<br /> SRI.LAIJU RAMAKRISHNAN(PRESIDENT)<br /> <br /> Complainant had taken an insurance policy named Mediclaim through the 3rd opposite party. The complainant paid Rs.1,050/- to the 3rd opposite party as premium and the 2nd opposite party has given a receipt of the same to the complainant. In the receipt the policy number is written as No.MVJ 5002287/14453. The period of the policy is specified as 20/08/2002 to 20/08/2003. The petitioner was admitted in Indo-American Hospital, BRAIN & SPINE CENTRE on 15/01/2003 for the treatment of Spine Thoracic & Lumbar Stiffman. The treatment expenses incurred Rs.16,179/-. The complainant applied for insurance claim through the 2nd opposite party with all the papers. But the 2nd opposite party sent a post card to the complainant telling that the documents produced are not sufficient. But the Original Band, Band photostat are not given by the 3rd opposite party to the complainant and so the complainant was not able to produce the same. The insurance claim is not yet given by the opposite party and the complaint is filed for getting the insurance claim as well as compensation for sufferings caused to the complainant due to long delay and for deficiency in service.<br /> <br /> 2. The Ist opposite party appeared and filed written version. In the written version, the Ist opposite party denied the insurance policy number issued by the 2nd opposite party as MVJ 5002287/14453. The Ist opposite party is not aware of the illness of the complainant. Nobody has made any claim to the opposite party. The 2nd and 3rd opposite parties are not the agents of the Ist opposite party. The Ist opposite party denied the averment that the complainant spent Rs.16,179/- towards the treatment. Hence there is no deficiency in service in the part of the Ist opposite party.<br /> <br /> 3. In the written version filed by the 2nd opposite party, it is stated that there is no role for the 2nd opposite party in the transaction between the Ist opposite party and the complainant. There is no role for the 2nd opposite party in the policy which was issued by the insurance company to the policy holder. There is no authority for the 2nd opposite party to sanction the claim. Whatever the claim submitted and asked for reimbursement by the petitioner is only with the Ist opposite party, who will enquire about the matter and if the claim is found genuine they will sanction the claim to the policy holder. If the petitioner is legally entitled for the policy coverage, it is the duty of the Ist opposite party alone to grant the compensation under the policy joined by him if the bills submitted found correct and genuine. There is no deficiency in service in the part of the 2nd opposite party.<br /> <br /> 4. In the written version filed by the 3rd opposite party, it is stated that there is no cause of action against the 3rd opposite party. The 3rd opposite party is only an agent of the 2nd opposite party. The insurance premium amount of Rs.1,050/-received by the 3rd opposite party from the complainant is duly paid at the 2nd opposite party's office and receipt is given to the petitioner which was issued bny the 2nd opposite party. The superior agent of the 3rd opposite party named V.P.Gopalakrishnan is a witness for the<br /> <br /> (cont..2)<br /> - 2 -<br /> <br /> same. Afterwards the documents relating the illness of the complainant was received from the petitioner and they are promptly given to the 2nd opposite party. The 2nd opposite party has sent the documents with claim form to Opposite Party 1 and the employees of the Ist opposite party conducted enquiry in Indo-American Hospital where the complainant was treated. It is the duty of the Ist opposite party to give insurance claim to the petitioner and it is the responsibility of the 2nd opposite party to make sure whether the complainant has received the same. The 3rd opposite party is only an agent of the 2nd opposite party. The 3rd opposite party is not having any responsibility in the above matter. So there is no deficiency in service on the part of the 3rd opposite party.<br /> <br /> 5. The points for consideration are whether there was any deficiency in service on the part of the opposite parties, and if so, for what relief the complainant is entitled to ?<br /> <br /> 6. The evidence consists of the oral testimony of PW1 and Exts.P1 to P6 marked on the side of the complainant and the oral testimony of DW1 on the side of the opposite parties.