| First Appeal No. A/3165/2016 | | ( Date of Filing : 14 Dec 2016 ) | | (Arisen out of Order Dated 07/10/2016 in Case No. CC/1316/2016 of District Mysore) |
| | | | 1. M.S. Manjunatha | | S/o Late Srinivasa No. 406, LIG-2, 7th Cross Swami Vivekananda Road Sharadadevi Nagar Mysore-570022 |
| ...........Appellant(s) | |
| Versus | | 1. Star Health and Allied Insurance Co-Ltd | | The Branch Manager C-51, 1st Floor, 5th Cross 8th Main, Above Porfessional Courier Office Saraswathipuram Mysore | | 2. Star Health and Allied Insurance Co-Ltd | | The Managing Director KRM Centre, 6th Floor No.2, Harrington Road Chetpet, Channai-34 |
| ...........Respondent(s) |
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| Final Order / Judgement | Dtd.16.11.2022 A/3165/2016 O R D E R BY Mr.K.B.SANGANNANAVAR : Pri.Dist & Session Judge (R) - JUDICIAL MEMBER. - This is an appeal filed U/s.15 of CPA 1986 by Complainant/Appellant aggrieved by the order dtd.07.10.2016 passed in CC/1316/2016 on the file of Mysuru District Forum.
- The Commission examined grounds of appeal, impugned order and heard the learned counsel for Respondents/OPs. Delay in filing appeal is condoned for the reasons stated in the IA.
- It is not in dispute that Appellant/Complainant has obtained “Senior Citizen Red Carpet Insurance” policy in favour of his mother on 31.01.2015 by paying premium of Rs.9,500/-. It is also not in dispute that, the policy was valid from 31.01.2015 to 30.01.2016 and the sum assured was Rs.2 lakhs and during the subsistence of policy his mother was admitted to hospital and while discharging from the hospital on 31.12.2015, hospital charged Rs.99,668.64, was paid, and when a claim was submitted to insurer, which came to be repudiated, as such raised consumer complaint before the Forum below. Appellant/Complainant submitted that during the course of enquiry proceedings before the Forum, a sum of Rs.61,749/- was paid by the OP as against his claim of Rs.99,668.64. In this regard, learned counsel for Respondents/OPs submits that it was paid towards full and final settlement of the claim as per terms & conditions of the policy. However, Complainant having not been satisfied for the amount arrived at Rs.61,749/- preferred this appeal. Learned counsel for OPs submit that Rs.61,749/- was settled towards full and final settlement of the eligible amount, and the Forum below rightly appreciated all the materials, but facts remain that, Commission could not be able to arrive at conclusion as to the inadmissible amount, charged by the hospital at Rs.99,668.64. In such circumstances, though Forum below proceed to disallow the claim, but awarded amount of compensation of Rs.3,000/- towards mental agony and hardship and Rs.2,000/- towards cost of the proceedings. In our view, Rs.61,749/- was paid by the insurer to the Complainant/Appellant herein is only during the course of complaint proceedings. In such circumstances, awarding Rs.3,000/- towards compensation for mental agony and Rs.2,000/- towards litigation cost has to be held meagre amount, which has to be enhanced to Rs.25,000/- towards compensation for mental agony and hardship caused and Rs.15,000/- towards cost of proceedings of the complaint and this appeal. Accordingly, appeal stands disposed off with a direction to deposit the amount either with the Commission or send amount directly to the Complainant.
- Notify copy of this Order to the District Commission and parties.
Lady Member Judicial Member *NS* | |
