KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

VAZHUTHACAUD, THIRUVANANTHAPURAM

APPEAL No. 510/2022

JUDGMENT DATED: 10.11.2022

(Against the Order in C.C. 135/2022 of DCDRC, Palakkad)

PRESENT:

HON’BLE JUSTICE SRI. K. SURENDRA MOHAN              : PRESIDENT

SRI.T.S.P. MOOSATH                                                                    : JUDICIAL MEMBER

SRI.RANJIT. R                                                                               : MEMBER

SMT. BEENA KUMARY. A                                                          : MEMBER

SRI. RADHAKRISHNAN K.R.                                                    : MEMBER

APPELLANT:

Kanthy Ramachandran, W/o Ramamchandran U.P., Mala Nivas, Kadukkamkunnam, Malampuzha, Palakkad-678 651.

                                                Vs.

RESPONDENTS:

1. The manager, HDFC ERGO General Insurance Company Ltd., 2^nd Floor, Chicago Plaza, Rajai Road, Nr. KSRTC Bus Stand, Kochi-682 034.

2. The Manager, HDFC ERGO General Insurance Company Ltd., 1^st Floor, HDFC House, Backbay Reclamation, H.T. Parekh Marg, Churchgate, Mumbai-400 020.

JUDGMENT

HON’BLE JUSTICE SRI. K. SURENDRA MOHAN : PRESIDENT

The complainant in C.C. No. 135/2022 of the District Consumer Disputes Redressal Commission, Palakkad (District Commission for short) is the appellant. She is aggrieved by an order dated 30.08.2022 dismissing her complaint as barred by the principles of res judicata.  The respondents herein are the opposite parties in the complaint. 

2.  The short facts of the case are summarised hereunder:

The appellant had purchased a Canara Bank Group Health Insurance policy (individual plan) from the Olavakode branch of Canara Bank under their easy health plan on 18.03.2016 by paying an amount of Rs. 4,836/-.  The policy was being renewed from time to time. While so, the appellant’s husband was admitted to the hospital for the treatment of TB Spine.  A cashless hospitalization request was made under the policy on 18.01.2020 by the appellant, supported by necessary documents.  But, the claim was declined.  Therefore the appellant paid the entire expenses for treatment and claimed Rs. 74,608/- from the respondent as treatment expenses.  However, the claim was rejected.  A lot of correspondence followed.  But the claim still remains unpaid.  Therefore, the appellant approached the Insurance Ombudsman, stating all the above facts.  However, as per an award dated 29.01.2021 the complaint of the appellant was dismissed. 

3. Thereafter the appellant preferred a complaint before the District Commission as C.C. No. 56/2021 challenging the action of the respondent, seeking an order for payment of the treatment expenses of her husband.  As per order dated 12.01.2022 the said complaint was dismissed by the District Commission holding that it was barred by the principle of res judicata.  The said order was not challenged by the appellant before any higher authority.  Instead, she filed C.C. No. 135/2022 before the District Commission.  The said complaint has been dismissed by the District Commission holding that the same was barred by the principle of res judicata.  The aggrieved complainant is before us in this appeal.

4.  We have heard the Power of Attorney holder of the appellant, at length.  According to him, the District Commission went wrong in dismissing the complaint, finding that it was barred by the principle of res judicata.  It is pointed out that, Insurance Ombudsman has not gone into the matter in detail and therefore there was no bar in entertaining the present complaint.

5.  Having heard the agent of the appellant, we are not satisfied that there is any merit in the contentions of the appellant.  Admittedly, the earlier complaint C.C. 56/2021 was dismissed holding that it was barred by the principle of res judicata.  If the appellant had any complaint against said order, the same should have been challenged in an appeal before a higher Forum.  Since that was not done, the said order has become final and binding on the appellant. Since the very same complaint filed by the same person had been dismissed once on an earlier occasion, another complaint against the same person on the same cause of action is not maintainable.  The same has therefore been rightly dismissed by the District Commission.

For the above reasons, we find no grounds to admit this appeal. The same is dismissed.  No costs.   

JUSTICE K. SURENDRA MOHAN  : PRESIDENT

                                    T.S.P. MOOSATH  : JUDICIAL MEMBER

                  RANJIT. R                : MEMBER

                                                                                          BEENA KUMARY. A         : MEMBER

                                                                                            RADHAKRISHNAN K.R.  : MEMBER

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