Senior Branch Manager, Syndicate Bank V/S Srikanthan Nair S/o. K. Gopalan Nair - Consumer Court Case

Karnataka

Raichur

CC/09/37

Srikanthan Nair S/o. K. Gopalan Nair - Complainant(s)

Versus

Senior Branch Manager, Syndicate Bank - Opp.Party(s)

C. Pandu

14 Sep 2009

ORDER

DIST. CONSUMER DISPUTES REDRESSAL FORUM
DIST. CONSUMER DISPUTES REDRESSAL FORUM,DC Office Compound, Sath Kacheri
consumer case(CC) No. CC/09/37

Srikanthan Nair S/o. K. Gopalan Nair						...........Appellant(s)
Vs.
Senior Branch Manager, Syndicate Bank The Divisional Manager, The Manager,						...........Respondent(s)

BEFORE:

Complainant(s)/Appellant(s):

1. Srikanthan Nair S/o. K. Gopalan Nair

OppositeParty/Respondent(s):

1. Senior Branch Manager, Syndicate Bank 2. The Divisional Manager, 3. The Manager,

OppositeParty/Respondent(s):

1. C. Pandu

OppositeParty/Respondent(s):

1. Sri. Sateesh.V.

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ORDER

JUDGEMENT By Sri. Pampapathi President:- This is a complaint filed by the complainant Srikantan Nair against the Opposite 1 to 4 U/sec. 12 of Consumer Protection Act for direct the opposite 2 to 4 to pay a sum of Rs. 39,621/- with 18% interest, to direct them to pay an amount of Rs. 25,000/- towards mental agony, inconvenience and for deficiency in service and to direct them to pay a sum of Rs. 5,000/- towards cost of litigation with other reliefs as deems fit to the circumstances of the case. 2. The brief facts of the complainant case are that, he covered under Synd Arogya Group Medi-claim policy issued by Opposite Nos. 2 to 4 through Opposite No- 1 and it was renewed subsequently by payment of Rs. 4,875/- for assured sum to Rs. 3,00,000/-. On 11-12-08 when he was going to Trivendrum from Raichur suddenly fell ill due to abdominal pain and he gone to Amrita Institute of Medical Science Kochi, for treatment. The doctors advised him to under go emergency operation of Inguinal Hernia. Therefore on 12-11-08 he was operated and thereafter on 14-11-08 discharged, he personally incurred medical expenses of it. The Opposite advised him to pay the medical bill from his pocket as the said hospital is not listed in the list of hospitals of them and assured for reimbursement of said medical bills. Thereafter he requested Opposite No.2 to reimburse the medical bills, but Opposite No-2 and Opposite No.4 have repudiated his claim, as such he filed this complaint for the reliefs as prayed in it. 3. Opposite Party No.1 appeared in this case through his Advocate and filed written version by denying entire case of complainant and prayed for to dismiss the complaint. 4. Opposite Party No. 2 appeared though his Advocate filed written version by admitting the case of the complainant regarding treatment taken by him while insurance policy was in-force. But according to him third policy is not a renewed policy of earlier there is an exclusion clause in the third policy as the first two years of the operation of the policy the expenses of some diseases are not payable by the company under the policy. As such there is no deficiency in their services, the complainant is not entitled for any of the reliefs and prayed for to dismiss the complaint among other grounds. 5. Opposite Nos. 3 & 4 have been placed Ex-parte. 6. In-view of the pleadings of the parties. Now the points that arise for our consideration and determination are that: 1. Whether the complainant proves that, he obtained renewed Synd Arogya Group Medi-claim policy of Respondents for a period of one year from 05-05-08 to 04-05-09 through Respondent No.1 and thereafter on 11-12-08 he fell seriously ill on the way to Trivendrum from Raichur, as such he admitted Amrita Institute of Medical Science, Kochi for emergency treatment and in the said hospital Inguinal Hernia operation took place, he met with an accident of Rs. 39,621/- thereafter he forwarded his claim petition along with necessary medical bills to the Respondents but all the Respondents shown their negligence in settling his claim, inspite of his request and thereby all the Respondents found guilty under deficiency in their services.? 2. Whether complaint is entitled for the reliefs as prayed in the complaint. 3. What order? 7. Our findings on the above points are as under:- (1) In the negative against Opposite No-1 and in affirmative against Opposite Nos. 2 to 4. (2) As discussed in the body of this judgement. (3) In-view of the findings on Point No- 1 & 2, we proceed to pass the final order for the following : REASONS POINT NO.1 & 2:- 8. To prove the facts involved in these two points, affidavit-evidence of the complainant was filed, he was noted as PW-1. The documents Ex.P-1 to Ex.P-18 are marked. 9. On the other hand affidavit-evidence of Senior Manager of Opposite No. 1 was filed, he was noted as RW-1. No documents filed. Affidavit-evidence of the Company Secretary of Opposite No.2 was filed, he was noted as RW-2. No documents filed and marked. 