By Sri. Chandran Alachery, Member:

The complaint is filed under section 12 of the Consumer Protection Act for an order directing the Opposite parties to pay a sum of Rs.60,000/- towards treatment expenses as incured by the complainant and to pay Rs.1,00,000/- as compensation for the deficiency of service of Opposite Parties and to pay the cost of the proceedings.

2. Complaint in brief:- The Complainant joined in a mediclaim policy through the 1^st Opposite party with the 2^nd Opposite party on 10.01.2012. The Complainant renewed the policy regulatory for 3 years and at least on 04.02.2014, the Complainant renewed the policy. The coverage will be to the mid night of 03.02.2015. The policy number is P/181315/01/2014/003623. On 28.06.2014, the Complainant admitted in Leo Hospital, Kalpetta and undergone a surgery and removed uterus hybrid. The Complainant was an inpatient from 28.06.2014 to 06.07.2014. She had to spent a sum of Rs.60,000/- as treatment expenses. The 1^st Opposite party promised at the time of admission that the treatment expenses will be met by the 2^nd Opposite Party company as cashless benefit. On 01.07.2014, the 2^nd Opposite party company rejected the claim. The Complainant did not have pre-existing disease as alleged by 2^nd Opposite Party. Aggrieved by this the Complaint is filed.

3. On receipt of complaint, notices, were issued to Opposite parties and notices were served to Opposite Parties on 18.09.2014. Opposite parties appeared before the Forum on 17.11.2014 and 19.11.2014 but not filed version even after 60 days are over after getting notice. Petition for enlargement of time to file version in rejected and Opposite parties set exparte.

4. On going through the complaint and documents the Forum raised the following points for consideration.

1. Whether there is deficiency of service from the part of Opposite parties?

2. What order as to cost and compensation?

5. Point No.1:- The case is posted for exparte evidence and the complainant filed proof affidavit and is examined as PW1, and Ext.A1 to A8 is marked. It is up to the Opposite parties to prove the reason for the rejection of cashless benefit to the Complainant. But Opposite parties remained exparte. There is nothing to disbelieve the case of Complainant, 1^st Opposite party is the agent of 2^nd Opposite party and both are  jointly and severally liable to pay the treatment expenses along with cost and compensation to the Complainant. The Forum found that there is deficiency of service from the part of Opposite parties in dealing with the matter. Point No.1 is found accordingly.

6. Point No.2:- Since point No.1 is found in favour of Complainant, the Complainant is entitled to get cost and compensation from Opposite Parties.

In the result, the complaint is partly allowed and Opposite Parties No.1 and 2 are directed to pay Rs.53,212/- (Rupees Fifty Three thousand Two hundred and Twelve) only towards Hospital expenses and Medical bills produced by the Complainant and Opposite Parties No.1 and 2 are also directed to pay Rs.10,000/- (Rupees Ten thousand) only as compensation and Rs.1,000/- (Rupees One thousand) only as cost of the proceedings. The 1^st and 2^nd Opposite Parties are jointly and severally liable to pay the above amounts to the Complainant within 30 days from the date of receipt of this order failing which the 1^st and 2^nd Opposite parties are liable to pay 12% interest from the whole sum from the date of this order till payment.

Dictated to the Confidential Assistant, transcribed by him and corrected by me and Pronounced in the Open Forum on this the 7^th day of January 2015.

Date of filing:12.08.2014.

PRESIDENT : Sd/-

MEMBER : Sd/-

MEMBER : Sd/-

/True copy/

Sd/-

PRESIDENT, CDRF, WAYANAD.

APPENDIX.

Witness for the complainant:

Nil.

Witness for the Opposite Parties:

Nil.

Exhibits for the complainant:

A1. Ultrasound Evaluation of the Pelvis dt:13.06.2014.

A2. Family Health Optima Insurance Policy- Schedule.

A3(1) Discharge Summary dt:06.07.2014.

A3(2) Prescription. dt:23.06.2014.

A3(3) Scan report.

A4. Discharge Bill. dt:06.07.2014.

A5. Copy of Letter. dt:01.07.2014.

A6 Series

(22 in Nos) Bill.

A7. To Whomsoever it may concern dt:06.07.2014.

A8. Advance Premium Receipt.

Exhibits for the opposite Parties.

Nil.