<br /> <br /> 7. POINTS :- The complainant paid the premium amount to the 3rd opposite party, who is the agent of the 2nd opposite party. The 2nd opposite party issued his own receipt to the complainant for Rs.1,050/- which is Ext.P1. The only dispute is that whether the 2nd opposite party paid the premium amount to the Ist opposite party. The 3rd opposite party is the agent of the 2nd opposite party who was examined as DW1. As per the evidence of PW1, he never knows that whether the 2nd opposite party paid the premium amount to the Ist opposite party. He did not see any receipt for the same. The 3rd opposite party is not aware that whether the 2nd opposite party gave the claim form to the Ist opposite party. The 3rd opposite party is not aware of any facts after disbursing money to the 2nd opposite party. The complainant who was examined as PW1, as per his evidence the premium amount was not directly paid to the Ist opposite party. The complainant paid the amount to the 3rd opposite party only. He is also not aware whether the 2nd opposite party paid the same to the Ist opposite party. The premium number described in the petition is the number written in P1 receipt. No policy certificate is issued to the complainant. Ext.P1 is a receipt issued in the name of “Jana Seva Foundation for Public Welfare” Reg.No.320/99, Palakkad. There is nothing written about the insurance premium or certificate of insurance. Several numbers are written in this receipt and one No. is MVJ 5002287/14453. It is not at all written that it is an insurance policy number. Rs.1,050/- is received from one Muraleedharan, not even the name of the complainant is written in the receipt. So it do not amounts to any insurance pemium receipt. So there is no evidence to connect the Ist opposite party in this transaction. There is no evidence to show that the 2nd opposite party is an authorised agent of the Ist opposite party. No service is hired from the part of the Ist opposite party by paying any consideration or any consideration offered. So the complainant is not a consumer of the Ist opposite party and no claim can be granted against the Ist opposite party. <br /> <br /> 8. The second point to consider is that whether any deficiency in the part of the 3rd opposite party. The complainant disbursed the premium amount to 3rd opposite party and the 3rd opposite party promptly paid the same to the 2nd opposite party. 3rd opposite party is only an agent of the 2nd opposite party. The receipt issued from the 2nd opposite party was delivered to the complainant by the 3rd opposite party. There is no other responsibility for the 3rd opposite party in this business. So there is no deficiency can be seen from the part of the 3rd opposite party.<br /> <br /> 9. The third point to consider is whether there is any deficiency in the part of the 2nd opposite party. Ext.P1, the receipt issued by the 2nd opposite party is admitted by written version. But there is no receipt produced by the 2nd opposite party to show the premium amount was paid to the Ist opposite party. There is no policy certificate produced by any of the parties to show that there is a valid policy is issued to the complainant by the Ist opposite party through the 2nd opposite party. The number written by the 2nd opposite party in written version as policy number is not at all reliable. It was absolutely denied by the Ist opposite party. There is no document produced by the 2nd opposite party to show that they have paid premium amount to the Ist opposite party. So it amounts to a conclusion that the 2nd opposite party has not remitted the premium amount to the Ist opposite party which is a gross deficiency in the part of the 2nd opposite party. Ext.P2(series) is the treatment certificate and bill produced by the complainant for Rs.16838.60. But the policy itself is denied by the Ist opposite party. No policy certificate is produced by the complainant. It is the duty of the complainant to keep the policy certificate in his own hand. If the policy certificate is not received after a long time, the complainant ought to have enquired about the matter in the concerned insurance company office. He did not give any complaint to any authority. Since no premium is seen paid no claim can be recovered from any other person. No insurance claim can be made against the 2nd opposite party because 2nd opposite party is not an insurance company. And 2nd opposite party is not an authorised agent of the Ist opposite party. The bill amount cannot be recovered from the 2nd opposite party because opposite party 2 is not an insurance company. But the 2nd opposite party must return the premium amount paid by the complainant as per Ext.P1. The complainant is suffering from the wilful act of the 2nd opposite party. The complainant was in good faith that there was a valid policy in the name of the complainant. The complainant is also entitled to get a compensation of Rs.3,000/- from the 2nd opposite party for deficiency in service. Also Rs.2,000/- for the cost of the petition.<br /> <br /> In the result, the petition is allowed in part. The 2nd opposite party is directed to give back Rs.1,050/- to the complainant which was paid by the complainant as premium. The 2nd opposite party is also directed to pay Rs.3,000/- as compensation for deficiency in service to the complainant and Rs.2,000/- for the cost of this petition within one month of receipt of a copy of this order, failing which the outstanding amount shall carry further interest at 12% per annum from the date of default.<br /> <br /> <br /> Pronounced in the Open Forum on this the 18th day of July, 2008<br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />