Kerala

Idukki

CC/118/2019

shaji P G - Complainant(s)

Versus

Oriental Insurance com ltd - Opp.Party(s)

26 Dec 2019

ORDER

 

DATE OF FILING : 17.6.2019

IN THE CONSUMER DISPUTES REDRESSAL FORUM, IDUKKI

Dated this the 26^th day of December, 2019

Present :

SRI. S. GOPAKUMAR PRESIDENT

SMT. ASAMOL. P MEMBER

CC NO.118/2019

Between

Complainant : Shaji P.G.,

Pazhayaveettil House,

Puthuppariyaram P.O.,

Chittoor, Thodupuzha, Idukki.

(By Adv: K.M. Sanu)

And

Opposite Parties : The Manager,

Oriental Insurance Co. Ltd.,

Jyothi Super Bazar, Thodupuzha,

Thodupuzha P.O., Idukki.

(By Adv: K. Pradeepkumar)

 

O R D E R

 

SMT. ASAMOL P., MEMBER

 

The case of the complainant is that, the complainant is a pensioner from excise department. The complainant had a mediclaim policy of LIC from 27.6.2011. The agent of opposite party approached the complainant for taking the mediclaim policy from opposite party and the agent inspired about the attractive benefits of the policy to the complainant. As per the inspiration from the agent of opposite party, on 8.5.2018, the complainant received the policy from opposite party and whereas he stopped the LIC policy. The complainant paid Rs.9274/- as first premium on 8.5.2018. The 2^nd premium of Rs.14,100/- paid on 7.5.2018 and renewed the policy. The insurance coverage of the policy was Rs.2 lakhs and it is getting benefits to the complainant, his wife and son.

 

On 2019 March, complainant suffered pain from passing of urine and fever. The complainant went to the local hospital but the doctor referred the complainant to Nephrology department of another hospital. Regarding that, the complainant went to Astermedcity on 4.3.2019. From this date to 7.3.2019, the complainant was in the treatment of Astermedcity as

(cont....2)

- 2 -

inpatient due to kidney problems. Renal Biopsy was taken and prescribed the medicines. There is a bill of Rs.40,000/- at the hospital expenses. The complainant produced the bill along with claim petition to the opposite party. The complainant obtained an insurance policy for a sum of Rs.2 lakhs coverage and he was in good health at the time of obtaining policy. But opposite party rejected the claim of complainant for the reason that he has illnes at the earlier stages and also there is no insurance coverage for treatment of Renal Biopsy for frist two years. Alleging deficiency in service on the part of opposite party, the complaint was filed by the complainant seeking directions against the opposite party to pay the amount of Rs.46,000/- with 12% interest and pay Rs.30,000/- as compensation and litigation expense of Rs.5000/-.

 

Upon notice, opposite party entered appearance and filed vakalath. But opposite party not filed objection or written version. The opposite party was absent and not represented by the counsel. So, opposite party set exparte.

 

The complainant adduced evidence by way of produced documents. Exts.P1 to P5 marked. Ext.P1 is the policy schedule, P2 is claim repudiation letter, P3 is discharge summary of Astermedcity, P4 is bill summary, P5 is policy certificate of LIC.

 

The point for consideration is whether there is any deficiency in service from the part of opposite party and if so, for what relief the complainant is entitled to ?

 

The POINT :- We have heard the counsel of the complainant and have perused the evidence on records. It is admitted that the complainant obtained an insurance policy for a sum of Rs.2 lakhs coverage by Ext.P1 document from opposite party. The complainant had taken treatment from Astermedcity. The opposite party repudiated the claim petition. Such repudiation is not justified. Opposite party did not file objection and version. Opposite party called absent and set exparte.

 

Hence the petition allowed. The Forum directs the opposite party to pay the amount of Rs.46,000/- and pay Rs.15,000/- as compensation and

(cont....3)

- 3 -

 

pay Rs.3000/- as litigation cost to the complainant within 30 days of the receipt of a copy of this order, failing which the amount shall carry 12% interest per annum from the date of default, till its realisation.

 

Pronounced in Open Forum on this the 26^th day of December, 2019

 

Sd/-

SMT. ASAMOL. P., MEMBER

Sd/-

SRI. S. GOPAKUMAR, PRESIDENT

 

 

APPENDIX

Depositions :

Nil.

Exhibits :

On the side of the Complainant :

Ext.P1 - policy schedule

Ext.P2 - claim repudiation letter

Ext.P3 - discharge summary of Astermedcity

Ext.P4 - bill summary.

Ext.P5 - policy certificate of LIC.

 

 

Forwarded by Order,

 

 

 

SENIOR SUPERINTENDENT