KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
VAZHUTHACAUD, THIRUVANANTHAPURAM
APPEAL No. 167/2023
JUDGMENT DATED: 29.03.2023
(Against the Order in C.C. 17/2022 of CDRC, Kottayam)
PRESENT:
HON’BLE JUSTICE SRI. K. SURENDRA MOHAN : PRESIDENT
SRI. AJITH KUMAR D. : JUDICIAL MEMBER
SRI.RANJIT. R : MEMBER
SMT. BEENA KUMARY. A : MEMBER
SRI. RADHAKRISHNAN K.R. : MEMBER
APPELLANT:
The Divisional Manager, Oriental Insurance Company Ltd., Divisional Office No. 1, Matteethara Buildings, 3rd Floor, Baker Junction, M.C. Road, Kottayam-686 001.
(Represented by its Manager, Third Party Hub, Ulloor, Thiruvananthapuram)
(By Adv. V. Manikantan Nair)
Vs.
RESPONDENT:
Ramesh M.K., S/o V.P. Madhavan, Suresh Bhavan House, Veloor P.O., Kottayam-686 003.
JUDGMENT
SRI. AJITH KUMAR D.: JUDICIAL MEMBER
This is an appeal filed against the order passed by the Consumer Disputes Redressal Commission, Kottayam (District Commission for short) in C.C No. 17/2022 dated 29.12.2022. The appellant is the opposite party.
2. The case of the complainant is that he had taken a Corona Rakshak policy from the appellant on 29.07.2020 on an assurance that in the event of detection of Covid-19 and treatment thereon for 72 hours the complainant will be entitled to get Rs. 1,00,000/- under the scheme. Having tested Covid 19 positive on 30.04.2021 the complainant was admitted in the first line treatment centre DCC CDI Retreat Centre, Kottayam. He underwent treatment there from 01.05.2021 to 10.05.2021 and was later shifted to District Hospital, Kottayam on 10.05.2021 where he was treated as inpatient till 19.05.2021. When he approached the opposite party for the sum assured, his claim was rejected on the ground that medical practitioner’s prescription advising admission and discharge summary including complete medical history were not produced. The Assistant Surgeon, General Hospital, Kottayam was in charge of the CFLTC functioning under the Department of Health Services and he was the authorised officer to issue the discharge Certificate. But the certificate for the complainant was issued by another doctor in the absence of the doctor in charge. The complaint was filed on the reason that there was deficiency in service.
3. The District Commission had passed an order directing the appellant to pay the sum assured in the policy to the complainant along with 9% interest from the date of repudiation till realization. It was also directed to pay Rs. 15,000/- as compensation and Rs. 2,000/- as costs. Aggrieved by that order, the instant appeal has been filed.
4. Heard the counsel for the appellant. Perused the records. The appellant would contend that the repudiation of the policy was necessitated as the discharge certificate issued by CFLTC did not disclose any active line of treatment. It is also contended that the District Commission did not consider Ext. B3 order passed by the Insurance Ombudsman rejecting the claim of the complainant. The learned counsel appearing for the appellant would submit that CFLTC is not a “hospital”as required under the clause contained in the policy. The District Commission had considered the contentions raised by the appellant and arrived at a conclusion that the complainant had availed treatment for a period of more than 72 hours as an inpatient, as he was found Covid positive. The twin conditions for allowing a claim are that the complainant must have tested positive to Covid and availed inpatient treatment for a period of more than 72 hours. During Covid Pandemic situation CFLTC’s in Kerala were constituted by the Department of Health Services under the supervision of Assistant Surgeons of the Govt. Hospital. The claim was denied on the reason that CFLTC was not a hospital. The contention raised by the appellant was rightly rejected by the District Commission. Covid pandemic was a serious problem faced by the Health Department. So the Health Department had constituted CFLTC to observe and evaluate the persons who were found Covid positive and to ensure quarantine to such individuals. Persons who develop serious symptoms were referred to General Hospital for further treatment. The contention raised by the appellant to repudiate the claim on the reason that the CFLTC was not a “hospital” as contemplated under the policy condition is found untenable. The learned counsel would submit that, had the policy conditions been fulfilled, the claim would have been granted. According to him there is an arguable case for the appellant and hence the appeal may be admitted.
5. On a perusal of the order passed by the District Commission and the documents produced in support of the appeal it is found that the appellant has no arguable case. No purpose will be served in admitting the appeal. So the appeal is only to be rejected.
In the result, the appeal is not admitted and hence dismissed.
Sd/-
JUSTICE K. SURENDRA MOHAN : PRESIDENT
Sd/-
AJITH KUMAR D. : JUDICIAL MEMBER
Sd/-
RANJIT. R : MEMBER
Sd/-
BEENA KUMARY. A : MEMBER
Sd/-
RADHAKRISHNAN K.R. : MEMBER
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