Date of filing: 29-07-2013.
Date of disposal: 30-01-2014.
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM - II:
VIJAYAWADA, KRISHNA DISTRICT
Present: Sri A. M. L. Narasimha Rao, B.Sc., B. L., President
Smt N. Tripura Sundari, B. Com., B. L., Member
Sri S. Sreeram, B.Com., B.A., B.L., Member
Thursday, the 30th day of January, 2014
C.C.No.136 of 2013
Between:
Kurapati Baby Rani, W/o Kurapati Lakshmi Narayana Rao, Hindu, Aged about 62 years, Housewife, Residing at House No.11-42-28, 1st Floor, Ramgopal Street, Vijayawada – 520001.
... Complainant
And
1. The Branch Manager, The New India Assurance Co., Ltd., Vijayawada Branch Office, 1 (620701), D.No.27-6-189, Prakasam Road, Governorpet, Vijayawada – 2.
2. Sri M.K. Ananda Rao, Agent, Hindu, Residing at House No.26-22-24/A, Mudunurivari Street, Gandhinagar, Vijayawada - 520003.
. … Opposite Parties.
This complaint is coming before for final hearing on 17-1-2014 in the presence of Sri Y.R.K. Reddy, advocate for complainant, Sri V.V.S. Sai Babu, advocate for opposite party no.1; opposite party no.2 remained absent and having stood over for consideration till this day, the Forum doth order the following:
ORDER:
(Delivered by Hon’ble Member Sri S. Sreeram)
This is a complaint filed by complainant under Sec.12 of Consumer Protection Act with a prayer to direct the opposite parties to pay the claim amount of Rs.21,662/- with interest at 24 per cent per annum, to pay Rs.20,000/- towards damages, Rs.1000/- towards costs of notice and for costs of complaint and other reliefs.
1. The brief facts of the case which lead to filing the present complaint are that the complainant has taken Mediclaim insurance policy for herself issued by 1st opposite party through 2nd opposite party vide policy No.62070134110100000564 and card was issued and the same is valid from 7-1-2012 to 1-6-2013. While so, the complainant slipped accidentally and sustained fracture to her bone and was admitted in Vijaya Orthopedic Accident care at Vijayawada and incurred Rs.21,662/- and paid the same. Later the complainant submitted the bills issued by hospital to the 1st opposite party for reimbursement of said amount. But the 1st opposite party has not paid the said amount even in spite of several visits by her husband. The complainant also got issued notices on 5-7-2013 and 17-7-2013 to the opposite parties, but they neither issued any reply nor complied with the demand and kept quiet without any response and thereby committed deficiency in service and caused mental agony. Hence, the complainant is constrained to file the present complaint.
2. After registering the complaint, notices were sent to the opposite parties 1 and 2. The 2nd opposite party remained absent. The 1st opposite party appeared through an advocate and filed version denying the material allegations of the complaint and contended that the husband of complainant Kurapati Lakshmi Narayana Rao obtained Medi claim policy for himself and his spouse i.e. complainant herein for Rs.1,00,000/- under policy No.620701/34/01/00000564, which is valid from 7-1-2012 to 6-1-2013 and that the medi claim policies should be issued only for one year and that the complainant slipped accidentally on 7-1-2013 at 7.30 a.m and as such the 1st opposite party is not liable for reimbursement of claim amount. It is further contended that the complaint is bad for non joinder of TPA of Heritage Health Care Pvt. Ltd., to which the complainant sent documents. Finally it is prayed to dismiss the complaint.
3. The complainant filed her affidavit reiterating the material averments of her complaint and got marked Ex.A1 to A15. The Deputy Manager of 1st opposite party filed affidavit and got marked Ex.B1 copy of policy.
4. Heard both sides and perused the record.
5. Now the points that arise for consideration in this complaint are:
- Whether there is any deficiency in service on the part of the opposite parties in not reimbursing the claim of complainant?
- If so is the complainant entitled for the reliefs as prayed for?
