CONSUMER DISPUTES REDRESSAL FORUM, KOTTAYAM
Present
Sri. Santhosh Kesavanath P. President
Smt. Bindhu M. Thomas, Member
Sri. K.N. Radhakrishnan, Member
CC No. 251/2011
Wednesday, the 20th day of June , 2012.
Petitioner : Satheesh Mathew Zacharias,
Mattam House,
Kurianadu P.O
Monippally, Kottayam.
Vs.
Opposite parties : 1) Reliance General Insurance
Co.Ltd., 570, Naigaon Cross
Road, Wadala (W)
Mumbai – 400 031.
2) Reliance General Insurance,
2nd Floor, Jacksons Plaza,
Manorama Junction,
Chelliyozhukkam Road,
Kottayam.
3) Medi Asst. India Pvt. Ltd.,
406, Chandralayam,
Kurusupally Road,
Temple Lane, Ravipuram,
Kochi – 682 015.
(Adv. Benny Jose Mathew &
Adv. Benoy Joseph Mathew)
O R D E R
Sri. Santhosh Kesavanath P., President.
Case of the petitioner filed on 28..9..2011 is as follows.
Petitioner is validly insured with opposite party for a sum of Rs. 1 lack by paying an amount of Rs. 6,139/- as premium to opposite party. Petitioner met with a motor accident on 2..1..2011 and was admitted at Carithas Hospital and treated as in patient till 7..1..2011. Petitioner have been under rest and under gone treatment at Carithas Hospital. Hospital authority suggested complete rest for the petitioner. Petitioner submitted a claim form
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for scrutiny and claim of petitioner was repudiated by opposite party stating that the claim was late in submitting for 93 days. Hence the petition.
Opposite party one and two filed joint version contenting that the petition is not maintainable. According to the opposite party petitioner paid the premium amount through a Cheque of SBT, Kozha Branch Cheque was dishonoured for want of fund. Contract of insurance is without consideration So, it is not allowable . Further more, the claim is it is to be submitted to the 3rd party administrator within 30 days of discharge from hospital. Here there is a delay 93 days in submitting the claim. According to opposite party there is no deficiency in service in repudiating the claim of the petitioner. So, they pray for dismissal of petition with their costs.
Points for determinations are:
i) Whether there is deficiency in service on the part of the opposite party?
ii) Reliefs and costs?
Point No. 1
The crux of the case of the petitioner is that the claim of petitioner is repudiated by opposite party. The repudiation letter issued by the opposite party to the petitioner is produced and same is marked as Ext. A3. In Ext. A3 it is stated that claim form is not submitted within 30 days from the date of discharge from hospital. Since there is a delay of 93 days claim is not admissible. Counsel for opposite party in the version taken a different contention that since the Cheque issued by the petitioner to the opposite party as premium is returned un paid for want of sufficient fund the claim is not
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allowable. Learned counsel for opposite party vehumently argued that since there is no consideration for the contract there is no valid contract. Further, opposite party produced the policy and the same is marked as Ext. B3. In Ext. B3 it is stated that in the event of dishonour of Cheque, policy document stand cancel from inception irrespective of whether communication sent or not. So, with regard to dishonour of Cheque no intimation is needed. In our view the reason for repudiation has stated in repudiation letter is that the claim is not submitted in proper time. In the version opposite party taken a different contention that there is no consideration for the contract.
We are of the view that opposite party cannot take a contention in contrary of the contention as taken in repudiation letter. Further more, due to the lack of intimation the petitioner is in a bonafide belief that policy is in an existence. From the repudiation letter also it can be seen that opposite party is also of a bonafide belief that their is existence of valid policy. Even otherwise opposite party shall mention the same also in Ext. A3 repudiation letter. As per insurance rules the opposite party has a bounden duty to intimate the petitioner with regard to non receipt of the premium at the earliest. From Ext. A5 copy of pass book it can be seen that their was sufficient funds in the account of petitioner at the time of honouring the Cheque. Here in our view act of the opposite party in repudiating the claim of the petitioner amounts to deficiency in service . Point No. 1 is found accordingly.
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Point No. 2
In view of the finding in point No. 1, petition is allowed. In the result opposite party is ordered to reimburse the petitioner by paying an amount of Rs. 22,380/-. Considering the facts and circumstances of the case no cost and compensation is ordered. Order shall be complied with within one month of receipt of copy of this order. If the order is not complied as directed award amount will carry 9% interest from e date of complaint till realization.
Dictated by me transcribed by the Confidential Assistant corrected by me and
pronounced in the Open Forum on this the 20th day of June, 2012.
Sri. Santhosh Kesavanath P. President Sd/-
Smt. Bindhu M. Thomas, Member Sd/-
Sri. K.N. Radhakrishnan, Member Sd/-
APPENDIX
Documents of the petitioner
Ext. A1: Policy issued by Reliance General Insurance Dtd: 29..11..2009
Ext. A2: Policy issued by Reliance General Insurance Dtd: 13..12..2010
Ext. A3: Repudiation letter Dtd: 24..5..2011
Ext. A4: Copy of letter issued by petitioner to the opposite party.
Ext. A5: Copy of the pass book of petitioner.
Documents for the petitioner
Ext. B1: Cheque Dtd: 13..11..2010
Ext. B2: Dishonour memo
Ext. B3: Policy with conditions of policy.
By Order,
Senior Superintendent
