Kerala

Kollam

CC/06/291

G.Prasad,Punnaveedu,Kalakodu.P.O. and Other - Complainant(s)

Versus

New India Assurance Company,Divisional Manager,Oth - Opp.Party(s)

A.K.Manoj

31 Mar 2010

ORDER


Consumer Disputes Redressal ForumCivil Station,Kollam
CONSUMER CASE NO. 06 of 291
1. G.Prasad,Punnaveedu,Kalakodu.P.O. and Other Paravoor ...........Respondent(s)


For the Appellant :
For the Respondent :

Dated : 31 Mar 2010
ORDER

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ADV. RAVI SUSHA, MEMBER

 

            Complaint for realization of compensation and costs etc.

The averments in the complaint can be briefly summarized as follows:

The 1st complainant is an NRI and 2nd complainant is the wife of the 1st complainant.   The 1st complainant subscribed a policy from the opp.party company under the name and style Pravasi Suraksha Kudumba Arogya Insurance Scheme with Policy No.4776140083219 valid from 3.0.1999 to 2.9.2004.   The Insurance premium of Rs.3850/- was received by the 2nd opp.party.   As per the policy the complainants and their son Nishant were insured.   .  On 29.8.2000 the 1st complainant came down to Kerrala on leave and he was admitted in the Kattakkal Arya Vaidyasala on 6.10.2000  and continued treatment as inpatient till 3.11.2000 for Vathasonitham.   The  treatment records and bill for a sum of Rs.26,112/- was submitted to the 1st opp.party office  from the Kottakkal Arya Vaidyhasala, Kottakkal is produced   The 1st complainant honoured the same after consultation with their panel of doctors and issued a cheque for Rs.23,893/- in favour of the 2nd complainant   On 1.1.2004 the 1st complainant came down for treatment for the same disease and he was admitted in the Kousthubham Ayureveda Hospital, Vadakkevila, Kollam from 15.1.2004 to 15.2.2004  The medical claim is submitted before the opp.party  in the proper form for Rs.37,977/-  But the claim was repudiated by the opp.party.    Hence the complainant filed this complaint for getting the claim amount.

 

          The opp.parties filed version  contending, interalia, that the complaint is not maintainable either in law or on facts.   The policy issued from Trivandrum and the opp.party is also carrying on lbusiness at Trivandrum the Forum lacks jurisdiction to entertain this complaint and to adjudicate upon the same   It is true that a Pravasi Suraksha policy has been subscribed by the complainant herein on 3.9.99.  The policy has been issued on utmost good faith by the Insurer to the Insured.    On the next year of policy itself he has preferred a claim to the tune of Rs.26,112/- on account of his treatment in Kottakkal Aryavydyashala for his ailment of Vadasonidam.  When it revealed that the policy issued by the insurer expires on 2.9.2004 the complainant preferred another claim in the month of January 2004 claiming reimbursement of Rs.35,356/-.  His claim form was supported by medical records and bills issued by Kottackal Aryavydyasala.    It is seen that his alleged ailment of Vathasonitham has been with him for more than 4 years  ie. Even before taking policy.    A perusal of the prior treatment records would also reveal that this was a preexisting disease at the time of taking policy.  Hence this opp.party referred the matter for expert Medical opinion, who also opinioned that it was a preexisting disease for a long time.     Based on the medical records and documents, more precisely on the expert opinion of the Doctor, the opp.party concluded that it is a pre-existing disease of the complainant which is excluded in the terms and conditions of the policy and hence the claim of the complainant cannot be entertained.   The repudiation of the claim was intimated to the complainant as early on26.4.2004.  The repudiation of the claim was made by the Insurer on 26.4.2004 and the same was intimated to the complainant as early on 40.4.04 the complainant is disentitled to challenge the repudiation of the claim after a period of two years as per the provisions of the Consumer Protection Act.  This complaint is filed only on 10.8.2006, which is after the period of limitation as per the CP Act.   The Review petition filed by the complainant to reopen the claim was also rightly dismissed by this opp.party in the month of June 2004 and hence at any right the claim is barred by limitation.  The complainant is not entitled to get the medical reimbursement or any other relief as sought for in the complaint.  There is no deficiency in service on the part of the opp.parties.   Hence the opp.parties prays to dismiss the complaint.

 

Points that would arise for consideration are:

1.     Whether the complaint is barred by limitation

2.     Whether there is deficiency in service on the part of the opp.parties

3.     Relief and costs.

For the complainant  PW.1 is examined.   Ext. P1 to P13 are marked.

For the opp.party DW.1 is examined.   Ext. D1 to D7 are marked.

Points:

 

          The first point to be decided is whether the complaint is barred by period of limitation.

According to opp.party the complainant is filed after the limitation period of two years after the cause of action had arisen.  On perusal of Ext. D5 it is seen that the opp.party had repudiated the claim on 26.4.2004 and it was received by the complainant on 30.4.2004.  It is seen that the complaint filed  on 16.8.2006 that means after a period of two years.  Hence there is a delay of 107 days.   The complainant did not file any petition to condone the delay.  Hence the complaint is barred by period of limitation.   Complainant’s counsel argued that by considering the period of correspondence between the complainant and opp.party there has no period of limitation.  But the Hon’ble National Commission in M.S. Subrahmanian V/s Institute of Costs and Works Accountants of India [NC 2990-NCJ 44] decided that Exchange of correspondence does not extend period of limitation.  By considering the above said decision and documentary evidence we are of the view that the complaint is barred by period of limitation.   Since the complaint is barred by period of limitation we are not entering into the merit of the case.

In the result, the complaint is dismissed.  No cost is ordered.

Dated this the    31ST        day of March, 2010.

K. VIAJAYUKUMARAN :Sd/-

`           ADV. RAVI SUSHA :Sd/-

R. VIJAYAKUMAR :Sd/-

                                                                              Forwarded/by Order,

 

                                                                              SENIOR SUPERINTENDENT.

 

 

I N D E X

List of witness for the complainant

PW.1. -     Sreelatha

List of documents for the complainant

P1. – Policy certificate

P2. – Terms and condition

P3. -  Medical bills

P4. – Discharge certificate

P5. – Medical certificate

P6. – Copy of cheque issued by opp.party

D7. – Claim form

P8. – discharge certificate from Kousthubham Hospital

P9. – Medical certificate

P10. – Medical bill dt. 15.2.2004

P11. – Letter dated 3.5.3004

P12. – Intimation of opp.party dt. 26.4.2004

P13. – Intimation dated 10.9.2004.

List of witnesses for the opp.party

DW.1. – V. Jayaraman

DW.2. – Sasikumar

List of documents for the 0opp.party

D1. – Discharge certificate

D2. – Medical certificate

D3. – Claim statement dt. 18.2.2004

D4. – Certificate issued by Dr. Sasikumar

D5. – Repudiation letter dt. 26.4.2004

D6. – Requesxt for reconsideration of claim

D7. – Policy condition .                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    

 

                                                                               

                 

 

           

 

                                                                                   

 

 


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