KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION
VAZHUTHACAUD, THIRUVANANTHAPURAM
APPEAL No.847/2015
JUDGEMENT DATED: 28.10.2024
(Against the Order in C.C.No.118/2014 of CDRC, Pathanamthitta)
PRESENT:
HON’BLE JUSTICE SRI. B. SUDHEENDRA KUMAR | : | PRESIDENT |
SRI. AJITH KUMAR D. | : | JUDICIAL MEMBER |
SRI. K.R. RADHAKRISHNAN | : | MEMBER |
APPELLANT:
| Indian Overseas Bank, Valanjavattom Branch, Pulikeezhu, Kadapra, Pathanamthitta represented by its Senior Manager |
(by Adv. B. Madhukumar)
Vs.
RESPONDENTS:
1. | Sobha Balakrishnan, W/o Late Balakrishna Panicker, residing at Sobha Nivas, Parmala Muri, Kadapra |
2. | Surya Balakrishnan, D/o Late Balakrishna Panicker, residing at Sobha Nivas, Parmala Muri, Kadapra |
(by Adv. B.S. Prasad Gandhi)
3. | Universal Sompo General Insurance Co. Ltd., A-201, Crystal Plaza, 2nd Floor, Opposite Infinity Mall, Link Road, Andheri West, Mumbai – 400 058 represented by its Manager |
4. | TTK Health Care Service Pvt. Ltd., Anmol Palani, 2nd Floor, 88 GN Chetty Road, T Nagar, Chennai represented by its Manager |
JUDGEMENT
SRI. AJITH KUMAR D. : JUDICIAL MEMBER
The 3rd opposite party in C.C.No.118/2014 on the files of the Consumer Disputes Redressal Commission, Pathanamthitta (the District Commission for short) is the appellant.
2. On 06.08.2015 the District Commission had allowed the complaint and directed the 1st and 2nd opposite parties to pay an amount of Rs.1,00,000/-(Rupees One Lakh only) towards the medical treatment of the husband of the 1st complainant, Rs.50,000/-(Rupees Fifty Thousand only) as compensation and Rs.3,000/-(Rupees Three Thousand only) as costs.
3. The appellant was also directed to pay an amount of Rs.25,000/-(Rupees Twenty Five Thousand only) as compensation to the complainants with a clause to pay interest @10% per annum.
4. In the complaint it was alleged that the 1st complainant had availed an insurance policy from the 1st respondent with insurance coverage of the 1st complainant and her husband. It was also pleaded that the policy was availed on account of the instigation of the 3rd opposite party, the Manager of the Indian Overseas Bank, Valanjavattom Branch. During the subsistence of the policy, the husband of the 1st complainant was admitted in the Pushpagiri Hospital. A claim was raised with respect to the treatment expenses which was rejected by the 2nd opposite party. According to the complainant, the rejection of the claim amounts to deficiency in service. Discrepant reasons were stated by the 1st and 2nd opposite parties in rejecting the insurance claim raised by the complainant. Hence, the complaint was filed.
5. The 1st opposite party had entered appearance and filed version that there was no deficiency in service on their part. According to them there was suppression of the pre-existing disease and the insured had violated the terms and conditions of the policy and hence, the claim was disallowed.
6. No version has been filed by the 2nd opposite party.
7. The 3rd opposite party had filed a version with a pleading that the complaint is not maintainable. The complainant No 1 was having banking transactions with the 3rd opposite party. The bank had never instigated the complainant to avail the insurance policy. The complainants had availed the policy at their own wish. There was no compulsion on the part of the 3rd opposite party in respect of the insurance policy availed by the complainant.
8. On the side of the complainant PWs 1 to 3 were examined. Exhibits A1 to A11 were also marked. No oral evidence was adduced by the opposite parties but, Exhibits B1 to B6 were marked on their side.
9. The appellant would assail the order passed by the District Commission on the following grounds: -
The District Commission failed to consider the fact that no evidence has been adduced by the complainant to prove that the insurance policy was availed by the 1st complainant solely due to the instigation of the appellant. The District Commission placed reliance upon Exhibit A11 wherein the 1st opposite party had shown the appellant as an intermediary. The finding of the District Commission that the appellant had an active role to enrol the complainant in the insurance policy is without any basis. The approval and settlement of the medical claims are the lookout of the 1st and 2nd opposite party and in that regard the 3rd opposite party had no role. Hence, the appellant would seek for setting aside the order passed by the District Commission.
10. Notices were served on the complainants/respondents in the appeal. They entered appearance. Records from the District Commission were called for and perused.
11. Heard both sides.
12. The limited question to be answered in this appeal is as to whether there is any deficiency in service on the part of the appellant in respect of the rejection of the insurance claim raised by the respondents. On a perusal of the records filed by the complainants, it could be seen that the 1st and 2nd opposite parties had rejected the claim on the reason that the complainant had suppressed the pre-existing illness while availing the policy. There was no role to the appellant in the rejection of the insurance claim raised by the complainants.
13. The evidence let in by the complainants would reveal that even at the time of tendering evidence before the District Commission, the complainants had renewed the insurance policy. If the insurance policy was availed by the complainants at the instigation of the appellants, they ought not have renewed it for the subsequent period. So the appellant/bank cannot be blamed for the rejection of the claim raised by the complainant. There is no specific pleadings in the complaint that which Manager of the 3rd opposite party had instigated the complainant for availing the insurance policy.
14. Availing an insurance policy is the choice of a customer. During the cross examination of the 1st complainant, it is revealed that she has got banking transactions with the appellant from 1993 onwards. She was unable to state as to on which date the insurance policy was availed at the first instance. She had also adduced evidence that she had an option to avail or not to avail an insurance policy. Her further admission would reveal that the insurance policy is being renewed at her own insistence. From this statement itself the allegation contained in the complaint that the complainant had availed the insurance policy solely at the instigation of the appellant is devoid of any merits. The subject matter of the dispute is in respect of the eligibility of the complainants in receiving the insurance coverage. The appellant had no role in these transactions. The facts elicited through the evidence adduced by the 1st complainant would reveal that she had taken the policy at her own will and the said policy is being renewed from time to time. So we find that there is no deficiency in service on the part of the appellant as alleged in the complaint.
15. The District Commission had fastened a liability to pay the complainant a sum of Rs.25,000/-(Rupees Twenty Five Thousand only) as compensation basing on a wrong appreciation of evidence. There are no materials to incriminate the appellant with respect to the deficiency attributed in the complaint. Therefore, the order awarding compensation of Rs.25,000/-(Rupees Twenty Five Thousand only) on the appellant is liable to be reversed.
16. In the result, the appeal is allowed. The order of the District Commission in C.C.No.118/2014 directing the appellant to pay the complainant a sum of Rs.25,000/-(Rupees Twenty Five Thousand only) as compensation along with interest @10% per annum is set aside and the complaint shall stand dismissed with respect to the appellant. Parties shall bear their respective costs.
The appellant is permitted to receive back Rs.13,000/-(Rupees Thirteen Thousand only) the statutory deposit made at the time of filing the appeal on proper acknowledgement.
JUSTICE B. SUDHEENDRA KUMAR | : | PRESIDENT |
AJITH KUMAR D. | : | JUDICIAL MEMBER |
K.R. RADHAKRISHNAN | : | MEMBER |
SL