of the opposite party and hence, approached this Commission seeking total compensation of Rs.12,41,805/- towards financial loss, deficiency in service and unfair trade practice.
2. Notice was issued to the opposite party. They neither enter appearance nor file their version. Hence, their name was called in open court and set-ex-parte.
3. The complainant filed brief affidavit and marked Exts.A1 to A7 as evidence. Ext.A1 is the copy of the policy document issued by M/s. Niva Bupa Health Insurance Company. Ext.A2 is the copy of the policy document issued by M/s. Liberty Insurance Company, Ext.A3 is the insurance rejection letter issued by M/s. Liberty Insurance Company, Ext.A4 is the copy of liberty Insurance Policy card, Ext.A5 is the copy of Adhar card of the complainant, Ext.A6 is the copy of pancard of the complainant and Ext.A7 is the screenshot of renewal premium payment made by the complainant by Googlepay.
4. From the evidences adduced, it is clear that the opposite party, instead of renewing the policy with Niva Bupa, issued a new policies from M/s.Liberty Insurance ie, effective from 28.01.2023. If the opposite party had renewed the policies with Niva Bupa, the policy cover would have been from the date of original policy and his medical claim would have been settled as per the terms and condition of that policy. Since the opposite party has not cared to file the version within the statutory period, they have failed to highlight the reason for unilaterally issuing a fresh policy instead of the renewal of the original policy that too from a different company without taking the consent of the parties concerned.
This is a definite case of unfair trade practice and deficiency in service on the part of the opposite party which resulted in the repudiation of medical claim of the complainant.
5. Resultantly, the complaint is allowed ordering the following reliefs;
1) The opposite party is directed to pay Rs.2,41,805/- along with interest @ 10% from 03.10.2023 till the date of payment.
2) The opposite party is also directed to pay Rs.1,00,000/- as compensation for deficiency in service and unfair trade practice.
3) The opposite party is also liable to pay Rs.25,000/- towards legal expenses.
The above amounts are to be paid within 45 days of receipt of this order, failing which the opposite parties are liable to give Rs.500/-as solatium per month or part thereof till the date of payment.
Pronounced in open court on this the 25th day of March, 2024.
Sd/-
VINAY MENON .V,
PRESIDENT.
Sd/-
KRISHNANKUTTY N .K,
MEMBER.
APPENDIX
Documents marked from the side of the complainant:
Ext.A1: Copy of the NivaBupa Insurance Policy dated 10.03.2021.
Ext.A2: Copy of the Liberty Insurance Policy dated 28.01.2023.
Ext.A3: Copy of the Liberty Insurance Hospital Re-imbursement rejected documents dated 03.10.2023.
Ext.A4: Copy of the Liberty Insurance Policy card.
Ext.A5: Copy of the Adhar card.
Ext.A6: Copy of the Pancard.
Ext.A7: Copy of the computer generated printout of Goolepay of Rs.8,865/- dated 25.02.2023.
NB: Parties are directed to take back all extra set of documents submitted in the proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission ProcedureRegulations), 2020 failing which they will be weeded out.
