N THE COURT OF CONSUMER DISPUTES REDRESSAL FORUM, MALAPPURAM

(Present: Smt. C.S. Sulekha Beevi, President,

Sri.K.T.Sidhiq, Member)

Date of filing: 7-6-2006

Date of Order: 12-9-2007

C.C.39/06

Kunduladi Muhammed Haji, 62 years ) Suhara Manzil, Kavanoor P.O., ) Complainant

Areacode -Via., Pin 673 644 )

 Vs

Charge Officer, )

Kudumbasree Community Development ) Society, ) Opposite party Kavanoor, Kavanoor Grama Panchayat. )

ORDER

By Smt.C.S. Sulekha Beevi, President

1. The case of the complainant is that he took a health insurance coverage for his family on 10-2-2006 by paying Rs.450/- as premium to the opposite party. His daughter sustained an accident on 28-4-2006. He submitted a written application on 17-5-2006 claiming benefits of the insurance. He has not received any amount so far. Hence the complaint. 2. Opposite party was set exparte on31-8-2007. Formerly a notice was issued to opposite party on 20-5-2006. This notice was returned as ’unclaimed’. Due to the vacancy in the post of the President there was no sitting at that time. Hence the opposite party had the privilege of service of notice for the second time. Even then opposite party has opted to remain absent, and set exparte. 3. The case came up for final hearing on 31-8-2007 and 5-9-2007. Complainant was personally present. Ext.A1 marked. 4. Accordingly to the complainant he has taken a medclaim/health policy covering his entire family members. Ext.A1 is the receipt of the premium paid by

him. The complaint is silent as to what is the sum assured, the period of policy, the conditions and details of policy. No documents are produced regarding these necessary details. Further although he contends that his daughter suffered an accident and is undergoing treatment, no documents are produced to show nature of accident, injuries and treatment expenses. 5. Ext.A1 proves that the complainant has paid Rs.450/- towards “Aarogyasree Insurance”. Apart from Ext.A1 receipt opposite party has not given a copy of Insurance Policy to complainant. When the complainant approached the concerned Panchayat and opposite party claiming the benefits he was asked to file an application to the District Mission Officer of Kudumbashree. He then made a written application on 17-5-2006. according to him it was whose who advised him to file a complaint before this Forum. Opposite party has failed to give a reasonable reply to the complainant why the benefits cannot be disbursed. Even after receiving notice from the Forum opposite party has not cared to appear or file a version in the case. This reveals the helplessness of a consumer which he faces against inaction of public bodies. We find that the above acts of the opposite party amounts to deficiency of service. 6. In the result the complaint is partly allowed and opposite party is ordered to pay compensation of Rs.10000/- (Rupees ten thousand only) within three weeks from the date of receipt of copy of this order.

Dated this 30th day of September, 2007.

C.S. SULEKHA BEEVI, PRESIDENT

K.T.SIDHIQ, MEMBER

APPENDIX

Witness examined on the side of the complainant : Nil

Documents marked on the side of the complainant : Ext.A1

Ext.A1 : Photo copy of the cash receipt for Rs.450/- dated, 10-2-2006

Witness examined on the side of the opposite parties : Nil

Documents marked on the side of the opposite parties : Nil

Sd/- 

C.S. SULEKHA BEEVI, PRESIDENT

Sd/-

K.T.SIDHIQ, MEMBER

ORDER

By Smt. C. S. Sulekha Beevi, President,

1. The case of the complainant is that he availed an 'arogyasree' health insurance scheme covering himself and his family conducted by first opposite party. He paid Rs.450/- on 10-2-2006 towards this scheme. A member of his family, his son, suffered injuries due to an accident on 28-4-2006. Complainant preferred a claim before first opposite party to reimburse the expenses incurred for the treatment. But opposite party has not acted upon such claim. Hence this complaint.

2. This case was originally disposed on 12-9-2007. First opposite party was then set exparte due to his absence and an order was passed against first opposite party. An appeal was preferred by first opposite party and by judgment dated, 02-3-2009 in F.A231/08 the order dated, 12-9-2007 was set aside and the case was remanded for fresh disposal to this Forum. Notice was issued to both sides and first opposite party entered appearance through counsel on 30-5-2009. The complainant filed I.A.377/09 and I.A.378/09 to implead supplemental opposite parties two to five and for amendment of complaint. These petitions were allowed. Opposite parties two to five were impleaded and some new averments in the complaint were also incorporated. Complainant produced the amended copy of complaint.

3. First opposite party filed version admitting that complainant had taken membership in the "Arogya Insurance Scheme' which was started by 'Kundumbasree'. The averment that complainant preferred a claim under the scheme is denied. It is submitted that the Government of Kerala under an agreement with ICICI Lombard Company had floated an Arogya Insurance Scheme for BPL families through the Kudumbasree. The amount of Rs.450/- was thus received from the complainant. But later as per order of the Government dated, 08-12-2006 vide 50111/b2/06LSGD the amount so collected was directed to be returned and to be retained by the respective Panchayats. Thereafter the Director of Kudumbrasree issued circular to return the amount so collected through the co-ordinators. That ICICI Lombard, the Government of Kerala, Director of Kudumbasree, District Co-ordinator are all necessary parties to this complaint. That opposite party is not liable for the reliefs claimed in the complaint.