10. From the pleadings of the parties and their respective evidences it is a fact that Respondents have not disputed regarding the treatment taken by the complainant in Amrita Institute of Medical Science, Kochi while his medi claim policy is in-force. The points required to decide in this case are whether the policy dt. 05-05-08 is a new policy or it is a renewed policy dt. 12-04-06. Admittedly the complainant obtained earlier policy dt. 12-04-06 which was for a period of one year upto 11-04-07 after gap of some days another policy dt. 23-04-07 was obtained which was valid upto 22-04-08. The Third policy is dt. 05-05-08 which was valid upto 04-05-09. The treatment taken by the complainant in Amrita Institute of Medical Science, Kochi from 12-11-08 to 14-11-08 which is a period covered under third policy. In the circumstances stated above, we are of the view that even if we accept the arguments of the Opposite No.2 that the policy dt. 05-05-08 is a fresh policy, then also the period of treatment covers the policy period dt. 05-05-08. In the light of the above said circumstances, we are of the view that giving much importance as to whether this policy dt. 05-05-08 is a renewed policy or fresh policy will not serve our purpose. The policy dt. 05-05-08 is covering the date of treatment of the complainant. The second contention of the Opposite No-2 is that as per the exclusion clause of policy dt. 05-05-08 the complainant is not entitled for medi claim. Admittedly the complainant under gone operational treatment of Inguinal Hernia the policy dt. 05-05-08 is for a period of one year. Under such circumstances exclusion clause No. 4.3 cannot be made applicable to the facts of the case of complainant, we have referred a ruling reported in I (2000) CPJ 241 the Honble Assam State Commission, New India Assurance Company Ltd., V/s. Anil Baruah, in the circumstances stated above, we are of the view that when medi claim policy dt. 05-05-08 is for a period of one year, then the application of exclusion clause for two years is meaning less and repudiation of the claim of complainant by the Opposite No. 2 to 4 on that ground is illegal, it is amounting to deficiency in their services, accordingly we answered affirmative against Opposite Nos. 2 to 4. The complaint is not maintainable against Opposite No.1 who was Senior Branch Manager, Syndicate Bank, Branch Raichur, as there was nothing to give service for the complainant out of the said medi claim of policy. 11. As regards to the relief claimed by the complainant, he claimed total expenditure incurred in Amrita Institute of Medical Science, Kochi to the extent of Rs. 28,840/- vide bills of the said hospital. Ex.P-5, 6, 7, 8 8(a) and 9, he claimed attendant charges of Rs. 15,000/-. We are of the view that under the said medi claim policy the complainant is entitled to recover actual expenditure incurred by him towards his treatment in the said hospital. The claim of Rs. 28,840/- is supported by bills of the hospital Ex.P-5, 6 , 7, 8 8(a) and 9, as such complainant is entitled for to get an amount of Rs. 28,840/- towards medical expenditure of him and he is not entitled for attendant charges, under the said policy accordingly we rejected the claim of complainant for Rs. 15,000/- towards attendant charge. 12. Definitely there is a deficiency in service on the part of Respondent Nos. 2 to 4 by repudiating the legal claim of complainant, as such we have granted lumpsum of Rs. 3,000/- which recoverable by the complainant on the Opposite No.2 to 4 for deficiency in their service. 13. As regards to the cost of litigation is concerned, we have taken note of the entire litigation of the complainant and awarded a lumpsum amount of Rs. 2,000/- towards cost of the litigation. Accordingly the complainant is entitled to recover a total sum of Rs. 33,840/- from Opposite No. 2 to 4 jointly and severally. The complainant is entitled to recover future interest at the rate of 9% p.a. on the above total sum from the date of this complaint till realization of the full amount, accordingly we answered Point No.2. POINT NO.3:- 14. In view of our finding on Point No-1 & 2 we proceed to pass the following order: ORDER The complaint filed by the complainant is partly allowed against Opposite Nos. 2 to 4 with cost. The complainant is entitled to recover a total sum of Rs. 33,840/- from the Opposite Nos. 2 to 4 jointly and severally. The complainant is entitled to recover future interest at the rate of 9% p.a. on the above total sum from the date of the complaint till realization of the full amount. The complaint filed by the complainant against Opposite No.1 is dismissed. One month time is given to the opposite Nos. 2 to 4 to make the payment above total sum with interest. Intimate the parties accordingly. (Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 14-09-09) Sd/- Sri. Pampapathi, President, District Forum-Raichur. Sd/- Sri. Gururaj, Member, District Forum-Raichur. Sd/- Smt.Pratibha Rani Hiremath, Member. District Forum-Raichur.

