D.O.F. 21.11.2009 D.O.O. 01.03.2011 IN THE CONSUMER DISPUTES REDRESSAL FORUM KANNUR Present: Sri. K. Gopalan : President Smt. K.P. Preethakumari : Member Smt. M.D. Jessy : Member Dated this the 1st day of March, 2011. C.C.No.314/2009 B. Abdulla, ‘Pranavam’ : Complainant P.O. Vilayancode, Mandoor (Via), Kannur District. (Rep. by Adv. C. Krishnan) United India Insurance Company Ltd., Payyannur Branch, Represented by its Senior Branch Manager, : Opposite Party P.B. No. 29, Temple Road, South Bazar, Payyannur, Kannur - 670307 O R D E R Sri. K. Gopalan, President. This is a complaint filed under Section 12 of Consumer Protection Act for an order directing the opposite party to pay ` 13,895 towards the claim amount and ` 50,000 as compensation with cost of this proceedings. The case of the complainant in brief is as follows : Complainant is a holder of Mediguard Insurance Policy with the opposite party. The complainant took a Mediguard Insurance Policy in the joint name of himself and his wife for the period from 30.06.2008 to 29.06.2009. There was no restriction in the policy for treatment under Ayurvedic system of medicine at the time of taking the policy. The present policy is a renewal of previous policy. Opposite party did not informed that there was no coverage for ayurvedic treatment. Complainant renewed the policy believing that it will cover the ayurvedic treatment. If it was informed complainant otherwise he would not have received the policy. The new condition was clandestinely incorporated at the time of renewal of policy to dodge the holders. It is an unfair trade practice. His wife was under treatment at the Parassinikkadavu Ayurvedic Medical College from 10.03.2009 to 24.03.2009. Claim was preferred for an amount of 13,896 but opposite party repudiated the claim as per the letter dated 09.04.2009. Since the rejection in unlawful complainant constraind to file this complaint. Pursuant to the notice opposite party entered appearance and filed the following version. The liability of the opposite party is covered by conditions, exclusions, exceptions, endorsements and other clauses contained in the policy. Ayurvedic Treatment taken in hospitals other than Government hospital are not payable. It is noted on the face of the policy. Government Ayurvedic Hospital at Pariyaram is very near to the residence of insured, whereas the insured chosen to go to Parassinikkadavu Ayurvedic Medical College. The insured has not complied with the terms and conditions. There is no deficiency of service on the part of opposite party. Hence to dismiss the complaint. On the above pleadings the following issues have been taken for consideration. (1) Whether there is any deficiency in service on the part of opposite parties? (2) Whether the complainant is entitled for the relief as prayed in the complaint? (3) Relief and cost. Evidence consists of oral testimony of complainant as PW1 and Ext.A1 to A10. Issues 1 to 3: Admittedly opposite party has issued the policy bearing No.100803/48/08/97/00000480 for the period 30.06.2008 to 29.06.2009. Complainant’s case is that there was no restriction in the policy for the expenses for treatment under ayurvedic system of medicines. His wife was undergone treatment at the Parassinikkadavu Ayurvedic Medical College. There is no dispute with respect to the period of coverage. But claim was repudiated on the ground that treatment taken other than Government hospitals is not admissible. The only question to be answered in this case is whether or not the ayurvedic treatment taken in hospitals other than Government hospital is payable? Opposite party contended it is not payable and it is noted on the face of the policy document issued to complaint – insured jointly. Ext.A1, Ext.A3, Ext.A4 and A8 etc are Mediguard Insurance Policies. Ext.A1 and A8 policies issued for the year 2008-09 and 2009-10 shows stamped with “{]IrXn NnInÕ, kÀ¡mÀ Bip-]-{Xn-I-fn- AÃm-sX-bp-ff tlmantbm, BbpÀthZ NnIn-Õ-IÄ¡v \jvS-]-cn-lm-cT e`n-¡p-¶-X-Ã.” |
Ext.A1 is the relevant policy the subject matter of discussion. Stamping is very clear and in such a manner inviting the attention of every insured. What is deposed by complainant in his cross examination is that “t]mfn-kn-bn Dff apgp-h³ kT-K-Xn-I-fpT hmbn¨p a\-Ên-em-¡n-bn-«pv. Cu t]mfn-kn-bn Bte-J-\T sNbvX endorsement-s\ Ipdn¨v bmsXmcp Bt£-]-hpT I¼-\n-bn D¶-bn-¨n-«nÃ. t]mfn-kn-bn {]Ir-Xn-Nn-InÕ kÀ¡mÀ Bip-]-{Xn-I-fn AÃm-sX-bp-ff BbpÀthZ, tlmantbm NnIn-Õ-IÄ¡v \jvS-]-cn-lm-cT e`n-¡p-¶-Xà F¶p 8þ#m-as¯ t]Pn ko sNbvXv ]Xn-¨n-«p-v. Hmtcm hÀj-hpT separate policy BWv issue sNbvXn-«pffXv.” The deposition of PW1 makes it clear that complainant has clear understanding with the meaning of the contents of stamping. No question of consensus-ad-idem does separately arise with respect to the contents of stamping since it has become part of the document. The evidence adduced by the complainant unequivocally makes it clear not only that the document contain the stamping as stated above but he was also well aware of the fact what really the content of stamping meant for. Hence it cannot be hold that the repudiation of claim is unjustifiable. Unfair and restrictive trade practice or deficiency in service cannot be attributed against opposite party. The repudiation of claim on the ground that the treatment taken in hospital other than Govt. Hospital is not admissible as per the terms and conditions. Hence the issue No.1 to 3 are found against the complainant. In the result the complaint is dismissed. Sd/- Sd/- Sd/- President Member Member APPENDIX Exhibits for the Complainant A1. Copy of Policy No.100803/48/08/97/00000480. A2. Cash receipt dated 12.06.2008. A3. Copy of Policy No.100803/48/06/12/00000555. A4. Copy of Policy No.100803/48/07/12/00000596. A5. Policy schedule dated 30.06.2005. A6. Cash receipt dated 30.06.2009. A7. Policy terms and conditions. A8. Copy of Policy No.100803/48/09/97/00000737. A9. SB transactions from 29.03.2001 to 11.06.2010 of Cheruthazham Service Co-op. Bank. A10. Letter dated 09.04.2009 Exhibits for the opposite party Nil Witness examined for the complainant PW1. Complainant. Witness examined for the opposite party Nil /forwarded by order/ SENIOR SUPERINTENDENT
| | [HONORABLE PREETHAKUMARI.K.P] Member[HONORABLE MR. GOPALAN.K] PRESIDENT[HONORABLE JESSY.M.D] Member | | 
