BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM, IDUKKI Dated this the 31st day of December, 2008
Present: SRI.LAIJU RAMAKRISHNAN PRESIDENT SMT.SHEELA JACOB MEMBER SMT.BINDU SOMAN MEMBER C.C No.54/2008 Between Complainant : Chinnamma W/o Raman Nair, Kottarathil Veedu, Pazhayarikandam P.O, Idukki District. (By Adv: Biju Vasudevan) And Opposite Parties : 1.The Branch Manager, United India Insurance Company Limited, Branch Office, Muvattupuzha. 2. The Branch Manager, United India Insurance Company Limited, Prakash Road, T.B Junction, Thodupuzha. (Both by Adv:T.J.Lakshmanan) O R D E R SRI.LAIJU RAMAKRISHNAN(PRESIDENT)
The complaint is filed for getting the insurance amount from the opposite party and also against deficiency in service. The complainant insured her milk cow to the opposite party through Veterinary Surgeon, Kanjikuzhy as per Kamadhenu Insurance Scheme. As per the Kamadhenu Insurance Scheme, if the cow is insured, the family members of the owner of the cow is also become the beneficiary of the insurance scheme. So the complainant has taken the policy for the coverage from 6.5.2005 to 5.05.2008 as per policy No.10101/47/05/00065 and the premium was also paid. In the existence of the policy period, the complainant was admitted in Aravind Hospital, Madurai for treatment of her left eye and a surgery was conducted on 16.01.2005, paid Rs.35,000/- for the same. The claim form was repudiated by the opposite party without any reasons. So the complaint is filed for getting the insurance amount from the opposite parties and also for compensation. 2. The opposite party filed a written version and admitted that the policy was given to the complainant for the period from 6.05.2006 to 5.05.2008. As per the treatment summary given by the complainant, it is revealed that the complainant had visited the said hospital first time on 11.03.2003 and again on 12.03.2003, also on 10.06.2003. Again she was admitted on 15.11.2005 and discharged on 25.11.2005. The first admission was also for the treatment of eyes. In the summary it is revealed that the complainant is having superior bullous retinal detachment in the left eye on 10.06.2003 onwards and left eye surgery was done on 16.11.2005, even after the surgery retinal detachment is still persisting, for which laser treatment was done on 24.11.2005. So it is clearly proved that the complainant is having the left eye problem even before the commencement of the policy coverage and for the said pre-existing illness she had undergone the operation. So the complainant had willfully suppressed the pre-existing illness at the time of proposing the policy coverage, she made a false representation before the company which can be seen from the policy certificate itself. Hence the claim is repudiated. 3. The point for consideration is 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 ? 4. The evidence consists of the oral testimony of PW1 and Exts.P1 to P5 marked on the side of the complainant. Opposite party was examined as DW1 and Ext.R1 marked on the side of the opposite parties. 5.The POINT :- The complainant has paid Rs.895/- as premium for the Kamadhenu Insurance policy for the period from 6.05.2005 to 5.05.2008. Complainant was examined as PW1 and Ext.P1 is the policy certificate issued from the opposite party. She was under treatment for her left eye due to shortage of vision in Aravind Hospital, Madurai and on 16.11.2005 an operation was conducted. The bill from the hospital were produced as Ext.P2 series. The learned counsel for the opposite party examined the complainant and the complainant admitted that she was undergone treatment for the right eye for the period from 11.03.2003 to 15.03.2003. The certificate issued from the hospital is marked as Ext.R1. But there was no disease for her left eye at the time of treatment on 1.03.2003. The doctor who treated the complainant at Aravind Hospital was examined as DW1, DW1 deposed that the complainant came to the hospital for loss of vision on the right eye and she was undergone treatment for the right eye, a surgery was conducted on 12.03.2003 and discharged on 15.03.2003. After 2 years the complainant again came to the same hospital on 15.1.2005 for a complaint of loss of vision on the left eye. She was advised to undergo surgery on 16.1.2005 for the left eye. As per the opposite party, the complainant willfully suppressed the material fact that the pre-existing illness. But the medical certificate produced by the opposite party and the doctor who treated the complainant at Aravind Hospital, for her treatment, deposed that the complainant was admitted in the hospital for the first time for the treatment of right eye and not for the left eye. The doctor clearly deposed that this disease is actually a separate one. It is only treatment like on the left hand and the right hand. Both eyes can be treated as separate organ in whole body. So it is not proper to repudiate the claim because she was under treatment for her right eye before the commencement of the policy. There was no disease caused to her left eye at the time of commencement of the policy. The disease caused to left eye is not a continuous one from the first disease. As per the deposition of DW1, it is clarified. So repudiating the claim due to the same is not proper. We think it is proper to order opposite party to disburse the insurance amount to the complainant as per Ext,.P1 policy. Hence the petition allowed. The opposite parties are directed to pay the insurance amount as per Ext.P1 to the complainant with 12% interest from the date of this petition 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% from the date of default. Pronounced in the Open Forum on this the 31st day of December, 2008 Sd/- SRI.LAIJU RAMAKRISHNAN(PRESIDENT) Sd/- SMT.SHEELA JACOB(MEMBER) Sd/- SMT.BINDU SOMAN(MEMBER) APPENDIX Depositions : On the side of Complainant : PW1 - Chinnamma On the side of Opposite Parties : DW1 - Dr.Anand Rajendran Exhibits: On the side of Complainant: Ext.P1 - Certificate of Insurance - Kamadhenu Insurance Scheme Ext.P2(a) - Photocopy of Certificate and Clarification to provide Reimbursement (Bill for Rs.20569.95) Ext.P2(b) - Photocopy of Medical Bill for Rs.224.55 Ext.P3 - Repudiation letter dated 19.04.2006 issued by the Ist opposite party Ext.P4 - Photocopy of Mediclaim Medical Certificate Ext.P5 - Photocopy of Order in O.P No.273/2003 dated 29.01.2004 before the CDRF, Idukki On the side of Opposite Parties : Ext.R1 - Case summary of the complainant issued from Aravind Eye Hospital, Madurai
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