JUDGEMENT By Sri. Pampapathi President:- This is a complaint filed by the complainant Srikantan Nair against the Opposite 1 to 4 U/sec. 12 of Consumer Protection Act for direct the opposite 2 to 4 to pay a sum of Rs. 39,621/- with 18% interest, to direct them to pay an amount of Rs. 25,000/- towards mental agony, inconvenience and for deficiency in service and to direct them to pay a sum of Rs. 5,000/- towards cost of litigation with other reliefs as deems fit to the circumstances of the case. 2. The brief facts of the complainant case are that, he covered under Synd Arogya Group Medi-claim policy issued by Opposite Nos. 2 to 4 through Opposite No- 1 and it was renewed subsequently by payment of Rs. 4,875/- for assured sum to Rs. 3,00,000/-. On 11-12-08 when he was going to Trivendrum from Raichur suddenly fell ill due to abdominal pain and he gone to Amrita Institute of Medical Science Kochi, for treatment. The doctors advised him to under go emergency operation of Inguinal Hernia. Therefore on 12-11-08 he was operated and thereafter on 14-11-08 discharged, he personally incurred medical expenses of it. The Opposite advised him to pay the medical bill from his pocket as the said hospital is not listed in the list of hospitals of them and assured for reimbursement of said medical bills. Thereafter he requested Opposite No.2 to reimburse the medical bills, but Opposite No-2 and Opposite No.4 have repudiated his claim, as such he filed this complaint for the reliefs as prayed in it. 3. Opposite Party No.1 appeared in this case through his Advocate and filed written version by denying entire case of complainant and prayed for to dismiss the complaint. 4. Opposite Party No. 2 appeared though his Advocate filed written version by admitting the case of the complainant regarding treatment taken by him while insurance policy was in-force. But according to him third policy is not a renewed policy of earlier there is an exclusion clause in the third policy as the first two years of the operation of the policy the expenses of some diseases are not payable by the company under the policy. As such there is no deficiency in their services, the complainant is not entitled for any of the reliefs and prayed for to dismiss the complaint among other grounds. 5. Opposite Nos. 3 & 4 have been placed Ex-parte. 6. In-view of the pleadings of the parties. Now the points that arise for our consideration and determination are that: 1. Whether the complainant proves that, he obtained renewed Synd Arogya Group Medi-claim policy of Respondents for a period of one year from 05-05-08 to 04-05-09 through Respondent No.1 and thereafter on 11-12-08 he fell seriously ill on the way to Trivendrum from Raichur, as such he admitted Amrita Institute of Medical Science, Kochi for emergency treatment and in the said hospital Inguinal Hernia operation took place, he met with an accident of Rs. 39,621/- thereafter he forwarded his claim petition along with necessary medical bills to the Respondents but all the Respondents shown their negligence in settling his claim, inspite of his request and thereby all the Respondents found guilty under deficiency in their services.? 2. Whether complaint is entitled for the reliefs as prayed in the complaint. 3. What order? 7. Our findings on the above points are as under:- (1) In the negative against Opposite No-1 and in affirmative against Opposite Nos. 2 to 4. (2) As discussed in the body of this judgement. (3) In-view of the findings on Point No- 1 & 2, we proceed to pass the final order for the following : REASONS POINT NO.1 & 2:- 8. To prove the facts involved in these two points, affidavit-evidence of the complainant was filed, he was noted as PW-1. The documents Ex.P-1 to Ex.P-18 are marked. 9. On the other hand affidavit-evidence of Senior Manager of Opposite No. 1 was filed, he was noted as RW-1. No documents filed. Affidavit-evidence of the Company Secretary of Opposite No.2 was filed, he was noted as RW-2. No documents filed and marked. 