Date of Filing: 24/06/2011
Date of Order: 30/08/2011
BEFORE THE I ADDITIONAL DISTRICT CONSUMER DISPUTES REDRESSAL FORUM SESHADRIPURAM BANGALORE - 20
Dated: 30th DAY OF AUGUST 2011
PRESENT
SRI.H.V.RAMACHANDRA RAO,B.SC.,B.L., PRESIDENT
SRI.KESHAV RAO PATIL, B.COM., M.A., LL.B., PGDPR, MEMBER
SMT.NIVEDITHA .J, B.SC.,LLB., MEMBER
COMPLAINT NO. 1157 OF 2011
Sri. G.R. Yoganarasimha,
S/o. late Ramaswamy G.R.,
R/at: No.106/1, Mahabala,
15th Cross, Gayathridevi Park Extension,
Vyalikaval, Bangalore-560 003.
(Rep. by Advocate Sri.H.R. Ananthakrishna Murthy) Complainant.
-V/s-
(1) M/s. Reliance General Insurance Co. Ltd.,
No.19, Walchand Hirachand Marg, Ballard East,
Mumbai-400 001, Rep. by its Manager.
At also
M/s. Reliance General Insurance Co.
No.28, East Wing, 5th Floor, Centenary Building,
M.G. Road, Bangalore-560 001.
Rep. by its Branch Manager.
(2) M/s. Alankit Health Care Ltd.,
No.42, 46/E, 2nd Floor, Lalbagh Road,
Bangalore-560 027, Rep. by its Branch Manager.
(3) M/s. Federal Mogul Goetze India Ltd.,
Near Sheshadripuram College,
Doddaballapur Road, Yelhanka,
BANGALORE-560 064.
(Rep. by Advocate Sri.Ravishankar Patil) Opposite parties.
BY SRI. H.V.RAMACHANDRA RAO, PRESIDENT
ORDER
The brief antecedents that lead to the filing of the complainant made Under Section 12 of the Consumer Protection Act, seeking direction to the opposite party No.3 to renew the medical insurance policy from 01.07.2010 onwards, and direct the opposite parties to pay a sum of Rs.4,73,479/-, are necessary:-
The complainant was working as a Deputy General Manager with the third opposite party No.3 took voluntary retirement on 05.01.2003. He was covered under the scheme Company’s Group Health Insurance from the date of joining the company, the premium is paid by the 3rd opposite party. The opposite parties entered in to an agreement in this regard. The insurance has been renewed up to 30.06.2010. Prior to November-2009 all medical claims made by the complainant has been settled on a regular basis. In respect of certain medical bills raised for Rs.43,402/- and Rs.1,72,810/- towards dialysis and Rs.2,50,669/- towards renal transplantation the complainant made complaint No.718/2010 which was disposed of on 08.03.2011 allowing the complaint with respect to the claim of Rs.43,402/- and regarding the rest of the claim it was ordered giving liberty to the complainant to file a fresh complaint after fulfilling the formalities. It is manifest, therefore, the third opposite party under took to forward the amount to the insurance company. Accordingly the complainant sent Rs.14,000/- for forwarding it to the third opposite party, but the cover was returned unopened. Hence the complainant took a fresh DD for Rs.14,000/- and handed over to the third opposite party which was sent back to him on 05.04.2011. The third opposite party has renewed the policy of other retired employees, but failed to renew the policy of the complainant. There is hostile discrimination. In pursuance of the said order this complaint is filed.
2. In this case the opposite party No.1 and 2 though served remained absent throughout the proceedings. In brief the version of the opposite party No.3 are:-
The complainant filing the complaint No.718/2010, its order are admitted. The opposite party has not received any amount from the complainant for forwarding the insurance premium to the other opposite parties nor there exist any privity of contract between the complainant and the opposite party No.3 in this regard. Hence the opposite party returned the DD. The opposite party was only a postman. The complainant has to make his own arrangement to pay the amount to the other opposite parties in case he requires and get the insurance and for which this opposite party is in way concerned. This has been intimated to the complainant. All the allegations to the contrary are denied.
