BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM,

ERNAKULAM.

Date of filing : 03/03/2010

Date of Order : 31/05/2012

Present :-

Shri. A. Rajesh, President.

Shri. Paul Gomez, Member.

Smt. C.K. Lekhamma, Member.

C.C. No. 121/2012

Between

And

O R D E R

A. Rajesh, President.

1. The undisputed facts of the complainant's case are as follows :

The complainant availed a Mediclaim Insurance Policy under the Sahridhaya Arogya Suraksha Scheme issued by the opposite parties. The complainant had undergone treatment for fibroid Uterus as inpatient form 24-09-2011 to 08-10-2011 at Medical Trust Hospital, Ernakulam. On 19-10-2011, the complainant submitted insurance claim application for Rs.65,283/-. On 30-01-2012, the opposite parties issued a cheque for Rs. 17,820/-. The opposite parties without sufficient reason denied the balance amount of insurance claim of Rs. 47,463/-. The complainant is entitled to get the amount with interest. This complaint hence.

2. Despite service of notice from this Forum, the opposite parties chose to remain absent and silent for their own reasons. Proof affidavit has been filed by the complainant and Exts. A1 to A6 were marked on her side. Heard the counsel for the complainant.

3. The points that arose for consideration are as follows :-

1. Whether the complainant is entitled to get the balance insurance claim from the opposite parties?

2. Whether the opposite parties are liable to pay compensation and costs of the proceedings to the complainant?

4. Point No. i. :- Admittedly, the complainant availed herself of an insurance policy from the 1^st opposite party for the period from 07-01-2011. According to the complainant, during the currency of the insurance policy she underwent treatment at Medical Trust Hospital. Admittedly on 19-01-2011, the complainant submitted a claim application before the opposite parties. Thereafter, the 1^st opposite party paid a sum of Rs. 17,820/- evidenced by Ext. A1 cheque dated 30-01-2012. There is nothing material on record before us except the averments and contentions of the complainant. However, nothing is forthcoming against on the part of the opposite parties in repudiating the claim of the complainant, on account of which we are only to uphold the claim of the complainant. The complainant had undergone treatment at Medical Trust Hospital, Ernakulam evidenced by Ext. A5 series documents and Ext. A4 series medical bills. The complainant is entitled to get the insurance claim fully from the opposite parties subject to the assured amount of insurance.

5. Point No. ii. :- Since nothing is placed before us sustaining or in proof of the policy details, we are not to award costs or compensation.

6. In the result, we partly allow the complaint and direct that the opposite parties shall jointly and severally pay the balance insurance claim of the complainant fully together with 12% interest p.a. from the date of complaint till realisation subject to the sum assured as per the policy.

The order shall be complied with, within a period of one month from the date of receipt of a copy of this order.

Pronounced in open Forum on this the 31^st day of May 2012

Sd/- A. Rajesh, President.

Sd/- Paul Gomez, Member.

Sd/- C.K. Lekhamma, Member.

Forwarded/By Order,

Senior Superintendent.

A P P E N D I X

Complainant's Exhibits :-

Opposite party's Exhibits :: Nil

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