Between:

E.Sreenivasulu,

S/o E.Venkata Ramudu,

R/o H.No.42/118, Gowli Street,

Kurnool – 518 001.                                      …Complainant

                                                                  -Vs-          

1. The Manager, I-Care Health Management,

   T.P.A. Services Private Limited,

   # 56, Syndicate Bank, Offers Colony,

   West Mered Palli,

   Secunderabad – 500 026.

2. The Regional Manager,

   United India Insurance Company Limited,

   Registered and Health Office-24,

   Whites Road,

   Chennai – 600 014,

   Tamail Nadu State.

3. The Divisional Manager,

   United India Insurance Company Limited,

   Shop No.40/304, Bhagya Nagar,

   Mourya Inn, Kurnool – 518 001.                                                  ...Opposite ParTies

This complaint is coming on this day for orders in the presence of Sri.M.Rama Krishna, Advocate for complainant and opposite parties 1 and 2 called absent and Sri. A.V.Subramanyam, Advocate for opposite party No.3 and upon perusing the material papers on record, the Forum made the following.                                   

                                    ORDER

(As per Sri. M.Krishna Reddy, Male Member)                                                             C.C. No.3/2012

1.     This complaint is filed by the complainant under section 11 and 12 of C.P. Act, 1986 seeking a direction on opposite parties for the payment of :-

(a)        The medical expenditure of Rs.20,599/- and other expenses of Rs.10,000/-;

(b)        Rs.95,000/- as compensation for causing mental agony;

(c)         Cost of the complaint;

2.    The complainant E.Sreenivasulu is a Journalist.  He paid Rs.925/- as premium and became the member of the policy ICUI 1400057512 which was valid from 05-10-2010.  He was hospitalized from 18-10-2010 to 01-11-2010 for left leg infection in Government General Hospital, Kurnool.  He underwent skin grafting surgery and incurred Rs.20,599/- for medical bills.  He also spent Rs.10,000/- for other miscellaneous expenses.  He sent claim form along with original bills to opposite party No.1 for settlement.  Despite several reminders and legal notice to opposite parties the claim was not settled.  Hence the complaint is filed by the complainant claiming appropriate reliefs.     

3.     Opposite parties 1 and 2 are called absent.

        Opposite party No.3 filed his written version denying his liability to the complainant’s claim.  Opposite party No.3 avered that opposite party No.1 is a third party agent (TPA) of opposite party No.2 Company.  The complainant being a journalist covered under the Group Insurance Policy issued to the Commissioner, Information and Public Relations Department, Hyderabad.   The policy was issued by united India Insurance Company Limited, Hyderabad Branch.  The details of TPA are 1-care Health Management and TPA Services Private Limited, Secunderabad.  According to the terms and conditions of the policy, the claim should be submitted to opposite party No.1 who intern investigate and forward it to opposite party No.2 for settlement.  Opposite party No.1 during his investigation found that the claim intimation was not given to him within 24 hours, which amounts to violation of terms and conditions of the policy.  Hence opposite party No.1 repudiated the claim and the same was informed to the complainant vide letter dated 23-09-2011.  Further opposite party No.3 submitted that the policy was issued by Hyderabad Branch.  The insured as well as insurer are at Hyderabad.  Any dispute that arises between them shall have Hyderabad as its jurisdiction.  Opposite party No.3 is added as a party only to get jurisdiction, though there is no deficiency of service on him.  In view of the above pleadings opposite party No.3 prayed this Forum to dismiss the complainant with cost. 

4.     Both parties filed their sworn affidavits. Complainant got his supporting documents marked as Ex.A1 to A14, while opposite party No.3 got marked his documents as Ex.B1 and B2.   

5.     Written arguments of complainant and opposite party No.3 are filed.

6.     Hence the points for consideration are:

                     i.        Whether the complainant made out a case against opposite Parties to prove deficiency?

                    ii.        Whether the complainant is entitled for any relief?

                  iii.        To what relief?

7.      POINTS I and ii:-   Admittedly the complainant was a member of Group Insurance Policy bearing ICUI 1400057512 issued to the Commissioner, Information and Public relations Department, Hyderabad by opposite party No.2 covering the risk of the journalist members for the period from 05-10-2010 to 04-10-2011.  The opposite party No.1 is the thirst party agent (TPA) of opposite party No.2 as per Ex.A11.  As per the terms and conditions of the policy Ex.B1, the claim intimation should be given to TPA within 24 hours and papers should be submitted within 15 days from the date of discharge.  TPA intern will send the claim to opposite party No.2 for settlement after due enquiry. The complainant got his left leg infection treated by undergoing skin grafting in Government General Hospital, Kurnool as in patient from 18-10-2010 to 01-11-2010.  Ex.A7 is discharge card.  He incurred Rs.20,599/- towards medical bills.  Ex.A10 medical bills.  As per the policy condition the beneficiary of the policy should inform the claim to TPA within 24 hours which the complainant did not do.  As the complainant has not fulfilled this condition, the repudiation of the claim on this ground by opposite party No.1 is in order.  Further the insured and the insurer are residing at Hyderabad.  The complainant’s cause of action arose at Kurnool.  Opposite party No.3 is a branch of opposite party No.2 at Kurnool has no nexus to this case.  Hence under section 11 of C.P. Act, 1986 this Forum has no jurisdiction to entertain this complaint.  From what is stated above the Form holds that the complainant failed to prove deficiency of service on the part of opposite parties and hence the case is liable for dismissal. 

8.     In the result, the complaint against opposite parties is dismissed without costs. 

        Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 12^th day of November, 2012.

Sd/-                                                                                      Sd/-

MALE MEMBER                                                                   PRESIDENT                     

                                 APPENDIX OF EVIDENCE

                                    Witnesses Examined

For the complainant: Nill             For the opposite parties : Nill

List of exhibits marked for the complainant:-

Ex.A1                Photos (Nos.2) along with documents.

Ex.A2                Postal Acknowledgement Card.

Ex.A3                Postal Acknowledgement Cards (Nos.2).

Ex.A4                Photo copy of Health Management Card ID

                No.ICUI 1400057512.

Ex.A5                Photo copy of Press ID Card along with Driving License.

Ex.A6                Office copy of Legal Notice dated 21-07-2011.

Ex.A7                Photo copy of Discharge Card dated 01-11-2010.

Ex.A8                Photo copy of Demand Draft dated 11-08-2010.

Ex.A9                Member Manual Guide Book.

Ex.A10       Medical Bills (Nos.14).

Ex.A11       Photo copy of Insurance Regularity and Development

                Authority dated 01-01-2009.

Ex.A12       Photo copy of Data Layout.

Ex.A13       Photo copy of Letter dated 03-01-2011.

Ex.A14       Photo copy of Hospitalization and Domiciliary Hospitalization

                Benefit Policy dated 30-01-2011.

List of exhibits marked for the opposite parties:-

Ex.B1                United India Insurance Policy bearing

                No.050305/48/10/41/00000409.

Ex.B2                Photo copy of Health Claim Repudiation Letter

dated 23-09-2011.

Sd/-                                                                                      Sd/-

MALE MEMBER                                                                   PRESIDENT

    // Certified free copy communicated under Rule 4 (10) of the A.P.S.C.D.R.C. Rules, 1987//

Copy to:-

Complainant and Opposite parties  :

Copy was made ready on             :

Copy was dispatched on               :