BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANGALORE
Dated this the 13th June 2014
PRESENT
SMT. ASHA SHETTY : HON’BLE PRESIDENT
SMT.LAVANYA M. RAI : MEMBER
COMPLAINT NO.69.2014
Admitted on 22.2.2014
Mr. Umesh Pai,
Aged about 71 years,
Rat UMASHREE,
Behind Bokkapatna School,
Mangalore. …….. COMPLAINANT
Advocate for Complainant: Mr.Sathish.K
VERSUS
Star Health and Allied Insurance Company Ltd.,
Regd and Corp Off No.1,
New Tank Street,
Valluvarakottam High Road,
Nungambakkam,
Chennai600 034. ……OPPOSITE PARTY
Opposite Party : Exparte
ORDER DELIVERED BY HON’BLE PRESIDENT
SMT. ASHA SHETTY:
I. 1. This complaint is filed under Section 12 of the Consumer Protection Act alleging deficiency in service as against the Opposite Party claiming certain reliefs.
The brief facts of the case are as under:
The complainant stated that, he is a senior citizen obtained a Carpet Insurance policy with the Opposite Party as per policy No.141211012013004436. During the existence of the policy the complainant had suffered left Senile Cataract problem, and undergone treatment as inpatient from 1.8.2013 to 2.8.2013 at Mangalore Nursing Home and conducted Left Micro PhacoemnSitication Astigmatism Acrysofiq Toric IOL Implant surgery to the complainant and spent Rs.46,000 out of that the opposite party has released only Rs.15,000 which is arbitrary and hence the complainant filed the above complaint under Section 12 of the Consumer Protection Act 1986 herein after referred to as ‘the Act’ seeking direction from this Forum to the Opposite Party to pay sum of Rs.1,50,000 as cost of the treatment including hospitalization charges, interest and damages and also costs of the proceedings.
II. 1. Version notice served to the Opposite Party by R.P.A.D. Opposite Party appeared through their counsel filed version and Opposite Party inspite receiving version not appeared nor represented the case till this date. Hence Opposite Party placed exparte and postal acknowledgement marked as Court Doc.No.1.
III. 1. In support of the complaint, Mr.Umesh Pai CW1 Complainant filed affidavit reiterating what has been stated in the complaint and produced Ex. C1 to C10. Opposite Party exparte.
In view of the above said facts, the points now that arise for our consideration in this case are as under:
- Whether the Complainant proves that the Opposite Party has committed deficiency in service?
- If so, whether the Complainant is entitled for the reliefs claimed?
- What order?
We have considered the notes/oral arguments submitted by the learned counsels and also considered the materials that was placed before this Forum and answer the points are as follows:
Point No.(i): Affirmative.
Point No.(ii) & (iii): As per the final order.
REASONS
IV. 1. POINTS NO. (i) TO (iii):
In order to substantiate the above complaint the complainant has filed affidavit supported by documents i.e. Ex.C1 to C10 wherein it reveals that the complainant obtained the above said policy i.e. policy bearing No.P 141211012013004436 for a sum of Rs.1,00,000 for the period from 26.8.2012 to 25.8.2013. As per the policy the complainant is covered and during the existence of the policy, the complainant admitted as an inpatient from 1.8.2013 to 2.8.2013 at Mangalore Nursing Home and during the treatment he had undergone Left Micro PhacoemnSitication Astigmatism Acrysofiq Toric IOL Implant surgery. The discharge summary produced by the complainant supports the statement of the complainant and further the medical bills produced by the complainant reveals that he had spent Rs.46,000 as per Ex.C3, C4 and C10 and further it is admitted by the complainant that Rs.15,000 was released out of Rs.46,000.
However, it is seen on record that, the Opposite Party insptite of receiving version notice by RPAD not bother to appeared nor contest the case before this FORA till this date. The entire material evidence produced by the complainant is not contradicted nor controverted by the Opposite Party, which requires no further proof.
There is no valid reasons or explanations given by the Opposite Party till this date why they have not considered the medical bills in question. The Opposite party should have given explanations why they have not considered the claim of the complainant in the entirety with supportive material documents. In the absence of the same, we hold that, the service rendered by the Opposite Party amounts to deficiency in service as well as unfair trade practice.
In view of the aforesaid reasons, Opposite Party i.e. Star Health and Allied Insurance Company Ltd., represented by its Divisional Manager Authorized Signatory shall pay a sum of Rs.46,000 Rs.15,000= Rs,31,000 Rupees Thirty one thousand only to the complainant. And also pay Rs.5,000 Rupees Five thousand only as damages for inconvenience and harassment and Rs.2,000 as cost of the litigations expenses. Payment shall be made within 30 days from the date of this order.
In the result, we pass the following:
ORDER
The complaint is allowed. The Opposite Party i.e. Star Health and Allied Insurance Company Ltd., represented by its Divisional Manager Authorized Signatory shall pay a sum of Rs.46,000 Rs.15,000= Rs,31,000 Rupees Thirty one thousand only to the complainant. And also pay Rs.5,000Rupees Five thousand only as damages and Rs.2,000 as cost of the litigations expenses. Payment shall be made within 30 days from the date of this order.
In case of failure to comply the above mentioned order within the stipulated time, the Opposite Party is directed to pay the amount mentioned above interest at the rate of 12% per annum on the above said total amount from the date of failure till the date of payment.
Copy of this order as per statutory requirements, be forward to the parties and file shall be consigned to record room.
Page No.1 to 6 dictated to the Stenographer typed by him, revised and pronounced in the open court on this the 13th day of June 2014
PRESIDENT MEMBER
