KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION
VAZHUTHACAUD THIRUVANANTHAPURAM
APPEAL NO.493/11
JUDGMENT DATED 31.3.2012
PRESENT
JUSTICE SHRI.K.R.UDAYABHANU -- PRESIDENT
SHRI.M.K.ABDULLA SONA -- MEMBER
Indian Overseas Bank Ltd,
Kayamkulam Branch,
Main Road Kayamkulam -- APPELLANT
Rep. by Chief Manager,
Mrs. Licy Jose
Regional Office, Ernakulam.
(By Adv.Josh)
Vs.
1. Sanjayarajan M.K.
Udaya Deepam, Kandalloor North,
Pattolo Market PO,
Pathanamthitta District.
2. TTK Health care Centre TPA Pvt.Ltd;
Anmol Palani, Number 88,
GN Chetty Road, 2nd Floor T Nagar,
Chennai – 600017. -- RESPONDENTS
3. TTK Health care Centre TPA Pvt.Ltd
39-4130, First loor, Mareena Building,
M.G.Road, Ernakulam,
Cochi -682016.
4. The United India Insurance Company Ltd;
Divisional Office 011100
Sudarsan Building,
White Road, Chennai 600014.
5. The United India Insurance Company Ltd;
Kayamkulam Branch, reptd.
By the Branch Manager.
(R1 by Adv.S.Williams & R4 and 5 by
Adv.R.Jagadishkumar)
JUDGMENT
JUSTICE SHRI.K.R.UDAYABHANU,PRESIDENT
The appellants are the third opposite party/Indian Overseas Bank in CC 84/10 in the file of CDRF, Alappuzha. The opposite parties including the appellants are to pay the amount vide the medical insurance policy amounting to Rs.57,986.59 with interest at 12% from the date of complaint and Rs.25,000/- as compensation and Rs.5,000/- as punitive costs and Rs.2,000/- as costs.
2. It is the case of the complainant that he had availed IOB Health Care Plus Policy floated by the bank in association with the United India Insurance Company. His wife was under the treatment at G.G. Hospital and at Amrita Institute of Medical Sciences and underwent a surgery. He has claimed the expense incurred towards the treatment of his wife is covered by the policy.
3. Opposite parties 1 and 2 the implementing agency and opposite parties 4 and 5 the Insurance Company stood ex-parte before the Forum.
4. The grievance of the appellant is that it is the Insurance Company that is liable to pay the amount ordered to be paid and not the bank. The complainant had produced exhibits A1 to A 36 the documents including the policy, the correspondence and the hospitalization/treatment bills which were proved by PW1, the complainant. Ext.B1 is the reply lawyer notice of the appellant wherein it is mentioned that the insurer has intimated that the claim cannot be allowed since the illness is existing for the past 4 years.
5. We find that no evidence as to the pre-existing illness has been adduced. Further the insurer has not contested the matter. The insurer has also not filed any appeal above the order of the Forum. All the same, we find that it is the insurer that is liable to pay the amounts and not the bank which has only facilitated the procurement of the policy. In the circumstances, the appeal is allowed. The third opposite party/appellant is exonerated from the liability. The rest of the opposite parties will be jointly and severely liable to pay the amount.
6. The direction to pay compensation of Rs.25,000/- and also a punitive cost of Rs.5000/- appears not required. Hence the above directions of the Forum are set aside. The rest of the order of the Forum is sustained.
7. In the result, the appeal is allowed in part as above. The opposite parties/insurer will make the payment within 3 months from the date of receipt of this order.
Office will forward the LCR along with a copy of this order.
JUSTICE SHRI.K.R.UDAYABHANU -- PRESIDENT
SHRI.M.K.ABDULLA SONA -- MEMBER
