<br /> COMPLAINT FILED: 30.06.2008<br /> <br /> BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AT BANGALORE (URBAN)<br /> <br /> <br /> 26th SEPTEMBER 2008<br /> <br /> <br /> PRESENT :- SRI. A.M. BENNUR PRESIDENT <br /> SMT. M. YASHODHAMMA MEMBER<br /> SRI.A.MUNIYAPPA MEMBER <br /> <br /> COMPLAINT NO.1463/2008<br /> <br /> <br /> COMPLAINANT Sri.Guruprakash B.AS/o Late B.Andanappa,Residing at New No.64/B,1st Floor, 1st Cross,Pipeline Road, Vijayanagar,Bangalore – 560 040.Old No.800/8,9th A Main RPC Layout, Vijayanagar,Bangalore – 560 040.Advocate – Sri.K.Narayana SwamyV/s.<br /> OPPOSITE PARTIES 1. Royal Sundaram,Alliance Insurance Company Limited,“Sundaram Towers”45 & 46, White Road,Chennai – 600 014.2. Royal Sundaram,Registered office,21, Patullos Road,Chennai – 600 002.Advocate – Sri.H.B.Vijayakumar3. Standard Chartered Bank,P.O. Box 5119,Bangalore – 560 001.Advocate – Sri.Rangarajan & Prabhakharan4. Medicare TPA Services (I) Pvt.,6, Bishop Lefroy Road,Kolkata – 700 020.5. Medical Officer,Mallya Apollo Hospital,No.2, Vital Mallya Road,Bangalore.<br /> <br /> <br /> O R D E R<br /> <br /> <br /> This is a complaint filed U/s. 12 of the Consumer Protection Act of 1986 by the complainant seeking direction to the Opposite Party.1 to 4 (herein after called as O.P) to settle the medical bill and pay a compensation of Rs.2,00,000/- and for such other relief’s on an allegations of deficiency in service. <br /> <br /> <br /> The brief averments, as could be seen from the contents of the complaint, are as under:<br /> <br /> Complainant and his wife Smt.Geetha H.N enrolled their names in “Health Shield Premiere” plan floated by the OP.1 & 2 on 27.01.2005. OP.3 covered the insurance to an extent of Rs.1,50,000/- to each one of these complainant and collected the premium of Rs.5,326/-. As the complainant has got the credit card from SCB he instructed the OP.3 to collect the premium from his account and go on renewing his policy. OP did oblige in renewing the said policy subsequently for two years. On 20.05.2007 complainant’s wife fell ill. He took her to Mallya Hospital OP.5 and narrated them that they are covered under the Health Shield Insurance. OP.5 contacted the OP.4 for confirmation and authorization to treat the patient under “Health Shield Insurance”. OP.4 accepted the cashless request of the Hospital. There after unfortunately OP’s repudiated their claim and failed to reimburse the medical expenses. Complainant for no fault of his is forced to pay the medical expenses by himself to the tune of Rs.37,699/-. Then made repeated demands to OP to reimburse the same but it went in vain. OP came up with the defence that his credit card was out dated and the policy was not renewed in time that too at the time of his wife taking treatment. The hostile attitude of the OP’s caused both mental agony and financial loss to him. Thus complainant felt deficiency in service on the part of the OP. Under the circumstances he is advised to file this complaint and sought for the reliefs accordingly.<br /> <br /> 2. On admission and registration of the complaint, notices were sent to the OP’s. Though OP.4 & 5 were duly served with the notice remained absent without any sufficient reason or cause. Hence they are placed Ex-parte.<br /> <br /> On appearance, OP.1 & 2 filed their version denying all the allegations made by the complainant in toto. According to them they act upon the instructions which they receive from OP.3. The said policy was valid from 31.01.2005 to 30.01.2006. For the second year policy was renewed. But as far as third year is concerned they didn’t receive any premium from third OP. Under the circumstances they are not liable to pay the reimbursement charges as claimed by the complainant. Though complainant is aware of lapse of his credit card he didn’t renew it in time. Hence no fault lies with the OP. It is further contended that complainant never opted for automatic renewal as alleged. Complainant has not followed the terms and conditions with regard to the renewal of the said card in time. The problem if any faced by the complainant may be at the fault of OP.3. So he can proceed against OP.3 not against OP.1 & 2. Among these grounds, OP.1 & 2 prayed for the dismissal of the complaint.<br /> <br /> OP.3 filed version mainly contending that the present complaint is filed with ulterior motive and intention. Complainant is aware of the terms and conditions with regard to the said card. Though it is brought to his notice that the card is expired in the month of October 2006. Complainant didn’t take any initiation to renew the same. So when the said card is not in force OP.3 is not obliged to honor or send any intimation to OP.1 & 2 to renew the policy because premium amount does not rest with them. When card was not activated it is not possible to honor any debit instruction towards the said card. The inconvenience if any faced by the complainant is mainly because of his own carelessness and negligence. For that OP.3 can’t be blamed. Among these grounds, OP.3 also prayed for the dismissal of the complaint.