Orissa

Rayagada

CC/80/2020

Mrs K.S Laxmi - Complainant(s)

Versus

The General Manager, Reliance General Insurance - Opp.Party(s)

Self

09 Apr 2021

ORDER

DISTRICT   CONSUMER  DISPUTES REDRESSAL    COMMISSION, RAYAGADA,

STATE:  ODISHA.

 

C.C. case No.   80    of 2020.                               Date. 9.4.2021

 

P R E S E N T .

Sri  Gadadhara  Sahu,                                           President.

Smt. Padmalaya  Mishra,                                     Member.

 

Mrs. K.S.Laxmi,  W/O  Sri  Kasturi Sanyasi Raju, Near Ring Road, Cooperative Colony, 2^nd. lane, Po/ Dist: Rayagada,  State:Odisha,  Cell No. 9692971903.                       

Bearing claim No. 201200045558  vide  policy  No.766892028451000001.

… Complainant.

Versus.

The General  Manager, Reliance General Insurance, Krishe Block, Krishe Sapphire,

No. 1-89/3/B/40 to 42/KS/301, 3^rd. floor, Madhapur, Hydrabad- Telangana State-500081.                                                                        .…. Opposite parties

 

Counsel for the parties:                         

For the complainant: - Self..

For the O.Ps :- Set  exparte.

                                J u d g e m e n t.

        The  present disputes arises out of the complaint petition filed by the above named complainant alleging deficiency in service  against  afore mentioned O.Ps for non payment  a sum of  Rs. 1,38,304/-  towards medi claim. The   brief facts of the case are summaried here under    .

On being noticed the O.Ps. neither entering in to appear before the forum nor filed their  written version inspite of more than  3 adjournments has been given  to them. Complainant consequently filed his memo and prayer to set exparte of the O.Ps.  Observing lapses of around 4 months  for which the objectives  of the legislature of the C.P. Act going to be destroyed to the prejudice of the interest of the complainant.  Hence after hearing  the  counsel for the complainant set the case  exparte against the O.Ps. The action of the O.Ps is against the principles of  natural justice as envisaged  in the C.P. Act. Hence the O.P.  was set exparte  as the statutory period  for filing of  written version was over to close the case with in the time frame permitted by the C.P. Act.

 

Heard   from the  complainant.  Perused the  record  filed by the parties.

                                               

Findings.

During the exparte  hearing the complainant examined himself and proved the payment  of the  money  to the Medical store, and  Amrutha Hospitals, Rajam, Andhrapradesh state   which is marked as Annexure-I  to Annexure-Viii.  The complainant also filed policy bond i.e. Reliance Wealth + health plan (Regular) which is marked as Annexure-9.  The complainant  also filed all the prescriptions, Testing  reports and corresponding letters between the parties relating to the Covid- 19 treatment  made by the Doctor.   The complainant also argued  due to non reimbursement  of the above money he  suffered a lot of financial trouble  and mental agony. The complainant prays the forum as the  O.Ps have   not heard any  grievance of the complainant till date   so the  O.Ps  be  directed to reimburse the  amount a sum of Rs. 1,38,304/-  as   the complainant treated covid-19 treatment in the above hospital.

After carefully examining the evidence on record, we find no cogent reason  to disbelieve or discard the evidence already adduced by the complainant. The documentary evidence  tendered by the complainant clearly tends support and absolute corroboration   to  the evidence.  

In absence of any rebuttal materials from the side  of   O.Ps  there is no reason to disbelieve the evidence put forth  by the  complainant  before the forum  whose evidence  suffers from no infirmity. The evidence adduced by the complainant  clearly leads us to arrive at a just conclusion that there is not only deficiency  in service  but also negligence  on the part of the O.Ps  in not   reimbursing the amounts a sum of Rs. 1,38,304/- to the complainant  towards medi claim   as per the  provisions laid down under section-39 of the  C.P. Act,2019.

On careful analysis   of the evidence on record both oral and documentary, we are clearly of the opinion  that  inspite of doing the needful, the O.Ps are failed to redress the grievances of the complaint which amounts to  deficiency in service  as a result the complainant was constrained  to file this complaint before the forum claiming the relief as sought for.  In that view  of the matter the O.Ps  jointly and severally liable.

 

On perusal of the record  this District Commision found  the O.Ps  have continuously received the premium from the complainant   with the above  assurance but when the claim is placed for  such reimbursement towards Medi claim as per policy condition they  are avoiding  the same and as  such  it is a deficiency of service and they have never intended to extend  such benefit to the consumers and with false representation they are continuing  the policy  and policy named  as  given Reliance wealth + Health plan (regular)  policy. While  the policy is in force  repudiation of Medi claim by the O.Ps  with out  any cogent reason  is an unfair trade practice and causing  financial hard ship and mental agony    to the complainant  and this policy  is only intended to collect the premium  and not to pay back the same at the event admitted/accepted  by the policy bond.

Not responding to the grievance of a genuine consumer amounts to deficiency in service and in that line we hold that all the parties  are jointly and severally liable.

            Hence to meet  the  ends  of  justice,  the following   order is  passed.

                                                           

 

ORDER.

            In  resultant  the complaint petition is  hereby  allowed in part  on exparte against  the O.Ps

                The O.Ps  are  ordered to  reimburse the   amount a sum of Rs. 1,38,304/- towards Medi claim (As per bill  issued by the hospital authority) inter alia Rs.5,000/- towards mental agony  and cost of litigation  to the complainant .  We therefore issued a “Cease and Desist” order against the O.Ps  directing  him to stop such a practice  forthwith and not to repeat in future. 

            The O.Ps are  ordered to comply the above direction within one month from the date of  receipt of this order. Service the copies of the order to the parties free of  cost.

Dictated and corrected by me

Pronounced on this               9th. day of   April, 2021.

 

                                               

 

MEMBER.                                                        PRESIDENT