D.O.F:09/11/2021

                                                                                                  D.O.O:20/08/2022

IN THE CONSUMER DISPUTES REDRESSAL COMMISSION KASARAGOD

CC.No.201/2021

Dated this, the 20^th  day of August 2022

PRESENT:

SRI.KRISHNAN.K                         :PRESIDENT

SRI.RADHAKRISHNAN NAIR.M : MEMBER

SMT.BEENA.K.G                            : MEMBER

1. The President

    Kerala Vyavasayi Ecopana Samithi,

    Cherkala Unit

    Chengala P.O, Kasaragod – 671541               : Complainants

2. Prashanth E.K  aged 35 years

    S/o Kunhambu Nair

    R/at Ottachal House

     Kotoor P.O – 671542

(Adv:  Manikandhan Nambiar. K)

And

1. The Branch Manager

     National Insurance Company

     Branch Office, Kasaragod – 671121               : Opposite Parties

2.  Good Health Insurance TPA Ltd.

     Represented by it’s Manager

     66/3199, Pullepady Junction

     Eranakulam North, Cochin - 682018

                             ORDER

SMT.BEENA.K.G: MEMBER

     The brief facts of the case is that complainant No:1 is the president of merchants association and complainant No:2 is member of 1^st complainant.  The Opposite Party No:1 introduced a group insurance policy as “Micro Gramin Suraksha Bima”.  The Opposite party canvassed the complainants to join the scheme.  The Opposite party No:2 is the implementory and claim disbursing agency under Opposite party No:1.  The first complainant encouraged its member for enrolling in the scheme.  The complainants are enrolled in the scheme and accepted the premium.  The policy is effected and activated from 23/01/2019 to the midnight of 22/01/2020.  The policy covers hospitalization charges, accident compensation up to Rs. 10,000/- including insured and 4 persons of his family.  The daughter of complainant No:2 Anshika P. is a 3 year old baby admitted at KIMS sunrise Hospital at Kasaragod on 27/08/2019 due to vomiting and weakness.  The baby is discharged on 29/08/2019.  An amount of Rs. 4115/- is paid at the hospital.  The 2^nd complainant spent another amount of Rs. 5000/- on account of hospitalization .  Both the complainants placed a claim before Opposite parties in prescribed form.  As per the advice of Opposite party No:1,  a separate claim with hospital bills is sent to Opposite party No:2 in a prescribed from through registered post.  The bank pas book copy of the 1^st complainant also sent along with claim form as per the advice of Opposite party No:1,  The Opposite party No:1 informed the complainants that the claim amount will be credited in the bank account of the complainant No:1.  But repudiated the claim on 10./03/2020.  Due to the unlawful trade practice and deficiency of service on the part of opposite parties, complainant suffered hardships mentally physically and financially.  The complainants No:1 suffered blame from organization side. Therefore the complainant  claim for compensation of  Rs. 95,000/- with cost.

   Notice of Opposite party served but did not turned up name of Opposite party called absent set exparte.

   The complainant filed proof affidavit in lieu of chief examination Ext A1 and A2 marked.  Ext A1 is the policy and Ext A2 is the inpatient invoice issued from hospital to Anushika.  The main question raised for the consideration are,

1. Whether there is deficiency in service or unfair trade practice on the part of Opposite party?
2. If so what is the relief.

For convenience question No:1 and 2 can be discussed together.

    Here the complainants joined in a group insurance policy Micro Gramin Suraksha Bima due to the influence of Opposite party No:1.  The complainants enrolled in the scheme and the policy is effected and activated from  23/01/2019 to 22/01/2020.  After joining the policy daughter of Opposite party No:2  Anushika admitted in KIMs hospital due to vomiting and weakness.  The baby is discharged on 29/08/2019 and amount of Rs. 4115/- is paid at the hospital.  Second complainant also spent Rs.5000/- on account of hospitalization.  As per the advice of Opposite party No:1 both these complainants placed separate claim form with bills to Opposite party No:2 in the prescribed form. The Complainants expected the claim amount will be credited to his account.  But unfortunately the claim repudiated on 10/03/2020.  The allegation of the complainant is that due to the repudiation of the claim they suffered heavy loss and mental agony.  Ext A1 is the policy and A2 is the inpatient invoice from KIMS Sunrise Hospital.

     We carefully gone through the affidavit and documents produced by the complainant.  The complainants case tallies with the documents produced by them.  In the absence of rebuttal evidence we are of the view that there is deficiency in service and unfair trade practice on the part of opposite parties.  The Opposite parties are bound to allow the claim submitted by the complainants on the strength of documents A1 and A2.   The rejection of the claim caused huge loss and mental agony to the complainants.  The complainants are entitled to get compensation from Opposite parties (OP No: 1 and 2). 

     The claim of complainants is Rs.95, 000/- with cost of litigation.  We are of the view that an amount of Rs. 50,000/- is a reasonable compensation in this case.  Therefore the complaint is allowed directing opposite parties to pay an amount of Rs. 50,000/- (Rupees Fifty Thousand only) as compensation with Rs. 5000/- (Rupees Five thousand only) as cost to the complainants.  Opposite party No: 1 and 2 are jointly and severally liable to compensate to the loss of the complainants.

Time for compliance is 30 days from the date of receipt of copy of the order.

Sd/- Sd/- Sd/-

MEMBERMEMBERPRESIDENT

Exhibits

A1-  Policy

A2- Inpatient invoice

       Sd/-                                                        Sd/-                                                    Sd/-

MEMBER                                                MEMBER                                          PRESIDENT

Forwarded by Order

                                                                                    Assistant Registrar

Ps/