<br /> <br /> 3. In order to substantiate the complaint averments, the complainant filed the affidavit evidence and produced some documents. OP.1, 2 & 3 have also filed their affidavit evidence and produced the documents. Then the arguments were heard.<br /> <br /> 4. In view of the above said facts, the points now that arise for our consideration in this complaint are as under:<br /> <br /> Point No. 1 :- Whether the complainant has Proved <br /> the deficiency in service on the part of <br /> the OP?<br /> <br /> Point No. 2 :- If so, whether the complainant is <br /> entitled for the relief’s now claimed?<br /> <br /> Point No. 3 :- To what Order?<br /> <br /> <br /> 5. We have gone through the pleadings of the parties, both oral and documentary evidence and the arguments advanced. In view of the reasons given by us in the following paragraphs our findings on:<br /> <br /> Point No.1:- In Negative<br /> Point No.2:- Negative<br /> Point No.3:- As per final Order.<br /> <br /> <br /> R E A S O N S<br /> <br /> 6. At the outset it is not at dispute that the complainant and his wife Smt.Geentha H.N have enrolled their names in “Health Shield Premiere” policy issued by the OP.1 & 2 dated 27.01.2005. They have also paid the necessary premium for the relevant year through their SCB card issued by the OP.3 to the tune of Rs.5,326/-. Now it is the contention of the complainant that he instructed the OP.3 to send the required premium automatically as and when occasion arises out of his amount available under the card. But unfortunately OP.3 failed to honor the said premium for the year 2007-08. Basically there is no proof that OP.3 had ever agreed to renew the said policy automatically every year. Under the circumstances that contention of the complainant rather does not hold much water.<br /> <br /> 7. The fact that the complainant wife was admitted at OP.5 hospital on 20.05.2007 and took the treatment is also not at dispute. Of course in the course of action when complainant intimated OP.5 that they are covered under the ‘Health Shield Insurance’. OP.5 contacted the OP.4 and OP.4 accepted the cashless request. But thereafter it appears the medical expenses incurred by the complainant were not honored on the ground that the said card was not at all in force. Complainant was made to pay the said bills from his pocket. Hence he felt deficiency in service.<br /> <br /> 8. As against this it is specifically contented by the OP.3 that the complainant is bound to know the terms and conditions of the card. According to OP.3 the said card expired in the month of October 2006 and it is brought to the notice of the complainant. This fact is not denied by the complainant. With all that it appears complainant didn’t approach OP.3 after the expiry of his card and sought for renewal of the same. When no such approach was made OP.3 destroyed the said card on 08.01.2007 being useless. Thereafter complainant wife took treatment on 20.05.2007. That means to say for the year 2007-08 that policy was not in force because of the lapse due to the non payment of the premium.<br /> <br /> 9. When the complainant has not got it activated from January 2007 onwards OP.3 is not obliged to honor any premium and to honor any debit instructions towards the said card. We find force in the contention of the OP.3. When the card itself is not in force the question of OP.3 having committed deficiency in service in not paying the premium to OP.1 & 2 does not arise. The other allegations of the complainant appear to be baseless.<br /> <br /> 10. Of course OP.1 & 2 wanted through blame on OP.3 for having not paid the premium in time. That is why they didn’t renew the policy for the third year that is from January 2007 onwards. For that OP.3 has given reasonable explanation which deserves to be believed in toto. When there is no proof of opting for automatic renewal, since the policy is lapsed due to the non payment of the premium, OP.1 & 2 are not obliged to reimburse the said medical expenses. OP.3 could not pay the premium because the card is expired. <br /> <br /> 11. Hence for all these reasons we find the inconveniences if any faced by the complainant is because of his own negligence. There is no proof of deficiency in service on the part of the OP’s. Complaint appears to be devoid of merits. Accordingly we answer point Nos.1 & 2 in negative and proceed to pass the following: <br /> <br /> O R D E R<br /> <br /> The complaint is dismissed. In view of the nature of dispute no order as to costs.<br /> <br /> (Dictated to the Stenographer and typed in the computer and transcribed by him, verified and corrected, and then pronounced in the Open Court by us on this the 26th day of September 2008.) <br /> <br /> <br /> <br /> <br /> MEMBER MEMBER PRESIDENT<br /> <br /> <br /> <br /> <br /> <br /> Vln* <br /> <br /> <br />