3. To substantiate their respective cases, the opposite party No.3 has stated that his version and documents be read as his affidavit. The complainant remained absent subsequently hence arguments were heard.
4. The points that arise for our consideration are:-
- Whether there is deficiency in service on the part of the opposite parties?
- What order?
5. Our findings on the above points are:-
Point (A):In the Negative
Point (B) : As per the final order
For the following:-
REASONS
POINT (A) to (B):-
6. Reading the pleadings in conjunction with the documents on record, it is an admitted fact that the complainant was a retired employee of the third opposite party and he was covered under the Group Insurance scheme of the opposite parties and he was paying the premium and it was renewed. Up to 01.06.2010 the insurance was renewed.
7. Regarding certain medi-claim the complainant has made C.C.No.718/2010 before the Third Additional Consumer Disputes Redressal Forum, Bangalore, wherein an order was passed on 08.03.2011. At Para- 7 and 8 of the said order the forum has ruled thus:-
“The complainant has pleaded that during the period from 26.01.2010 to 06.03.2010 he took the treatment for dialysis as per document No.49 to 69 and he has spent Rs.57,963/-. The complainant does no pleaded that he has made any claim relating to this amount to opposite parties 1 and 2 and that claim was rejected by the opposite party. Even before this Court, the complainant has not made any specific prayer for awarding this sum. Hence, we are of the opinion that this claim is not in dispute in this case. Hence, if the complainant is interested, he may make specific claim to the opposite parties and get the amount according to the terms of the insurance policy. With this liberty to the complainant, we hold that this claim of Rs.57,963/- cannot be considered in this case.”
“By amending the complaint, the complainant has pleaded that he has spent Rs.2,50,669/- for renal transplantation and he has made a payer for directing the opposite parties 1 and 2 to pay this amount. In our opinion, this relief need not be considered in this case, because the complainant has not pleaded that he has made a claim relating to this amount before the opposite parties 1 and 2 and they have repudiated that claim. In the absence of such pleadings, there is no cause of action to consider this prayer. Hence, it is observed that the complainant may make a claim relating to this amount before the opposite parties 1 and 2. With this liberty to the complainant, this prayer for payment of Rs.2,50,669/- is not granted in this complaint.”
That means regarding the dialysis and renal transplantation it was held that the complainant had not made a claim before the insurance company and that cannot be considered in that case. After disposal of the said complaint the complainant should have laid claim before the opposite party No.1 and 2 with all the documents and if the opposite parties failed to comply with the order then he could have rushed to the forum and not otherwise. In this case after disposal of this case the complainant he had only issued a notice to the opposite parties through his advocate and not laying the claim hence the complaint is pre-mature so for as this two amounts are concerned. The complainant is at liberty to claim and after any order is passed, if he is aggrieved, he may approach the forum, for which this order will not come in that way.
8. In this case the complainant wants the insurance has to be renewed by the third opposite party, which is impermissible in law. The third opposite party is not the insurance company. The third opposite party might have forwarded the insurance premium given by the complainant to the other opposite parties earlier, now they have stopped. If there is any discrimination then the remedy of the complainant is to approach the appropriate forum or tribunal or court and not this forum. Regarding the renewal of this policy the complainant has not paid any service charges to the opposite party No.3 nor the opposite party No.3 has collected any money from the third opposite party for sending the amount of the complainant to the other opposite parties. The remedy of the complainant is else ware so for as the renewal of the policy is concerned. The opposite party No.3 is only a post man doing service freely earlier now they do not want to extend that service. Hence the complainant cannot be a consumer so far as this prayer is concerned vis-à-vis with the third opposite party. Hence there is no deficiency in service. Hence we hold the above points accordingly and proceed to pass the following:-
ORDER
1. The complaint is Dismissed.
2. Return the extra sets filed by the parties to the concerned as under Regulation 20(3) of the Consumer’s Protection Regulation 2005.
3. Send a copy of this order to the complainant free of costs, immediately.
(Dictated to the Stenographer, transcribed and typed by him, corrected and then pronounced by us in the Open Forum on this the 30th Day of August 2011)
MEMBER MEMBER PRESIDENT
