IN THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI

                                 BEFORE :        Hon’ble Justice R. SUBBIAH                    PRESIDENT

                                              Thiru R   VENKATESAPERUMAL             MEMBER                        

F.A.NO.407/2022

(Against order in CC.NO.19/2022 on the file of the DCDRC, Salem)

DATED THIS THE 21^st DAY OF NOVEMBER 2022

Branch Manager

Star Health and Allied Insurance Co. Ltd.,

Branch Office – II

Door No.62-64, Sri Sai Kamatchi Complex                    M/s.M.B.Gopalan

2^nd Floor, Kumarasampatty                                             Counsel for

Cherry Road, Salem – 636 007                                     Appellant / Opposite party

                                                         Vs.

N. Srinivasan

S/o. Natesan

No.5/2258, Uthukuli Kadu                                        M/s. R.Setuvarayar

Ammani Kondalampatty                                                Counsel for

Salem – 636 010                                                Respondent/ Complainant

          The Respondent as complainant filed a complaint before the District Commission against the opposite party praying for certain direction. The District Commission allowed the complaint. Against the said exparte order, this appeal is preferred by the opposite party praying to set aside the order of the District Commission dt.13.7.2022 in CC. No.19/2022.

          This petition is coming before us for hearing finally today.  Upon hearing the arguments of the counsel appearing for appellant, perusing the documents, lower court records, and the order passed by the District Commission, this commission made the following order in the open court:

JUSTICE R. SUBBIAH ,  PRESIDENT  (Open court)

1.      The opposite party before the District Commission is the appellant herein.

2.       The case of the complainant before the District Commission is that the complainant had obtained health insurance “Corona Kavach Policy” from the opposite party.  On 17.5.2021, when the complainant approached the hospital since he was suffering from cold, cough and fever, he was diagnosed as positive for COVID-19, and had undergone treatment as inpatient as per the advise of the doctor.  Since the complainant was having the policy cover for covid-19, he made a claim with the opposite party, for reimbursement of Rs.1,00,000/- which he spent towards treatment.  Since the same was refused by the opposite party stating that as per the guidelines from AIIMS, New Delhi and Ministry of Health and Family Welfare, Government, the complainant need only home isolation.  Instead the complainant opted for treatment by hospitalization.  But the complainant had treatment as per the standard Covid-19 protocol of the Government of India, therefore he is eligible for the reimbursement.  Thus alleging negligence on the part of the opposite party he filed the complaint before the District Commission, claiming relief.

3.       The  Appellant/  opposite party, though served, remained absent before the District Commission, hence an exparte order was passed in favour of the Respondent/ complainant, directing the  Appellant/ opposite party to pay a compensation of Rs.1,00,000/- towards medical bills alongwith compensation of Rs.2,00,000/-.    Aggrieved over the said exparte order, this appeal has been preferred by the opposite party as appellant herein.

4.       We have heard the learned counsel appearing for bothsides.

5.       The learned counsel for the appellant would contend that there was no   medical necessity for hospitalization and no significant treatment had been given by the hospital to justify the medical expenses.  The Government protocol itself does not require hospitalization. As per policy limits the maximum liability of the appellant was only Rs.78600/-.  The District Commission failed to appreciate the above facts.  The opposite party has a fair chance of succeeding the matter.  The non-appearance before the District Commission by the appellant is neither willful, nor wanton.  Thus prayed for an opportunity to contest the matter on merit. 

6.       The learned counsel for the appellant argued, that an opportunity, which was denied by the District Forum, may be given to the opposite party, by remanding the case, for fresh disposal, by setting aside the exparte order, which we are unable to deny, considering the facts and circumstances of the case. Eventhough on considering the facts and circumstances of the case, we are inclined to allow this appeal on imposing certain cost, accordingly we have directed the appellant/ opposite party to pay a sum of Rs.3000/- as cost to the Respondent counsel, which was complied, and the Counsel for the Respondent also received the cost.  Hence this appeal is allowed today by remanding the complaint back to the District Commission for fresh disposal.  

 7.      In the result, the appeal is allowed by setting aside the order of the District Commission, Salem in C.C.No.19/2022 dt.13.7.2022, and the matter is remanded back to the District Commission, Salem, for fresh disposal according to law on merit.

Parties are directed to appear before the District Commission, Salem on 19.12.2022, for taking further instructions. On which date itself, the appellant/ opposite party shall file not only the vakalat, but also the written version, proof affidavit, and documents if any. The District Commission is directed to dispose of the complaint, within 3 months from the date of appearance, according to law on merit.  

The amount deposited, by the appellant, shall abide the order of the District Commission, in the original complaint, on merit.

R   VENKATESAPERUMAL                                                           R. SUBBIAH

               MEMBER                                                                             PRESIDENT