Kerala

StateCommission

A/15/139

managing director, hdfc standard life insurance co ltd - Complainant(s)

Versus

soymol thomas - Opp.Party(s)

saji issac

24 Feb 2016

ORDER

KERALA STATE CONSUMER DISPUTES REDRESSAL

COMMISSION  VAZHUTHACAUD, THIRUVANANTHAPURAM

APPEAL NO. 139/15

 

JUDGMENT DATED:24.02.2016

PRESENT : 

JUSTICE SHRI. P.Q. BARKATHALI                         :  PRESIDENT

SHRI.V.V. JOSE                                                          : MEMBER

1. The Branch Manager,

HDFC Standard Life Insurance Company Ltd.,                                            

HDFC SL, Pala, Vadayattu Building, 1^st floor,

Petta Road, Pala, Kottayam-686 575.

 

2. The General Manager,                                                       : APPELLANTS

HDFC Standard Life Insurance Co. Ltd.,

Ramon House, H.T Parek Marg,

169, Backbay Reclamation, Churchgate,

Mumbai-400 020.

 

(By Adv: Sri. Saji Isaac K.J)

 

            Vs.

Soymol Thomas, W/o Bijoy Mathew,

Madathil House, Edappally.P.O,

Bharanganam, Kottayam, Kerala.

Rep. by policy holder-

Bijoy Mathew residing at:-                                               : RESPONDENT

Madathil House, Pala P.O,

Njondimackal Kavala, Kottayam, Kerala.

 

JUDGMENT

 

JUSTICE SHRI. P.Q. BARKATHALI:  PRESIDENT

 

This is an appeal filed by the opposite parties in CC.181/2014 on the file of Consumer Disputes Redressal Forum, Kottayam, challenging the order of the Forum dated January 19, 2015 directing the opposite parties to pay to the complainant Rs.57,793/- being the treatment expenses incurred by the complainant.

2.      The case of the complainant as detailed in the complaint before the Forum in brief is this:-

Complainant was a holder of HDFC Health Assurance Plan Policy of the opposite parties which was valid for the period from June 27, 2013 to June 26, 2014.  On January 14, 2014 she was admitted in MOSC Medical College Hospital and Cholecystectomy was done.  She had spent about Rs.1,00,000/- for treatment.  The opposite parties repudiated their claim.  Therefore complainant filed the complaint claiming compensation of Rs.3,00,000/-.

3.      The opposite party is HDFC Standard Life Insurance Company Limited in their version contended that complainant had taken policy on June 27, 2013 had undergone a surgery on January 15, 2014, ie within 24 months of taking the policy and that therefore they are not liable to pay the amount.

4.      Complainant filed his proof affidavit and Exts.A1 to A18 were marked and no evidence was adduced on the side of the opposite parties before the Forum.  Forum accepted the contentions of the complainant and directed the opposite parties to pay Rs.57,793/- being the bill amount.  Opposite parties have now come up in appeal challenging the said order of the Forum.

5.      Heard the counsels for the appellant and the complainant who appeared in person.

6.      It is seen from the records that complainant was not cross-examined by the counsel for the opposite parties.   I.A.613/14 filed by the opposite parties seeking permission to cross-examine the complainant, was dismissed.  Taking into account the nature of the contentions raised by the parties we feel that an opportunity should be given to the opposite parties to cross-examine the complainant.  Hence appeal will be allowed on payment of cost of Rs.3000/- to the complainant.

7.      Cost paid, appeal is allowed.  The impugned order of the Forum allowing the complaint is set aside.  Matter is remanded to the Forum for fresh disposal in accordance with law.  Both parties shall appear before the Forum on March 30, 2016.  Opposite party is permitted to cross-examine the complainant.

 

JUSTICE P.Q. BARKATHALI:  PRESIDENT

 

V.V. JOSE : MEMBER

VL.