10. From the pleadings of the parties and their respective evidences it is a fact that Respondents have not disputed regarding the treatment taken by the complainant in Amrita Institute of Medical Science, Kochi while his medi claim policy is in-force. The points required to decide in this case are whether the policy dt. 05-05-08 is a new policy or it is a renewed policy dt. 12-04-06. Admittedly the complainant obtained earlier policy dt. 12-04-06 which was for a period of one year upto 11-04-07 after gap of some days another policy dt. 23-04-07 was obtained which was valid upto 22-04-08. The Third policy is dt. 05-05-08 which was valid upto 04-05-09. The treatment taken by the complainant in Amrita Institute of Medical Science, Kochi from 12-11-08 to 14-11-08 which is a period covered under third policy. In the circumstances stated above, we are of the view that even if we accept the arguments of the Opposite No.2 that the policy dt. 05-05-08 is a fresh policy, then also the period of treatment covers the policy period dt. 05-05-08. In the light of the above said circumstances, we are of the view that giving much importance as to whether this policy dt. 05-05-08 is a renewed policy or fresh policy will not serve our purpose. The policy dt. 05-05-08 is covering the date of treatment of the complainant. The second contention of the Opposite No-2 is that as per the exclusion clause of policy dt. 05-05-08 the complainant is not entitled for medi claim. Admittedly the complainant under gone operational treatment of Inguinal Hernia the policy dt. 05-05-08 is for a period of one year. Under such circumstances exclusion clause No. 4.3 cannot be made applicable to the facts of the case of complainant, we have referred a ruling reported in I (2000) CPJ 241 the Honble Assam State Commission, New India Assurance Company Ltd., V/s. Anil Baruah, in the circumstances stated above, we are of the view that when medi claim policy dt. 05-05-08 is for a period of one year, then the application of exclusion clause for two years is meaning less and repudiation of the claim of complainant by the Opposite No. 2 to 4 on that ground is illegal, it is amounting to deficiency in their services, accordingly we answered affirmative against Opposite Nos. 2 to 4. The complaint is not maintainable against Opposite No.1 who was Senior Branch Manager, Syndicate Bank, Branch Raichur, as there was nothing to give service for the complainant out of the said medi claim of policy. 11. As regards to the relief claimed by the complainant, he claimed total expenditure incurred in Amrita Institute of Medical Science, Kochi to the extent of Rs. 28,840/- vide bills of the said hospital. Ex.P-5, 6, 7, 8 8(a) and 9, he claimed attendant charges of Rs. 15,000/-. We are of the view that under the said medi claim policy the complainant is entitled to recover actual expenditure incurred by him towards his treatment in the said hospital. The claim of Rs. 28,840/- is supported by bills of the hospital Ex.P-5, 6 , 7, 8 8(a) and 9, as such complainant is entitled for to get an amount of Rs. 28,840/- towards medical expenditure of him and he is not entitled for attendant charges, under the said policy accordingly we rejected the claim of complainant for Rs. 15,000/- towards attendant charge. 12. Definitely there is a deficiency in service on the part of Respondent Nos. 2 to 4 by repudiating the legal claim of complainant, as such we have granted lumpsum of Rs. 3,000/- which recoverable by the complainant on the Opposite No.2 to 4 for deficiency in their service. 13. As regards to the cost of litigation is concerned, we have taken note of the entire litigation of the complainant and awarded a lumpsum amount of Rs. 2,000/- towards cost of the litigation. Accordingly the complainant is entitled to recover a total sum of Rs. 33,840/- from Opposite No. 2 to 4 jointly and severally. The complainant is entitled to recover future interest at the rate of 9% p.a. on the above total sum from the date of this complaint till realization of the full amount, accordingly we answered Point No.2. POINT NO.3:- 14. In view of our finding on Point No-1 & 2 we proceed to pass the following order: ORDER The complaint filed by the complainant is partly allowed against Opposite Nos. 2 to 4 with cost. The complainant is entitled to recover a total sum of Rs. 33,840/- from the Opposite Nos. 2 to 4 jointly and severally. The complainant is entitled to recover future interest at the rate of 9% p.a. on the above total sum from the date of the complaint till realization of the full amount. The complaint filed by the complainant against Opposite No.1 is dismissed. One month time is given to the opposite Nos. 2 to 4 to make the payment above total sum with interest. Intimate the parties accordingly. (Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 14-09-09) Sd/- Sri. Pampapathi, President, District Forum-Raichur. Sd/- Sri. Gururaj, Member, District Forum-Raichur. Sd/- Smt.Pratibha Rani Hiremath, Member. District Forum-Raichur.