Karnataka

Kolar

CC/26/2022

Sri.Raghunath - Complainant(s)

Versus

The Manager, Oriental Insurance Co.Ltd - Opp.Party(s)

Sri.C.V.Srinivas

29 Jul 2022

ORDER

                          Date of Filing: 14.06.2022

Date of Disposal: 29.07.2022

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, OLD D.C. OFFICE PREMISES, KOLAR – 563 101.

 

Dated: 29^TH DAY OF JULY 2022

PRESENT

SRI. SYED ANSER KALEEM, B.Sc., B.Ed., LL.B., …… PRESIDENT

SMT. SAVITHA AIRANI,B.A.L., LL.M., …..LADY MEMBER

 

CONSUMER COMPLAINT NO. 26 OF 2022

Sri. Ragunath,

S/o. Govindappa,

Aged About 35 Years,

R/at: Kamanur Village,

Avani Hobali, Mulbagal Taluk,

Kolar District.                                                     ….  COMPLAINANT.

(Rep. by Sri. C.V. Srinivas, Advocate)

- V/s –

The Manager,

Oriental Insurance Company

Limited, BELL Fast Management

Private Limited, 8^th Floor,

No.4809, High Point IV,

Palace Road, Bangalore.

(Exparte)                                                               …. OPPOSITE PARTY.

ORDER

BY SRI. SYED ANSER KALEEM, PRESIDENT

01.   The complainant has filed this Consumer Complaint Under Section 35 of the Consumer protection Act, 2019 against the Opposite party - Insurance Company alleging deficiency in service (defective service) on the part of the OP Insurance Company and seeking this Hon’ble Commission to award global compensation of Rs.2,00,000/- with interest at the rate of 12% per annum from the date of admission of the complainant to the hospital as an in-patient and to pay compensation amount in the interest of justice and equity.

02.   The brief facts of the complainant’s case is that, it is the specific case of the complainant is that, the complainant has taken the Corona Kavach Insurance Policy bearing No. 462600/48/2021/2602.  The validity of the policy commenced from 29.07.2020 to midnight of 09.05.2021.  The complainant states that, the above said policy is for the period of 10 months only.  That on 06.05.2021 the complainant was admitted to the Ellen Thoburn Cowen Memorial Hospital, Kolar, due to pandemic COVID.  It is stated that, complainant was taken treatment at the above hospital and incurred expenditure of Rs.91,420/- and in addition to that, miscellaneous expenditure of Rs.50,000/- and incurred medical expenditure of Rs.1,33,620/-.  It is submitted that, subsequent to discharge from the hospital the complainant submitted all the documents along with the claim form to the OP – insurance Company, but the OP – insurance company did not respond to the complainant despite submitting of claim form with supporting documents.  Further complainant also got issued the legal notice dated: 11.04.2022 and the OP – Insurance Company has refused the said notice.  Hence the complainant alleged deficiency in service (defective service) on the part of the Op – insurance company and filed this complaint.

03.   On service of notice from this Commission, OP – Insurance Company remained absent and thereon OP placed exparte.

04.   In order to prove the case of the complainant he has filed his affidavit evidence along with supporting documents.

05.   Heard the arguments of the complainant.

06.   On perusal of the pleadings of the complainant and the documents placed on record, the following points will do arise for our consideration:-

1. Whether the complainant has proved deficiency in service on the part of the OP – Insurance Company?

 

2. Whether the complainant is entitled for relief as sought in the complaint?

 

3. What order?

 

07.    Our findings on the above points are:-

POINT (1):-      In the Affirmative

POINT (2):-      Partly in the Affirmative

POINT (3):-      As per the final order

for the following:-

REASONS

08.   POINTS (1) & (2):-   These points are taken up together for common discussion for the sake of convenience and to avoid repetition of facts.

09.  On perusing the affidavit evidence and the supporting documents filed by the complainant it discloses that, in the affidavit evidence the complainant has retreated all the facts stated in the complaint petition.  The main allegation of the complainant is that, he had taken the Corona Kavach Insurance Policy No.462600/48/2021/2602 and the validity of the insurance policy is from 29.07.2020 to midnight of 09.05.2021 i.e., for the period of 10 months only.  On perusal of the insurance policy document No.4 it discloses that, the policy is specially meant for Corona Kavach Policy issued by the Oriental Insurance Company Limited and the date of commencement of the policy is from 29.07.2020 to midnight of 09.05.2021.  Further on perusal of the discharge summary Document No.05 issued by the Ellen Thoburn Cowen Memorial Hospital, Kolar, it is evident that, due to pandemic disease of Corona the complainant was admitted in the said hospital as an inpatient from 06.05.2021 and discharged on 14.05.2021.  Further on perusing Document No.06 it discloses that, the competent authority has issued certificate certifying that, the complainant was suffering from Corona as per the Lab report and hence he was admitted to the said hospital for the treatment. 

10.   Further on perusing the document No.07, 08(a) to (c) it also discloses that, complainant has incurred the medical expenditure of Rs.91,420/- and however the complainant did not filed any supporting documents for miscellaneous medical expenditure incurred as stated in the complaint.  Hence we cannot accept the additional expenditure as canvassed by the complainant and also pleaded by the complainant.  Law mandates plead and prove but the complaint failed to provide cogent evidence in respect of additional expenditure incurred by him.

11.   It is note worthy to mention that, the insurance is a contract and binds to both the parties as per the documents placed on record.  It is crystal clear that, complainant suffered from Covid disease (Corona) and got admitted to the private hospital and incurred expenditure of Rs.91,420/-.  On perusal of the legal notice document No.1 dated: 11.04.2022 and the postal receipt and the acknowledgment it discloses that, notice was served on the OP – Insurance Company, the OP being the responsible insurance company refused to take the notice and this kind of attitude leads to deficiency in service and they might have attempted exonerate their liability.  Furthermore despite service of notice from this Commission the OP-insurance company did not turn to appear before this Commission to answer the claim made by the complainant.  However the OP – insurance company has not honoured the legal notice also.  Under the circumstances we have no other option to accept the entire allegations made in the complaint against the OP – insurance company.  On perusal of the affidavit evidence and the supporting documents placed on record it clearly establishes that, the complainant has proved deficiency in service on the part of OP – Insurance Company.  Accordingly we answered Point No.1 is in the Affirmative and Point No.2 is partly affirmative.

POINT (3):-

12.   On the basis of the reasons assigned while answering Points Nos. (1) & (2) we proceed to pass the following:-

ORDER

01.   The complaint is allowed-in-part with cost.

02.   The OP – Insurance Company is directed to pay Rs.91,420/- to the complainant within 30 days from the date of the order failing which the OP is liable to pay interest @ 9% per annum on Rs.91,420/- to the complainant from the date of filing of the complaint till realization of the amount. 

03.   Further OP – Insurance Company is also directed to pay a sum of Rs.2,000/- towards cost of the proceedings.

04.   Send a copy of this order to both parties free of costs.

(Dictated to the Stenographer, transcribed by him, corrected and then pronounced by us on this 29^th  DAY OF JULY 2022.

 

 

    LADY MEMBER                               PRESIDENT