6. Point No.1 : On perusing the material on hand (complaint, affidavit and documents), there is no dispute with regard to obtaining the Medi claim policy by the husband of complainant for himself and his spouse i.e. complainant herein under policy No.62070134110100000564 on 7-1-2012 by paying requisite premium amount. Ex.B1 copy of policy marked through 1st opposite party discloses the said fact. Further as seen from Ex.B1 policy, the period of insurance is from 7-1-2012 to 6-1-2013. But on the other hand, the case of complainant is that the insurance is valid from 7-1-2012 to 1-6-2013 and that she sustained fracture injury on 7-1-2013 within the period of insurance and that she was shifted to Vijay Orthopedic and Accident Care Center, Vijayawada and spent Rs.21, 662/-. The bunch of medical bills marked on behalf of complainant discloses the fact that she took treatment at the above said hospital and spent Rs.21,662/-. The further case of complainant is that she produced the said original bills to the 1st opposite party for reimbursement of said amount, but the 1st opposite party has not paid the same in spite of issuing notices under Ex.A8 and A11. In this regard, the contention of 1st opposite party is that the period of insurance is from 7-1-2012 to 6-1-2013 and the complainant sustained injury on 7-1-2013 and as such she is not entitled for reimbursement.
7. In view of the above rival contentions, the only point that stood for consideration before us is that whether the complainant is entitled for reimbursement as claimed. From the perusal of record and from the own version of complainant she slipped accidentally on 7-1-2013 and sustained injury. Ex.A14 Discharge summary marked on behalf of complainant discloses the date of admission as 7-1-2013. But a perusal of Ex.B1 policy, it is clear that the period of insurance is from 7-1-2012 12 a.m to 6-1-2013 11.59 p.m. In this regard, the contention of complainant is that as seen from Ex.A1 card issued by Health Heritage Pvt. Ltd., through which the complainant processed the claim to 1st opposite party discloses the period of insurance valid up to 1-6-2013. It is pertinent to note that, in general, the period of insurance will be for a period of one year only. It seems that the date column was mentioned in the middle and the month was mentioned in the first coloumn i.e. as 1-6-2013 instead of 6-1-2013 in Ex.A1 card following MM-DD-YYYY method in stead of DD-MM-YYYY method. As such the said contention cannot be accepted more particularly in light of Ex.B1 copy of policy, which discloses the period of insurance as 7-1-2012 to 6-1-2013.
8. In view of the above discussion, we are of the considered opinion that the ground taken by the 1st opposite party in not reimbursing the claim of complainant is valid and we found no deficiency in service on the part of opposite parties.
In the result, the complaint is dismissed, but there is no order as to costs.
Type written by Steno N. Hazarathaiah, corrected by me and pronounced by us in the open Forum, this the 30th day of January, 2014.
PRESIDENT MEMBER MEMBER
Appendix of evidence
Witnesses examined
On behalf of the complainant:-None- On behalf of opp. parties:-None
Documents marked
On behalf of the complainant:
Ex.A1 Original identity card of the complainant.
Ex.A2 07.01.2013 Copy of invoice.
Ex.A3 08.01.2013 Copy of invoice.
Ex.A4 09.01.2013 Copy of invoice.
Ex.A5 10.01.2013 Copy of invoice.
Ex.A6 11.01.2013 Copy of invoice.
Ex.A7 07.01.2013 Original copy of radiology & ABC bill
Ex.A8 05.07.2013 Copy of legal notice got issued by complainant to Ops.
Ex.A9 Postal acknowledgement.
Ex.A10 Postal acknowledgement.
Ex.A11 17.07.2013 Copy of letter issued by complainant’s counsel to Ops.
Ex.A12 Postal acknowledgement.
Ex.A13 Postal acknowledgement.
Ex.A14 12.01.2013 Original copy of discharge summary and bills.
Ex.A15 12.01.2013 Copy of invoice.
On behalf of opposite parties:
Ex.B1 Policy schedule.
PRESIDENT
