D.O.F:08/09/2023
D.O.O:16/05/2024
IN THE CONSUMER DISPUTES REDRESSAL COMMISSION, KASARAGOD
CC.274/2023
Dated this, the 16th day of May 2024
PRESENT:
SRI.KRISHNAN.K : PRESIDENT
SMT.BEENA.K.G : MEMBER
K. Shobha
W/o K. Soorya Kumar
Shiva Durga Nilaya
Pulikoor
Shiribagilu Post
Kasaragod. : Complainant
And
M/s Universal Sompo General
Insurance Company
TR/54/3106-C, 2nd Floor
Grace Corner, K.K. Road
Kadavantra Junction,
Kadavantra
Kochi – 682020. : Opposite Party
ORDER
SMT.BEENA.K.G : MEMBER
The complainant is a middle-aged woman having health Insurance Card of opposite party. The petitioner had undergone treatment at Moodubidri Hospital, Karnataka during the month of January, 2023 and had spent Rs. 11,000/- for treatment. Thereafter the petitioner had submitted all relevant medical bills to opposite party for refund of the bill amount. But opposite party had sent Rs. 500/- only to the petitioner instead of refund of the full amount. At the time of joining Health Insurance Scheme, opposite party assured that the complainant will refund full amount of medical expenses. The petitioner had requested opposite party to refund the claim amount many times directly and through phone. But so far, the amount is not refunded. Hence the complaint for necessary redressal.
Notice of opposite party served, name called absent, set exparte.
The complainant filed proof affidavit and the documents produced are marked Ext.A1 series and Ext. A2 policy. The issues raised for consideration are;
- Whether there is any deficiency in service on the part of opposite party in repudiation of the complainant’s claim?
- Whether the complainant is entitled for relief?
- If so, what is the relief?
The complainant’s husband Soorya Kumar had taken a Health Insurance policy of opposite party. The policy covers all family members. In the meanwhile, the complainant had undergone treatment at Moodubidri Hospital during the month of January 2023. The complainant had spent an amount of Rs. 11,000/- in the hospital. Ext. A1 series is produced to prove the treatment expenses. The complainant had submitted all relevant medical bill and claim application to opposite party. But the opposite party had sent only 500 rupees instead of Rs.11,000/-. As a policy holder, the complainant is entitled for the entire bill amount. But unfortunately, the office of opposite party sent only Rs. 500/- instead of Rs. 11,000/-. The above said act of the opposite party caused severe mental agony and monitory loss to the complainant. In the absence of rebuttal evidence, complainant is entitled for the balance amount with compensation and cost. Considering the facts and circumstances of this case, this commission is of the view that an amount of Rs. 5,000/- is a reasonable compensation in this case.
Therefore, complaint is partly allowed, directing opposite party to pay Rs. 10,500/- (Rupees Ten thousand Five hundred only) as balance bill amount with 8% interest from the date of complaint till payment with a compensation of Rs. 5,000/- (Rupees five thousand only) and a cost of Rs. 3,000/- (Rupees Three thousand only) to the complainant within 30 days from the date of receipt of copy of this order.
Sd/- Sd/-
MEMBER PRESIDENT
Exhibits
A1 - Series
A2 – Policy
Sd/- Sd/-
MEMBER PRESIDENT
Forwarded by Order
Assistant Registrar
JJ/
