IN THE DISTRICT CONSUMERS’ DISPUTES REDRESSAL FORUM AT MYSORE<br /> <br /> PRESENT: 1. Shri.A.T.Munnoli<br /> B.A., L.L.B (Spl.) - President <br /> <br /> 2. Smt.Y.V.Uma Shenoi<br /> M.Sc., B.Ed., - Member<br /> 3. Shri. Shivakumar.J.<br /> B.A., L.L.B., - Member<br /> <br /> CC 227-2010 DATED 23.07.2010<br /> ORDER<br /> <br /> Complainant Bharath, <br /> S/o Thulasidar, No.1426, <br /> 7th Cross, Behind Irwin Road, Kolada Sandhi Beedhi, Mysore.<br /> <br /> (By Sri. Shashidhara, Advocate)<br /> <br /> Vs. <br /> Opposite Parties 1. Manager, M/s The Oriental Insurance Co.Ltd., No.1, Thejas Complex, CSI, S.R.Road, P.B.27, Mysore.<br /> 2. The Authorised Officer, <br /> M/s Raksha TPA Pvt. Ltd., No.25, Ashirwad, I Floor, 29th Main, II Stage, BTM Layout, <br /> Bangalore-560076.<br /> (By Sri. Jaganath Suresh Kumar, Advocate for O.P.1 and <br /> O.P.2 - EXPARTE)<br /> <br /> Nature of complaint : Deficiency in service<br /> Date of filing of complaint : 01.06.2009<br /> Date of appearance of O.P. : 16.06.2010<br /> Date of order : 23.07.2010<br /> Duration of Proceeding : 1 MONTH 7 DAYS<br /> <br /> <br /> PRESIDENT <br /> <br /> <br /> <br /> MEMBER<br /> <br /> <br /> MEMBER<br /> <br /> <br /> Sri. A.T.Munnoli,<br /> President<br /> <br /> 1. The complainant has filed the complaint against the opposite parties Under Section 12 of the Consumer Protection Act, alleging deficiency in mediclaim service. It is alleged that, father of the complainant took treatment in Chitra Hospital and was admitted, for which in all Rs.7,882/- was spent, but, the opposite parties failed to pay the said amount, in spite of the request made.<br /> <br /> 2. The first opposite party in the version has contended that, second opposite party is the third party administrator has to look into the matter and further, it is contended that, the ailments for which father of the complainant took treatment are excluded as per the conditions of the policy and further, it is stated that, Osteoarthrities is not covered for the first four years from the policy and HTN is not covered for the first two years and hence, the complainant is not entitled for the amount.<br /> <br /> 3. Second opposite party in spite of service of notice, has remained exparte.<br /> <br /> 4. The complainant has filed his affidavit and produced certain documents. For the first opposite party, Divisional Manager has filed his affidavit and produced certain documents. For the complainant, written arguments are filed. We have heard the arguments of both learned advocate for the complainant and the first opposite party and perused the records.<br /> <br /> 5. Now, the point for our consideration is, whether the complainant has proved any deficiency in service on the part of both or any one of the opposite parties and that he is entitled to the reliefs sought?<br /> <br /> 6. Our finding is in affirmative, for the following reasons.<br /> <br /> REASONS<br /> <br /> 7. The fact that, the complainant had taken mediclaim policy from the first opposite party, details of which are furnished in the second paragraph of the complaint, is not in dispute. Likewise, the tests that father of the complainant has undergone and the treatment taken, details of which are mentioned in third paragraph of the complaint, is not in dispute. To substantiate the said facts alleged in the complaint, the complainant has filed his affidavit and so also, produced various documents.<br /> <br /> 8. The claim of the complainant has been denied or disputed mainly on the ground that, the ailments are excluded from the terms of the policy, particularly that Osteoarthrities is not covered for the first four years from the date of inception of the policy and hypertension is not covered for the first two years from the inception of the policy. To meet this contention of the first opposite party, the complainant has produced copy of earlier mediclaim polcies, where from, it can be seen that, complainant had earlier policies for which, premium was paid. Hence, it is clear that, from time to time mediclaim policies are taken or renewed and hence, the said contention of the first opposite party to repudiate the claim, cannot be accepted. Consequently, deficiency in service on the part of the opposite parties, is established.<br /> <br /> 9. First opposite party further contend that, the second opposite party is TPA, which is governed by the Regulations and the claim of the complainant shall have to be scrutinized and it has pay the amount if admissible and then recover the same from the first opposite party. But, that does not absolve the liability of the first opposite party. Considering the facts, in fact both opposite parties are jointly and severally liable. <br /> <br /> <br /> 10. Accordingly, our finding on the above point is in affirmative.<br /> <br /> ORDER<br /> <br /> 1. The Complaint is allowed.<br /> 2. The opposite parties jointly and severally are directed to pay a sum of Rs.7,882/- to the complainant, within a month from the date of this order, failing which the amount shall carry interest at the rate of 10% p.a.<br /> 3. Further, both opposite parties jointly and severally are directed to pay a sum of Rs.2,000/- towards compensation for mental agony and inconvenience caused, within a month from the date of this order, failing which the amount shall carry interest at the rate of 10% p.a.<br /> 4. Likewise, opposite parties to pay cost of Rs.1,000/- to the complainant.<br /> 5. Give a copy of this order to each party according to Rules.<br /> <br /> (Dictated to the Stenographer, transcribed by her, transcript revised by us and then pronounced in the open Forum on this the day 23rd July 2010)<br /> <br /> <br /> <br /> <br /> (A.T.Munnoli) <br /> President <br /> <br /> <br /> <br /> (Y.V.Uma Shenoi)<br /> Member<br /> <br /> <br /> <br /> (Shivakumar.J.)<br /> Member<br /> <br />