BEFORE THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT PUDUCHERRY
THURSDAY, the 20th day of October, 2016
FIRST APPPEAL No. 17/2016
M. Krishnamurthy, S/o Manickam,
No.25, First Cross Street,
Thiruveni Nagar, V.Manavely,
Arumparthapuram Post,
Puducherry. …….. Appellant
Vs.
1. Star Health & Allied Insurance Co. Ltd.,
No.1, New Tank Street,
Valluvar Kottam High Road,
Nungampakkam, Chennai – 34.
2. Star Health & Allied Insurance Co. Ltd.,
No.41/1, G.A.B. Complex,
Opp: Daily Thanthi, Imperial Road,
Cuddalore. ……… Respondents
(On appeal against the order passed in C.C..No.45/2013, dt.16.03.2015 by District Forum, Puducherry)
C.C.No.45/2013
M. Krishnamurthy, S/o Manickam,
No.25, First Cross Street,
Thiruveni Nagar, V.Manavely,
Arumparthapuram Post,
Puducherry. …….. Complainant
Vs.
1. Star Health & Allied Insurance Co. Ltd.,
No.1, New Tank Street,
Valluvar Kottam High Road,
Nungampakkam, Chennai – 34.
2. Star Health & Allied Insurance Co. Ltd.,
No.41/1, G.A.B. Complex,
Opp: Daily Thanthi, Imperial Road,
Cuddalore. ……… Opposite Parties
BEFORE:
HON’BLE THIRU JUSTICE K.VENKATARAMAN,
PRESIDENT
TMT. K.K.RITHA,
MEMBER
THIRU. S.TIROUGNANASSAMBANDANE,
MEMBER
FOR THE APPELLANT:
Tvl S.Vimal & K.Ashok Kumar
Advocates, Puducherry.
FOR THE RESPONDENTS:
B.Mohandass,
Advocate, Puducherry.
O R D E R
(By Hon'ble Justice President)
This appeal is directed against the order of the District Consumer Disputes Redressal Forum, Puducherry, dated 16.03.2016 made in C.C.45/2013.
2. The Complainant therein is the appellant herein and the opposite parties thereon are the respondents. The parties are referred in the same position before District Forum.
3. The complainant has preferred a complaint before the District Consumer Disputes Redressal Forum, Puducherry claiming the following reliefs:
i) to refund a sum of Rs.5,592/- (being the principal sum of Rs.5,168/- with interest at 24% p.a. from 07.06.2012 till 10.10.2012 i.e. Rs.424/-) and subsequent interest at 24% p.a. from 11.10.2012 on Rs.5,168/- till complete payment and discharge;
ii) To pay a sum of Rs.50,000/- with interest at 24% p.a. from the date of complaint till complete discharge towards compensation for the physical hardship and mental agony caused to complainant due to opposite parties' unfair trade practice and deficiency in service; and
iii) to pay a sum of Rs.3,000/- to litigation cost and expenditure.
4. The case of the complainant before the District Forum is that he is the retired Sub-Inspector of Police, Puducherry. On 25.03.2009, the complainant's son K.Soumakiyan proposed for his medical insurance with the opposite parties on payment of a sum of Rs.5,846/-. The proposal was accepted by the 1st opposite party and the complainant was insured with the 1st opposite party through 2nd opposite party under Medi Classic Individual Policy and the same was periodically renewed and the law renewal was on 29.03.2009 and was remain valid till 29.03.2013. He developed defective vision in the year 2012 and therefore approached Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology in Puducherry, a listed hospital by the opposite parties. He was treated therein and he had incurred an expenditure of a sum of Rs. 5,168.75 towards his treatment. He approached the opposite parties with a claim application. However, the claim was repudiated by the opposite parties. Hence, the complainant approached the District Forum.
5. Reply version was filed by the 1st opposite party which was adopted by the 2nd opposite party. The following facts were set out in the reply version. The claim was rejected for the reason "pterygium is a fibro vascular growth of the conjunctiva over the ocular surface extending onto the cornea". The treatment could be taken as in-patient. Therefore, as per the policy conditions, the complainant is not entitled for the amount which he has claimed.
6. Before the District Forum, the complainant has not examined himself and he has not chosen to examine any witness. However, 5 documents were filed on behalf of the complainant and marked as Exs.C1 to C5. On behalf of the opposite parties, 2 witnesses were examined and 2 documents have been filed which were marked as Exs.R1 and R2.
7. The District Forum has deterred three points for decision, namely, (1) Whether the complainant is a consumer, (2) Whether any deficiency in service attributed by the opposite parties and (3) To what relief, the complainant is entitled for?
8. On the first point, the District Forum came to the conclusion that the complainant is a consumer. On the second point, the District Forum found that the opposite parties are to refund the sum of Rs.5,169/- towards medical expenses incurred by the complainant and also the complainant is entitled to Rs.20,000/- as compensation for deficiency in service for loss and injury sustained and also directed the opposite parties to pay Rs.5,000/- towards costs.
9. As already said, the present appeal is filed challenging the above said order.
10. Mr.S.Vimal, learned counsel appearing for the appellant/complainant staunchly contended that the District Forum should have been awarded more amount towards deficiency in service and for the loss and injury suffered by the complainant. Though he pleaded so, he has not raised any valid points to substantiate his contention that the District Forum should have awarded more amount towards compensation. In our considered view, the District Forum not only directed to refund the amount spent by the complainant towards medical expenses, but also has ordered a compensation of Rs.20,000/- for deficiency in service and for loss and injuries suffered by the complainant. That apart, a sum of Rs.5,000/- was also ordered towards litigation expenses. In our considered view, the said amount ordered by the District Forum is adequate and reasonable. No grounds have been raised on behalf of the complainant to substantiate his case that he deserves more compensation.
11. Therefore, we are of the view that the appellant/complainant has not made any case for payment of more amount. Taking such view, we are inclined to dismiss the appeal and accordingly the appeal is dismissed. The order of the District Forum made in C.C.45/2013 on 16.03.2016 is confirmed.
Dated this the 20th day of October, 2016
(Justice. K.VENKATARAMAN)
PRESIDENT
(K.K.RITHA)
MEMBER
(S.TIROUGNANASSAMBANDANE)
MEMBER
