IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Monday the 31st day of October, 2016
Filed on 29..10..2015
Present
- Smt. Elizabeth George (President)
- Sri. Antony Xavier (Member)
- Smt. Jasmine D (Member)
in
C.C.No. 322/2015
between
Complainants:- Opposite Party:-
- Smt. Geetha Reghu The Divisional Manager
W/o Late Reghu Thekkepolyil The United India Insurance Company Manalady Ramankari.p.o Divisional Office, Saradha Complex
Alappuzha- 689 595 Mullakkal, Alappuzha
- Sri. Renjith.R
S/o Late Reghu, Thekkepolyil
Manalady, Ramakari.P.O
Alappuzha-689 595
- Rejini.R
D/o Late Reghu, Thekkepolyil
Manalady, Ramakari.P.O
Alappuzha-689 595
- Smt.Bhavani
M/o Late Reghu, Thekkepolyil
Manalady, Ramakari.P.O
Alappuzha-689 595
(Adv. Kora Jimmy(
O R D E R
SMT. JASMINE D. (MEMBER)
The case of the complainant in short is as follows:-
The complainants are the legal heirs of the deceased Reghu who is having a valid RSBY (Rashtriya Swasthiya Bheema Yogana) card. Mr. Reghu met with an accident on 14/12/2013 and was seriously injured and he was died on 15/2/2013 at Medical College Hospital Kottayam. According to the complainant since the deceased Reghu has a valid RSBY card, complainants are entailed to get the claim amount of Rs. 2,00,000/- as per the insurance scheme. The complainant submitted the claim before the opposite party along with all relevant documents but the opposite party repudiated the claim hence filed this complaint.
2. Notice was served to the opposite party they appeared before the Forum and filed version.
3. The version of the opposite party is follows:-
The complaint is not maintainable the deceased Reghu joined the RSBY scheme policy, the policy end date as per the computer document is 31/03/2012, and that it is not seen that it was in force subsequent to 31/3/2012. Inspite of directions to the petitioners, whenever they approach the respondent, they have not produced the original RSBY card, to find out whether the name of Reghu had been continued in the scheme. From the available records with this respondent we could not found out his name after 31/03/2012 and we believe bonafide, that Reghu’s name had not been continued after 31/03/2012 in the scheme. In any case complainants are not entitled 12% interest as claimed. Nonpayment of compensation was due to the laches on the part of the petitioners. Hence the complaint may be dismissed.
- The complainant was examined as PW1 and Ext A1 to A7 were marked. One Witness District Nodel Officer (CHIAK/RSBY was examined as PW2. Opposite party was examined as RW1 and documents Ext.B1 to Ext.B4 were marked.
- Considering the allegations of the complainants and contention of the opposite party the Forum has raised the following issues for consideration.
- Whether there is any deficiency in service on the part of the opposite party?
- Whether the complainant is entitled to get the relief as prayed for?
- Issues 1 and 2:- The case of the complaint is that they are the legal heirs of the deceased Reghu and he had valid RSBY card. The card holder died on 15/2/2013 followed by an accident. After the death of the deceased the complainants submitted the claim before opposite party. But the claim was repudiated by the opposite party. According to the opposite party the validity of RSBY card ends on March 2012 and hence they denied the claim.
- The complainants produced the original RSBY card Ext.A1 before the Forum on a bare persual of Ext.A1 it can be seen that the said card is valid upto 31/3/2013, but according to the opposite party the computer generated screen shot of the said RSBY card shows that the validity ends on 31 march 2012 and relaying on the said computer generated screen shot they have repudiated the claim of the complainants.
- Admittedly RSBY is the Government run Health Insurance Scheme for the families belongs to Below Poverty Line. The responsibility for implementation the scheme was entrusted to the State Nodel agency when PW2 the District Nodel Officer was examined he deposed that the Sticker affixed behind the card shows the validity and in the instant case the card is valid upto 2013 March 31. The witness further stated that Akshaya Agency was entrusted to renew the card and the error accrued while reading the card is might be a software error or by the mistake of Akshaya Agency. Further Ext.A7 shows that Mr. Reghu availed treatment from MCH Kottayam using RSBY card. From the documents and the oral testimony to PW2 proves the case of the complainant and they are entitled to get insurance claim. Since the opposite party failed to provide the insurance claim, they have committed deficiency in service. So the complaint is to be allowed.
In the result the complaint is allowed. The opposite party is directed to pay the insurance claim of Rs. 2,00,000/- (Two Lakhs only) to the complainant with 9% interest from the date of complaint till realization to opposite party and further directed to pay an amount of Rs. 2000/-(Two Thousand only) towards cost of the proceedings. The order shall be complied within one month from date of receipt of this order.
Dictated to the Confidential Assistant, transcribed by him and corrected by me and pronounced in Open Forum on this the 31st day of October 2016.
Sd/- Smt. Jasmine D (Member)
Sd/- Smt. Elizabeth George (President)
Sd/- Sri. Antony Xavier (Member)
Appendix:-
PW1 - Renjith R
PW2 - K.R.Manesh
Evidence of the complainants:-
Ext. A1 - Original RSBY card
Ext. A2 - Letter issued by the opposite party Dtd 29/5/2013
Ext.A3 - Copy of the letter issued to the opposite party Dtd 13/10/2014
Ext.A4 - Letter issued by the opposite party Dtd 10/10/2014
Ext.A5 - copy of the Death Certificate
Ext.A6 - Copy of the legal heir Ship Certificate
Ext.A7 - Copy of case sheet/record/ admission/ discharge register
Evidence of the opposite parties:-
RW1 : Bindu. B
ExtB1 : Copy of the letter dtd.29/05/2013
ExtB2 : Copy of the letter dtd.20/01/2014
Ext B3 : Copy of the Registered letter
Ext. B4: Copy of the Identity card
-//True copy//-
By Order,
Senior Superintendent.
To
Complainants/Opposite party/SF
Typed by: Br/-/-
Compd.By:
