DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD

Dated this the  25^th day of May, 2023 

Present      :   Sri. Vinay Menon V., President                                

                  :  Sri. Krishnankutty N.K., Member                                Date of Filing: 06/11/2019 

                         CC/256/2019

Indu Surendrdan,

“Nalanda”, Muthuthala Post,

Pattambi Via, Palakkad – 679 303

(Party in person)                                                   -                       Complainant

                                                                                                Vs

1. Divisional Manager,

M/s.Nationa Insurance Co.Ltd.,

Divisional office II,

Ambika Arcade, M.G.Road,

Thrissur – 680 001

2. M/s. Good Health TPA Ltd. - Kochi

Radhika, 66/3199, Rajaji Road,

Opp. Axix Bank, Ernakulam – 682 018           -                       Opposite parties

       (By Adv.M/s. Ratnavally & Kiran G Raj A)

O R D E R

By  Sri. Vinay Menon V., President

1. Facts are undisputed.Though complainant’s claim was initially rejected, the opposite party allowed the claim of the complainant and paid the amount admissible on the date posted for appearance of the O.P. before this Commission. Complainant holds fast to his grievance and seeks retribution for making him file this Complaint and for repudiating the claim twice.
2. The sole question that requires consideration is whether the delay in payment tantamount to a dispute.
3. In a nutshell, case is that the complainant underwent treatment which required hospitalization. But claim was rejected as O.P. was of the opinion that the treatment did not require hospitalization. Aggrieved by the repudiation of claim, this complaint was filed.
4. On 19.12.2019, the O.P. credited the amount admissible into the account of the complaint.
5. S.2(1)(e) of the Consumer Protection Act, 1986 defines a “Consumer dispute” as follows:

“(e) “consumer dispute” means a dispute where the person against whom a complaint has been made, denies or disputes the allegation contained in the complaint.”

This definition makes it clear that a dispute arises only when the opposite party denies or disputes the allegations contained in the complaint. Therefore whatever be the dispute prior to initiation of a proceeding by filing of a memorandum of complaint, what is to be considered are the contents in the memorandum of complaint and the response of the opposite party to the said allegation. If the opposite party denies or disputes the allegations, a “dispute” arises. Otherwise, if the complainant admits to the pleadings, there is no dispute.

6. Upon receipt of the notice from this Commission, O.P. paid the amount in dispute and settled the matter. Thus the O.P. has by their conduct acquiesced and admitted the claim of the complainant. Thus there is no dispute whatsoever, as contemplated under the Act of 1986.
7. The complainant has no case that they are entitled to any further benefits. Thus she is also satisfied by the amount credited into her account.  In the absence of a dispute (since the complainant has not amended the memorandum of complaint after this subsequent development), this complaint is only liable to be dismissed.
8. As the question to be answered can be ascertained by the discussions above, we are not resorting to a detailed discussion of any further facts or evidence.
9. Accordingly, this complaint is dismissed.

                  Pronounced in open court on this the 25^th  day of May, 2023.   

                                                                                             Sd/-

                                                                                                Vinay Menon V

                                                                              President     

                                         Sd/-             

                              Krishnankutty N.K.

                                                                                                                        Member

APPENDIX

Exhibits marked on the side of the complainant :

Ext. A1 – Copy of policy schedule   

Ext. A2 –  Copy of claim form   

Ext. A3 –   Copy of discharge summary  dated 16/7/19

Ext. A4 (a) –    Copy of repudiation letter dated 27/9/19

Ext.A4(b) – Copy of repudiation letter dated 22/10/2019

Ext. A5 –   Copy of certificate dated 2/10/19  

Ext. A6 –   Copy of  communication dated 9/10/19

Ext. A7 –   Copy of  pass book of the complainant

 Exhibits marked on the side of the opposite party:    

Ext. B1 – Copy of policy schedule alongwith terms and conditions  

Ext. B2 – Same as Ext.A4(a)

Ext. B3 – Same as Ext.A5

Ext. B4 – Same as Ext.A3

Court Exhibit:  Nil

Third party documents:  Nil

Witness examined on the side of the complainant:  

PW1 – Surendran (Representative of complainant)

Witness examined on the side of the opposite party:  Nil

Court Witness: Nil

NB : Parties are directed to take back all extra set of  documents submitted in the proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission Procedure) Regulations, 2020 failing which they will be weeded out.