BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANGALORE
Dated this the 28th March 2014
PRESENT
SMT. ASHA SHETTY : HON’BLE PRESIDENT
SMT.LAVANYA M. RAI : MEMBER
COMPLAINT NO.352/2013
(Admitted on 24.12.2013)
Mrs.Savitha,
Wo Santhosh Kumar,
Aged about 27 years,
Ro Yashovishwa,
Near Bus Stand, Talapady,
Mangalore 575 023. …….. COMPLAINANT
(Advocate for Complainant: Sri J.Ravindra Naik)
VERSUS
Mr.Venkataswamy K.
CRM Medi Assist. India TPA Pvt. Ltd.,
No.1 10 74, Flat No.G 201,
2 Floor, Galada Towers,
Survey No.44, Vile Bapuji Estate,
Begumpet, Hyderabad 500 016. ……OPPOSITE PARTY
(Opposite party : Exparte.)
ORDER DELIVERED BY HON’BLE PRESIDENT
SMT. ASHA SHETTY:
I. 1. This complaint is filed under Section 12 of the Consumer Protection Act alleging deficiency in service as against the Opposite Party claiming certain reliefs.
The brief facts of the case are as under:
The complainant stated that, the Opposite Party is a Medical Assistance providing to its policy holder and he was working in M/s Agrigold at Thokkottu at Mangalore Branch for five years and had benefit of insurance, the opposite party issued a policy No.MA.ID.4012250192 to the complainant. It is stated that, the policy holder is M/s. Agrigold Constructions Private Ltd., at Mangalore and complainant is the employee at Agrigold Constructions Private Ltd. and covered under the policy for Medi-Assist and policy was valid up to 26.4.2013. It is stated that, the complainant had delivered a male child at Mangalore Nursing Home, on 19.9.2012 and spent Rs.34,000/- and covered under the Medi-Assist Policy and thereafter claimed the said amount under the policy, but Opposite Party has not settled the claim and complainant issued lawyer’s notice dated 8.7.2013, but Opposite party failed to comply the demand made therein. Hence the complainant filed the above complaint under Section 12 of the Consumer Protection Act 1986 (herein after referred to as ‘the Act’) seeking direction from this Forum to the Opposite Party to pay a sum of Rs.34,000/- along with compensation and cost of the proceedings.
II. 1. Version notice served to the Opposite Party by R.P.A.D. Opposite Party inspite of receiving version notice neither appeared nor contested the case before this FORA. Hence, we have proceeded exparte as against the Opposite Party. The postal acknowledgement marked as Court Doc. No.1.
III. 1. In support of the complaint, Mrs. Savitha (CW1) – Complainant filed affidavit reiterating what has been stated in the complaint and produced Ex. C1 to C6. Opposite Party not filed any evidence, hence placed exparte.
In view of the above said facts, the points now that arise for our consideration in this case are as under:
- Whether the complaint is bad for non-joinder of necessary parties?
- Whether the Complainant proves that the Opposite Party has committed deficiency in service?
- If so, whether the Complainant is entitled for the reliefs claimed?
- What order?
We have considered the notes/oral arguments submitted by the learned counsels and also considered the materials that was placed before this Forum and answer the points are as follows:
Point No.(i) & (ii): Negative.
Point No.(iii) & (iv): As per the final order.
REASONS
IV. 1. POINTS NO. (i) TO (iv):
In the instant case, the complainant filed affidavit in order to substantiate the averments made in the complaint along with documents i.e. Ex.C1 to C6. On perusal of the affidavit as well as documents, discharge summary issued by the Mangalore Nursing Home reveals that the complainant was admitted on 19.9.2012 and discharged on 25.9.2012 and delivered a male child and spent Rs.36,460/- towards medical expenses. However, in order to show that she is the policy holder she produced policy particulars as per Ex.C6, wherein, it shows that the complainant Savitha was insured and also shows that she is employee of M/s. Agrigold Constructions Private Ltd., and policy valid up to 26.4.2013. The original documents i.e. Ex.C1 to C5 are submitted to the Insurance Company, but in the instant case the Oriental Insurance Company Limited who had issued the policy not honoured the claim of the Complainant.
However the Opposite party inspite of receiving version notice not appeared nor contested the case. The entire evidence placed on record not contraverted nor contradicted. Hence which requires no further proof.
Apart from the above, it is also observed that the complainant before filing a consumer complaint also issued legal notice dated 8.7.2013 to the Opposite Party i.e. CRM Medi Assist. India Pvt. Ltd., however we further observed that the insurance policy was issued by the Oriental Insurance Company Ltd., is not by the third party administrator. So that the insurance company is also necessary party to the proceeding in this case. Since the complainant is not made the insurance company as necessary party to the proceedings the complaint deserves to be dismissed for non-joinder of necessary parties. Hence the complaint deserves to be dismissed with a liberty to file fresh complaint. No order as to cost.
In the result, we pass the following:
ORDER
The complaint is dismissed. No order as to cost.
Copy of this order as per statutory requirements, be forward to the parties and file shall be consigned to record room.
(Page No.1 to 5 dictated to the Stenographer typed by him, revised and pronounced in the open court on this the 28th day of March 2014)
PRESIDENT MEMBER
ANNEXURE
Witnesses examined on behalf of the Complainant:
CW1 – Mrs. Savitha - Complainant.
Documents produced on behalf of the Complainant:
Ex C1 : 25.9.2012:Copy of Discharge summary.
Ex C2: 21.3.2013: Copy of Medical bill.
Ex C3: 30.3.2013:Receipt for having sent the claim through speed post to O.P.
Ex C4: 8.7.2013: Office copy of Lawyer’s Notice.
Ex C5: 19.7.2013: Acknowledgement card.
Ex C6: Notarized copy of card issued by the O.P.
COURT DOCUMENT:
DOC.No.1: Postal acknowledgment.
Witnesses examined on behalf of the Opposite Party:
-Nil-
Documents produced on behalf of the Opposite Party:
-Nil-
Dated:28-03-2014 PRESIDENT
