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.137 of 2013
Between:
Kurapati Kurapati Lakshmi Narayana Rao, S/o Chandra Sekhar Rao, Hindu, Aged about 70 years, Retired Business, 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.11,787/- with interest at 24 per cent per annum, to pay Rs.10,000/- towards damages, Rs.1000/- towards costs of notice and for costs of complaint and other reliefs.
1. The brief facts which lead to filing the present complaint are that the complainant has taken Mediclaim insurance policy for himself 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 had undergone both cataract and glaucoma eye operation at Vasan Eye Care, Vijayawada on 20-8-2012 and incurred an expenditure of Rs.35,787/- and paid the same to hospital. Thereafter he submitted bills worth Rs.35,787/- including all charges incurred by him to the 1st opposite party though M/s.Heritage Health TPA (P) Ltd., Visakapatnam. But the 1st opposite party paid Rs.24,000/- only and has not paid remaining amount of Rs.11,787/-. After receipt of said amount, the complainant wrote a letter dt.22-9-2012 requesting to pay the remaining amount. But the 1st opposite party dragged on the matter and thereby committed deficiency in service and caused mental agony. 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. 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 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 complainant informed that he has proposed to undergo Cataract eye surgery in Vasan Eye care, Vijayawada and accordingly they sought preauthorization for cash less treatment from TPA and the said TPA M/s.Heritage has sanctioned Rs.24,000/- for Cataract operation as per policy and the same was paid to complainant. It is further contended that subsequently the complainant sought treatment for Glaucoma which was separately claimed and the TPA has sanctioned Rs.9,000/- and they are ready to pay the same and requested the complainant to furnish his bank particulars to deposit the said amount. But the complainant failed to furnish bank particulars. As such there is no deficiency in service on the part of 1st opposite party. 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 A12. The Deputy Manager of 1st opposite party filed affidavit and got marked Ex.B1 copy of policy.
4. Heard both sides.
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 non payment of remaining amount to 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 complainant under policy No.62070134110100000564 on 7-1-2012 by paying requisite premium amount. Ex.A1=Ex.B1 copy of policy discloses the said fact. Further as seen from Ex.A1=B1 policy, the period of insurance is from 7-1-2012 to 6-1-2013. The case of the complainant is that he underwent surgery at Vasan Eye Care, Vijayawada on 20-8-2012 and incurred an expenditure of Rs.35,787/- and paid the same and later he submitted the bills to 1st opposite party through M/s. Heritage Health TPA (P) Ltd., Visakapatnam and the 1st opposite party paid Rs.24,000/-, but has not paid the remaining amount in spite of several requests including legal notices issued under Ex.A7 and A10. Ex.A8, A9, A11 and A12 postal acknowledgment disclose the receipt of notices by opposite parties 1 and 2. Ex.A2 to A6 bills disclose the factum of complainant undergoing treatment at Vasan Eye Care, Vijayawada and payment of amounts. In this regard, the contention of 1st opposite party is that the complainant in the first instance has undergone treatment for Cataract and they have paid Rs.24,000/- to complainant as per the approval of M/s.Health Heritage TPA Ltd., Visakapatnam and later the complainant sought treatment for Glaucoma and the same was claimed separately and the TPA has approved Rs.9,000/-. It is the further contention of 1st opposite party that though they have requested the complainant to furnish bank particulars for deposit of amount, the complainant did not oblige the same.
7. In view of the above circumstances, it is clear that the complainant underwent treatment at Vasan Eye care, Vijayawda and spent Rs.35,787/-. Further it is clear that the complainant received Rs.24,000/- from the 1st opposite party. The granting of amount of Rs.24,000/- in the first instance to complainant towards cataract surgery is seems to be in consonance with circular which is appended to Ex.B1 policy. Further it is the contention of 1st opposite party that they paid the said amount as per the approval of M/s.Heritage Health Care Pvt. Ltd., Visakapatnam. As such to that extent, the 1st opposite party has performed its part of contract. Further as per the own version of opposite party, they are ready and willing to pay an amount of Rs.9,000/- for the Glacouma treatment as per the approval of M/s.Heritage Health Care Pvt. Ltd., Visakapatnam and they could not deposit the same as the complainant failed to furnish bank particulars. But to substantiate the said contentions, the opposite party has not filed any documentary evidence such as letters addressed by 1st opposite party to complainant seeking bank particulars. In the absence of any such proof, the contention of 1st opposite party cannot be accepted. Further the complainant also got issued legal notices twice requesting payment of balance amount and the opposite parties received the same. But the 1st opposite party has not issued any reply seeking bank particulars. Further the 1st opposite party has not placed any material as to how the 1st opposite party and the said Health Care Pvt. Ltd., arrived the amount as Rs.9,000/-. Further it is not the case of complainant that the policy is not in force.
8. In view of the above discussion, we are of the considered opinion that there is deficiency in service on the part of 1st opposite party in non payment of remaining amount. As such the complainant is entitled for Rs.11,787/- with interest and costs. But in view of the circumstances of the case, we are not inclined to grant compensation. So far as 2nd opposite party is concerned, he is only an agent of 1st opposite party through whom the complainant obtained policy from 1st opposite party. As such he cannot be made liable in the present case.
9. In the result, the complaint is allowed against 1st opposite party while dismissing against 2nd opposite party. The 1st opposite party is directed to pay a sum of Rs.11,787/- with interest at 9 per cent p.a., from 30.7.2013 the date of filing this complaint till realization besides costs of Rs.1000/-. Time for compliance is one month from the date of this order. The other claims of complainant if any shall stand dismissed.
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 09.12.2011 Copy of collection receipt cum adjustment voucher.
Ex.A2 Photocopy of invoice.
Ex.A3 Photocopy of invoice.
Ex.A4 14.08.2012 Photocopy of invoice.
Ex.A5 Photocopy of invoice (2).
Ex.A6 20.08.2012 Photocopy of invoice.
Ex.A7 05.07.2013 Copy of legal notice got issued by complainant to Ops.
Ex.A8 Postal acknowledgement.
Ex.A9 Postal acknowledgement.
Ex.A10 17.07.2013 Copy of letter issued by complainant’s counsel to Ops.
Ex.A11 Postal acknowledgement.
Ex.A11 Postal acknowledgement.
On behalf of opposite parties:
Ex.B1 Policy schedule.
PRESIDENT
