<br /> <br /> By R.VIJAYAKUMAR, MEMBER.<br /> <br /> <br /> The complaint is filed for getting medical reimbursement Rs.15,000/- along with <br /> interest at the rate of 12% and compensation Rs.5,000/- and cost.<br /> <br /> The avernments in the Complaint can be briefly summarized as follows.<br /> <br /> The Complainant, a milk Farmer, having a cow joined in the Kamadhenu Insurance Scheme lodged by Kerala State Government Animal Husbandry Department and Local Administration Department jointly. Opposite parties examined, satisfied and inserted a tag holding No. 43981. Under the provision of the scheme as his was a BPL family had remitted Rs.450/- ie 50% of the total premium amount Rs.895. Policy dated 16/2/04 holding No. KIS 128081 was issued to the Complainant. The term of scheme was 3 years. The scheme assured benefit for Medical reimbursement for hospitalization, treatment and compensation for death of the person and family and the cattle insured.<br /> <br /> <br /> On 13/07/2005 the complainant was hospitalized at Karunagappally Govt. hospital and treated as in Patient from 13/7/05 to 18/7/05. Treatment is continuing. The Complainant informed the matter to the office of OP1 at Kollam. After discharged from hospital, on 20/07/2005 the Complainant applied to the opposite parties for treatment benefit as per the Policy with all relevant documents. The application was not considered by the opposite parties. The opposite parties will fully defaulted in allowing the Medical Reimbursement, which the complainant deserves to get. This gross deficiency in service amounts to financial loss and mental agony to the Complainant. Hence the complaint.<br /> <br /> The opposite party entered appearance, but even after sufficient opportunities were given failed to file version and adduce evidence. The complainant filed affidavit, Exhibits P1 to P6 marked.<br /> <br /> <br /> <br /> The points that would arise for considerations are.<br /> <br /> <br /> 1. Whether there is any deficiency in service on the part of opposite party.<br /> 2. Compensation and cost.<br /> <br /> <br /> <br /> The Complainant could prove his case through complaint, affidavit and exhibits marked. Section III of the exhibit P1 Policy specifically mentioned and ensures medical reimbursement for hospitalization. Exhibit P2 is the receipt of remittance of beneficiary contribution. P3 is the discharge Card from Govt. Hospital Karunagapplly. Exhibit P4 is the Scan report and P5 is bills for purchase of medicines. <br /> <br /> On perusal of documents we find that there is deficiency in service on the part of opposite party. Hence the complaint is allowed. The opposite party is directed to pay Rs.15,000/- to the complainant as medical reimbursement along with interest at the rate of 9% per annum. The opposite party is also directed to pay Rs.3,000/- as compensation and cost.<br /> <br /> The order is to be complied with within one month of the date of receipt of this order. <br /> <br /> <br /> Dated this the 28th July, 2008<br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> INDEX<br /> <br /> List of witness for the complaint<br /> PW1 K. Thankappan.<br /> <br /> List of documents for the complaint<br /> Ext: P1 Insurance certificate given by Opposite party to the Complainant.<br /> Ext. P2 Receipt of Kamadhenu insurance submitted by complainant Thodiyoor Panchayath.<br /> Ext. P3 Discharged Card received from Karunagappally District Hospital by the complainant <br /> Ext. P4 The sean report of complainant <br /> Ext. P5 Medical bills( 20 in numbers) amounted Rs.12,267/-<br /> Ext. P6 Receipt of submitted by the Complainant <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />