This C.C. is coming on before us for final hearing in the presence of Sri.Md. Hussain, Advocate for Complainant and of Sri. G. Sita Rama Rao, Advocate for opposite party No.3; opposite parties No.1 & 2 served, called absent; upon perusing the material papers on record; upon hearing and having stood over for consideration, this Forum passed the following order;

O  R  D  E  R

(Per Sri R. Kiran Kumar, FAC President)

          This Complaint is filed u/s.12-A of Consumer Protection Act, 1986. 

2.       The averments made in the complaint are that the son of the complainant by name Mohammed Haneef @ Haneefuddin died in a motor accident, during his life time he worked with opposite party No.1 company as PACS Accounts Executive and Computer Operator from April 2011 till his death.  The complainant submitted that the opposite party No.1 had introduced Medi Claim Policy with the help of opposite party No.2 in the year 2011 obtained group policy with opposite party No.3 vide policy No. MAID5004364463 valid up to 30-03-2012.  The complainant further submitted that his son while coming from Kothagudem to Khammam, reached to near Julurpahad Police Station on a motor bike, when a bull suddenly came on to the road the son of the complainant applied sudden breaks and lost control over the vehicle, due to which he fell down and received severe head injury and while undergoing treatment at Mamata General Hospital, Khammam, he died on 29-08-2011.  The complainant further submitted that he applied Medi Claim through the opposite party No.1 by enclosing all necessary documents, requesting to send the application and documents to opposite party No.2, but the opposite party No.1 refused to send the same, due to the said act the complainant is suffered both mentally and physically as such the complainant filed this Complaint. 

3.       On behalf of the complainant to prove his case, the complainant filed the following documents and the same have been marked as Exs.A-1 to A-7.

Ex.A.1 –Policy Identification card issued by the Opposite party No.3 in favour of the son of the complainant.

Ex.A.2 –Claim Form along with Medical Certificate issued by the treating Doctor.

Ex.A.3 –Billing statement issued by the Mamata General Super Speciality Hospital, Khammam.

Ex.A.4 –Photocopy of Death certificate issued by Khammam Corporation.

Ex.A.5 –Photocopy of House Hold Card.

Ex.A.6 –Bunch Bills issued by Mamata Super Speciality Hospital and Pharmacy, Khammam (20 nos.)

Ex.A.7 –Acknowledgement of certificates, dt.05-07-2010 issued by Opposite party No.1 in favour of the son of the complainant.

4.       Notice of opposite party No.1 & 2 served, none appeared on behalf of opposite party No.1 and 2.  On receipt of notice, the opposite party No.3 appeared through their counsel and filed counter.  In their counter opposite party No.3 submitted that the insurance policy between the insurer and the insured represents a contract between the parties, the insurer undertakes to compensate the loss suffered by the insured on account of risk covered by the insurance policy, the terms of the agreement have to be strict construed to determine the extent of liability of the insurer, the insured cannot claim anything more than what is covered by the insurance policy.  The opposite party No.3 further submitted that they have not rendered any deficiency of service by declining the claim of the complainant and the complainant is not entitled for any of the claim prayed in the complaint.  The opposite party No.3 further submitted that they does not admit the averments of the complaint, that the opposite party No.1 had introduced Medi Claim policy with the help of opposite party No.2 in the year 2011 with opposite party No.3 vide policy No. MAID No.5004364463 valid up to 30-03-2012, the son of the complainant died on 29-08-2011 due to Motor accident, for which the complainant applied Medi Claim through opposite party No.1 by enclosing all necessary documents, requesting to send the application and documents to the opposite party No.2, the opposite party No.1 refused to send the same and the complainant has spent an amount of Rs.29,514.06 in Mamata General Hospital, Khammam are not admitted by opposite party No.3. The opposite party No.3 further submitted that the complainant did not mention that for what reason the opposite party No.1 repudiated the claim of the complainant, by suppressing such fact, the complainant filed the present complaint with a malafide intention to have wrongful gain, in view of such suppression of facts the complainant is not maintainable and prayed to dismiss the complaint.

5.       No documents filed on behalf of opposite parties.

6.       Written Arguments of opposite party No.3 filed.

7.       Heard Oral Arguments.

8.       Upon perusing the material papers on record, now the points that arose for consideration are,  

Whether there is any deficiency of service by the opposite parties against the claim made by the complainant?

Point :-

          In this case the son of the complainant joined in Medi Claim Group Insurance policy vide policy No.MAID No.5004364463 valid up to 30-03-2012 with opposite party No.3 through opposite parties No.1 & 2.  According to the complainant the son of the complainant died in the Motor Accident on 29-08-2011, for which the complainant applied Medi Claim through opposite party No.1 by enclosing all necessary document and requesting to send the claim form and other documents to the opposite party No.2 & 3 but the opposite party No.1 refused to send the same, for that the complainant approached the Forum for redressal. 

          From the documents and material available on record there is no dispute about the Medi Claim Group Insurance policy obtained by the son of the complainant from opposite party No.3 through opposite party No.1 & 2.  Also there is no dispute about the death of Md. Haneefuddin in a Motor Accident.  From the record we observed that the complainant approached the opposite party No.1 and obtained claim form and Medical certificate to be filled in by the Doctor treating the patient (Exhibit A2) collected from opposite party No.1 & 2 and after obtaining the certificate from the concerned doctor he submitted the same to the opposite party No.1 for claim.   But the complainant failed to produce any documentary evidence to support his case.  In view of the above circumstances, the age of the complainant and death of his son in Motor Accident, taking into consideration we are directing the complainant to submit claim form along with all necessary documents to the opposite party No.3 and on such claim the opposite party no.3 is directed to consider the claim as per their rules and regulations.    

9.       In the result, the complaint is allowed in part directing the complainant to submit claim form along with all necessary documents to the opposite party No.3 and on such claim the opposite party No.3 is directed to consider the claim of the complainant with the support of the opposite parties No.1 and 2.  

         Typed to dictation, corrected and pronounced by us in the open forum, on this the 28^th day of August, 2015.

    Member                  FAC President              

District Consumer Forum, Khammam.

APPENDIX OF EVIDENCE

WITNESSES EXAMINED

For Complainant                                                       For Opposite party   

       -None-                                                                           -None-

DOCUMENTS MARKED

For Complainant                                                       For Opposite party

                Member              FAC President             

District Consumer Forum, Khammam.