| Complaint Case No. CC/10/64 |
| | | | 1. Chava Rama Sekhar, S/o. Nageswar Rao, Age: 39 years, Occu: Private Employee, R/o. H.No.10-6-39/3A, Vidyanagar Colony, Khammam District. | | Chava Rama Sekhar, S/o. Nageswar Rao, Age: 39 years, Occu: Private Employee, R/o. H.No.10-6-39/3A, Vidyanagar Colony, Khammam District. | | Khammam | | Andhra Pradesh |
| ...........Complainant(s) | |
| Versus | | 1. The Branch Manager,Bajaj Allianz Life Insurance Co. Ltd.,Khammam. | | The Branch Manager,Bajaj Allianz Life Insurance Co. Ltd.,Khammam. | | Khammam | | Andhra Pradesh |
| ............Opp.Party(s) |
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| ORDER | | BEFORE THE DISTRICT CONSUMERS FORUM AT KHAMMAM Dated this, the 15th day of June, 2011 CORAM: 1. Sri Vijay Kumar, B.Com., L.L.B. - President, 2. Sri R. Kiran Kumar, B.Sc. L.L.B - Member C.C. No.64/2010 Between: Chava Rama Sekhar, s/o. Nageswar Rao, age: 39 years, occu: Private employee, r/o.H.No.10-6-39/3A, Vidyanagar Colony, Khammam ….Complainant And The Branch Manager, Bajaj Allianz Life Insurance Co. Ltd., I Floor, above Bajaj Show Room, Wyra Road, Khammam. …Opposite parties This C.C. is coming before us for final hearing, in the presence of Sri.K.Jagan Mohan Rao, Advocate for Complainant and of Sri.G.Sita Rama Rao, Advocate for opposite party; upon perusing the material papers on record; upon hearing the arguments and having stood over for consideration, this Forum passed the following:- O R D E R (Per Sri R. Kiran Kumar, Member) 1. This complaint is filed under section 12(A) of the Consumer Protection Act, 1986. The brief facts of the complaint are that the complainant had obtained Bajaj Allianz Health Care policy vide policy No.0103202497 on 18-7-2008 for Rs.1,00,000/- by paying annual payment of Rs.1500/-. On 11-3-2009 he suffered with dengue fever and had obtained treatment at Khammam and Yashoda Hospital, Hyderabad, spent an amount of Rs.18,581.13ps. The complainant submitted that he produced all the necessary bills and documents to the opposite party for reimbursement of the expenses, but they failed to reimburse the expenses incurred by the complainant and addressed a letter to the complainant on 3-7-2009 for requirement of original documents, which were already submitted by the complainant. On 5-3-2010 the complainant issued notice to the opposite party, even after receipt of notice, the opposite party did not pay the amount. Since, the policy was in force, the complainant is entitled for the reimbursement of the expenses incurred by him, the opposite party committed deficiency in service. Hence, the complainant approached the forum for seeking redressal. On behalf of the complainant, the following documents were filed and got marked as Exs.A.1 to A5. Ex.A.1 - Letter, dt.9-4-2009 addressed by the opposite party to the complainant. Ex.A.2 - Letter, dt.3-7-2009 addressed by the opposite party to the complainant. Ex.A.3 - Treatment record Ex.A.4 - Office copy of legal notice, dt.5-3-2010 Ex.A.5 - Courier receipt, dt.5-3-2010. On receipt of the notice, the opposite party appeared through their counsel and filed counter. In the counter opposite party denied all the averments made in the complaint and submitted that the complainant suffered from ill health from the date of taking policy, he suppressed the same and obtained policy. In view of suppression of material facts, the complainant is not entitled for the benefits covered under the policy. Hence, the complaint is liable to be dismissed and also submitted that several complicated question of law and facts are involved. It is civil court, can adjudicate the same, there is no deficiency of service on their part. As such the complaint is not maintainable and prayed to dismiss the complaint. On behalf of the opposite party, except filing of counter and written arguments, no scrap of document has been produced. Heard on both sides. The complainant and opposite party submitted their written arguments. Perused the oral and documentary evidence on record. Upon which the points, that arose for consideration are, 1. Whether the complainant is entitled for claim as prayed for? 2. To what relief? Point No.1: In this case as per the averments made in the complaint, the complainant had obtained Bajaj Allianz Health Care Policy vide policy bearing No.0103202497 on 18-7-2008 for Rs.1,00,000/-. On 11-3-2009 he suffered with dengue fever, had taken treatment at Khammam and Yashoda hospital, Hyderabad and further he spent Rs.18,581.13ps. The complainant submitted all the documents/ medical bills to the opposite party company for the reimbursement of medical expenses, the opposite party addressed a letter to the complainant to submit original documents. On 5-3-2010 the complainant issued legal notice to settle his claim, even after receipt of notice also, opposite party failed to pay the amount. As such the complainant approached the forum for redressal. From the documents available on record, we observed that the claim put-forth by the complainant, the claim was repudiated by the opposite party company on the ground that “the complainant was suffering ill health by the date of taking policy, but he suppressed the same and obtained policy. In view of suppression of material facts, the complainant is not entitled to claim for the benefits under the policy.” Except taking of plea in their counter, the insurance company failed to produce any oral or documentary evidence to show that at the time of taking policy, the complainant is suffering from ill health. From the record, the complainant obtained health policy on 18-7-2008 and he had taken treatment for dengue fever suffered in the month of March, 2009. In the absence of material evidence, the fact remains that the complainant never suppressed any material facts regarding his health, the same was observed by the Hon’ble National Commission in L.I.C. of India Vs. Parlyapalli Sujatha and others I (2010) CPJ 106 (NC). In view of the above circumstances, this point is answered in favour of the complainant. Point No.2: In the result, the complaint is allowed, directing the opposite party to pay an amount of Rs.18,581-13ps. with interest at 9% P.A. from the date of letter issued by opposite party (i.e. Ex.A.1, dt.9-4-2009) till the date of actual payment and also directed to pay Rs.5,000/- towards damages and costs of the litigation. Dictated to the steno, transcribed by her, corrected and pronounced by us in the open forum on this the 15th day of June, 2011. PRESIDENT MEMBER DISTRICT CONSUMERS FORUM KHAMMAM APPENDIX OF EVIDENCE Witnesses examined for complainant: -None- Witnesses examined for opposite party: -None- Exhibits marked for complainant: Ex.A.1 - Letter, dt.9-4-2009 addressed by the opposite party to the complainant. Ex.A.2 - Letter, dt.3-7-2009 addressed by the opposite party to the complainant. Ex.A.3 - Treatment record Ex.A.4 - Office copy of legal notice, dt.5-3-2010 Ex.A.5 - Courier receipt, dt.5-3-2010. Exhibits marked for opposite party: -Nil- PRESIDENT MEMBER DISTRICT CONSUMERS FORUM KHAMMAM | |
