This complaint coming up before us for hearing on 02-07-14                                in the presence of Sri K. S. R. Prasad, advocate for complainant and                         opposite parties remained absent and set exparte, upon perusing the material on record and having stood over till this day for consideration this Forum made the following:-

O R D E R

Per Sri A. Hazarath Rao,  President:-      The complainant filed this complaint under section 12 of the Consumer Protection Act seeking reimbursement of Rs.196326/- being the medical expenses incurred by her; Rs.10,000/- towards mental pain and suffering and for costs.

2.   In brief the averments of the complaint are these:

          The complainant obtained medical insurance policy from the                            1^st opposite party vide No.P/131214/01/02010/000817 for Rs.2,00,000/-.   The said policy covered the period from 10-02-10 to 09-02-11.   The complainant renewed the policies and those renewed policies covered the period from 10-02-11 to 09-02-12 and 10-02-12 to 09-02-13.   The complainant took treatment in M/s Krishna Institute of Medical Sciences Limited, Secunderabad for Osteoarthritis of left knee.   The complainant underwent total knee replacement on 03-08-12 and incurred Rs.196326/- towards treatment.   The 3^rd opposite party informed that cashless authorization could not be done and the insured may come for reimbursement by sending claim form.  Under those circumstances, the complainant paid Rs.196326/- to M/s Krishna Institute of Medical Sciences Limited, Secunderabad.   The complainant on 13-08-12 sent claim form along with necessary documents to the opposite party who inturn failed to settle the claim.  The opposite parties not settling the claim amounted to deficiency in service.   The complainant got issued notice through her counsel to settle lawful mediclaim of the complainant.   There was no response from the opposite parties.    

3.   The opposite parties though received notices remained exparte.

4.  Exs.A-1 to A-10 were marked on behalf of complainant.  

5.   Now the points that arose for consideration in this complaint are:

          1. Whether this Forum has territorial jurisdiction to entertain the                           complaint?

          2. Whether the opposite parties not settling the claim amounted to                        deficiency in service?

          3. Whether the complainant is entitled to compensation?

          4. To what relief?

6.   POINT No.1:-    The registry raised an objection regarding territorial jurisdiction of this Forum to entertain the complaint as the subject policy under which claim arose was issued at Vijayawada.   On hearing the complainant’s counsel this Forum prima facie opined that this Forum has jurisdiction to entertain the case.

7.      In Ex.A-3 it was clearly mentioned that it was renewed on 2^nd occasion under which the claim arose.   The originals of Ex.A-1 and A-2 were issued by the 1^st opposite party at Guntur while the subject policy under which the claim arose was issued by the 2^nd opposite party.   In view of specific mention that the original of Ex.A-3 was a 2^nd renewal, we opine that part of cause of action arose at Guntur and as such this Forum has territorial jurisdiction to entertain the complaint.   We therefore answer this point against the opposite parties.

8.  POINTS 2&3:-    Ex.A-9 is copy of discharge summary issued by M/s Krishna Institute of Medical Sciences Limited, Secunderabad and it disclosed that the insured/complainant took treatment as in patient from 03-08-12 to 06-08-12 and the insured underwent total knee (left) replacement.  Ex.A-9 is copy of hospitalization charges list showing hospitalization charges amounting to Rs.2,35,139/-.   Ex.A-9 further disclosed that M/s Krishna Institute of Medical Sciences Limited, Secunderabad received Rs.196326/- for the treatment from the complainant. 

9.      It is the case of the complainant that on 13-08-12 she sent claim form along with necessary documents.   The complainant mentioned so in his notice Ex.A-5 dated 30-11-12.   The opposite parties received original of Ex.A-5 under Exs.A-6 to A-8.   The complainant for the reasons best known to her did not file any document to show that she sent claim form on                    13-08-12 along with concerned documents.   In the absence of any document showing that the complainant sent claim form along with documents to the opposite parties the said contention cannot be accepted.    Absence of reply from the opposite parties in our considered opinion did not amount to admitting complainant’s case by the opposite parties.   The said contention of the learned counsel for the complainant is devoid of merit.   For the above discussion we hold that the opposite parties did not commit any deficiency of service and the complaint is not entitled to any compensation much less the one claimed.

10.    As the complaint was filed in time claiming indemnification under      Ex.A-3 policy disposing off this complaint with certain directions will meet ends of justice rather than dismissing it.

 11.   POINT No.4:-   In view of above findings, in the result the complaint is disposed off with the following directions as indicated below:

          1.  The complainant is directed to submit claim form along with                             relevant documents to the opposite parties under acknowledgment        within two weeks from the date of receipt of this order.

          2.  The opposite parties are directed to process the complainant’s       claim within six weeks thereafter after the receipt of claim form and         documents from the complainant.

          3.   There is no order as to costs.   

Typed to my dictation by Junior Stenographer, corrected by us and pronounced in the open Forum dated this the 9^th day of July, 2014.

Sd/xxx                                        Sd/xxx                                  Sd/xxx

MEMBER                                     MEMBER                              PRESIDENT

  APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite parties:    NIL   

                                                                                                     Sd/xxx

                                                                                              PRESIDENT

NB:   The parties are required to collect the extra sets within a month after receipt of this order either personally or through their advocate as otherwise the extra sets shall be weeded out.