4. Third opposite party filed version on behalf of himself and second and fourth opposite parties. It is submitted that though a health insurance scheme was started under a tie up with ICICI Lombard General Insurance Company,t he scheme did not materialise to it's finality and was not implemented. The Government had withdrawn from the scheme. Necessary directions were given to return the money so collected to the subscribers. That only the initial steps towards the scheme was done and that the contention of the complainant that he joined in the scheme is incorrect. The amount collected was not accepted by ICICI Lombard and it was returned to those from whom it was collected. That there was no conclusion of contract of insurance. The complainant was not issued any policy certificate by the Government or the Insurance Company. The other averments in the complaint are denied as false. That complainant is not entitled to any reliefs.

5. Fifth opposite party though appeared through a counsel did not file any version.

6. Evidence consists of the proof affidavit filed by complainant and Exts.A1 to A6 marked for him. Third opposite party filed counter affidavit on behalf of second and third opposite parties. Exts.B1 to B3 marked for them. Fifth opposite party did not file any affidavit or document. Either side has not adduced any oral evidence.

7. Complainant is aggrieved that even though he paid rs.450/- towards Arogyasree Insurance to first opposite party, his claim to reimburse the expenses incurred for the treatment of injuries sustained to the member of his family, minor son Mahir, was not honoured by opposite parties. He alleges deficiency in service.

8. The complaint is resisted by opposite parties raising the contention that such Insurance Scheme was started by the Government of Kerala on a tie up with Fifth opposite party. But later this scheme was withdrawn and the amount collected was not accepted by fifth opposite party. Thus there was no completed contract of insurance.

9. Complainant admits that the scheme was started through the Panchayats by the Government in tie up with ICICI Lombard Company. Ext.B1 is an advertisement of fifth opposite party which states that the insurance scheme will take effect only on receiving the insurance identity card by the subscriber. Complainant does not have a case that he was issued such identity card by opposite parties. He has no case that any policy certificate was issued in evidence of the acceptance of his proposal. The mere payment of premium will not create a concluded contract of insurance. Ext.B2 and B3 are Government orders which show that the scheme was not implemented and that direction was issued to return the money to those from whom it was collected. These documents sufficiently establish eh case of opposite parties to be true and correct. Hence the claim of complainant for benefits under the insurance scheme is unsustainable. But the complainant is definitely entitled to the refund of Rs.450/- paid by him. It was submitted on behalf of opposite parties that the amount was tendered to the complainant by money order. It was returned as refused by complainant. It was further submitted that first opposite party is willing to pay the amount at any time. The complainant who was personally present refused to accept the same. From the foregoing discussions we hold that there is no deficiency in service on the part of opposite parties. We consider that complainant can take the refund of Rs.450/- from first opposite party.

10. In the result we order that first opposite party shall refund an amount of Rs.450/- (Rupees Four hundred and fifty only) tot he complainant within one month from the date of receipt of copy of this order. There is no order as to costs. Complaint disposed accordingly.

Dated this 21^st day of January, 2010.

C.S. SULEKHA BEEVI, PRESIDENT

MOHAMMED MUSTAFA KOOTHRADAN,

MEMBER E. AYISHAKUTTY, MEMBER

APPENDIX

Witness examined on the side of the complainant : Nil

Documents marked on the side of the complainant : Ext.A1 to A6

Ext.A1 : Residence Certificate dated, 06-7-2009 from Village Officer, Kavanur

to complainant's son.

Ext.A2 : Attested true copy of receipt dated, 17-5-2006 from District Mission Co-ordinator

to complainant.

Ext.A3 : Attested true copy of Ration Card of complainant.

Ext.A4 : Out patient record from Prasanthi Hi-tech Hospital & Research centre, Manjeri.

Ext.A5 : Computer print discharge details dated, 10-3-2006 of complainant's son.

Ext.A6 : Attested photostat copy of cash receipt dated, 10-2-2006 for Rs.450/- from

Charge Officer, CDS., Kavanur to complainant.

Witness examined on the side of the opposite parties : Nil

Documents marked on the side of the opposite parties : Ext.B1 to B3

Ext.B1 : Photo copy of the advertisement of Arogyasree.

Ext.B2 : Photo copy of the letter dated, 08-12-2006 from Secretary to Government

to Executive Director, Kudumbashree, Thiruvananthapuram.

Ext.B3 : True photostat copy of the letter dated, 04-7-2009 from Executive Director

Kudumbashree to All District Mission Co-ordinator.

C.S. SULEKHA BEEVI, PRESIDENT

MOHAMMED MUSTAFA KOOTHRADAN,

MEMBER E. AYISHAKUTTY, MEMBER