order dated 26/02/2009<br /> <br /> <br /> O R D E R<br /> <br /> M.R. DEVAPPA, PRESIDENT<br /> <br /> Briefly stated the case of the complainant is as follows;<br /> <br /> 1. That the complainant obtained a mediclaim policy from the opposite party for the period 7-2-2006 to 6-2-2007 and as the complainant had a mole in front of the right ear which started bleeding touch and continued to bleed for about 2 months and therefore he visited Athreya Hospital Virajpet on 6-2-2007 and the Doctor admitted him as an inpatient and surgically removed the mole and was discharge the same day and in this connection the complainant spent Rs.1,500/-.<br /> <br /> 2. That the complainant after receiving the bill from the Hospital and the Doctor Certificate submitted a claim to the extent of Rs.1,500/- and the claim was addressed to TTK Health Care Services Pvt. Ltd., Bangalore and the copy of the RPAD Letter is produced.<br /> <br /> 3. That the claim of the complainant was not settled and reminder was issued to settle the claim.<br /> <br /> 4. That the opposite party failed to settled the claim of the complainant, which compelled the complainant to issue several notices.<br /> <br /> 5. That the complainant had obtained another mediclaim policy for the period 7-2-2007 to 6-2-2008 which is produced for perusal. <br /> <br /> 6. That the complainant’s claim was neither settled nor any reply was received despite several reminds issued to O.P and therefore finally the complainant has approached the Forum praying for following relief;<br /> <br /> a) The costs of hospitalization Rs.1500-00<br /> b) Cost of traveling from Madikeri<br /> to Virajpet 20 times at Rs.100<br /> per visit. Rs.2000-00<br /> c) Notice charges Rs. 500-00<br /> d) Towards mental agony Rs.3000-00<br /> and the Op may directed<br /> to pay the interest also. -------------<br /> Total Rs.7000-00<br /> =========<br /> <br /> 7. The complainant has produced the required documents.<br /> <br /> 8. Upon admitting the complaint version notice was sent to the opposite party. The opposite party without filing the version has conceded the claim of the complainant and filed a memo enclosing the cheque for Rs.1,500/-. The complainant has acknowledged the receipt, without prejudiced to other reliefs.<br /> <br /> 9. The opposite party has neither filed version nor the affidavit of the opposite party. In the meanwhile complainant’s advocate has filed an application explaining all the events leading to file an application as to how the complainant has been towards and despite the amount and other documents are submitted to the OP, his policy is not renewed and how the opposite party is prejudiced to the complainant etc., etc. The copy of the application was furnished to the opposite party. But in the mean while as stated above the opposite party has submitted a cheque to be delivered to the complainant. <br /> <br /> 10. Having regard to the above the following issues arise for determination;<br /> <br /> 1. Whether the opposite party for not reimbursing the expenditure incurred towards hospitalization and for not renewing the mediclaim policy despite several request made in this regard; has committed deficiency in service?<br /> <br /> 2. To what order ?<br /> <br /> R E A S O N S<br /> <br /> 11. The opposite party was discussed in the preceding paragraphs has admitted the liability and conceded the claim of the complainant after the complainant has approached the Forum but prior to that though several requests were made to the opposite party O.P has not considered the claim and the complainant has been unnecessarily made to spend money for filing a complaint and the complainant is also put to hardship and mental agony as his claim is not settled prior to approaching the Forum, for which the complainant is to be suitably compensated. No doubt the opposite party has paid Rs.1,500/- by way of handing over cheque for Rs.1,500/- during the pendency of the complaint, but yet we can hold that the opposite party has committed deficiency in service in not settling the claim within the stipulated period because the complainant has been unnecessarily driven to the Forum and therefore we answer point no.1 positively.<br /> <br /> 12. The complainant has also brought to the notice of the Forum that the opposite party is unnecessarily prejudiced towards him as he has approached the Forum. His policy is not renewed for the past several months though all the requirements are complied by him which according to the complainant also amounts to deficiency in service. In this regard it may not be out of place to observe that the opposite party Insurance Company, without renewing the policy has unnecessarily caused anxiety to the complainant even during the pendency of the case which the opposite party is not supposed to do so. But however the learned advocate for the opposite party has orally submitted that he is given to understand that the policy is renewed. The complainant who is present also orally submitted that he has been informed that his policy is renewed. In this regard it is necessary to issue direction to opposite party to renew the Insurance policy immediately from the date of issuance of cheque, if all the requirements are complied by the complainant. <br /> <br /> 13. With the above observations we proceed to pass the following order.<br /> <br /> O R D E R<br /> <br /> The complaint is allowed. Since the complainant has acknowledged the receipt of Rs.1,500/- which he has claimed from the opposite party; no order is necessary in this regard. The opposite party is hereby directed to pay Rs.500/- as compensation for complainant being put to hardship and mental agony and to pay Rs.1,000/- towards the cost of this proceedings to the complainant and further the opposite party is directed to renew the mediclaim policy from the date of issuance of cheque from the complainant.<br /> <br /> The above order shall be complied by the opposite party within sixty days from the date of receipt of the order.<br /> <br /> <br /> Communicate the order to the parties. <br /> <br /> Dictated to the Stenographer. Got it transcribed and corrected. Pronounced in the open Forum on this 26th day of February 2009.<br /> <br /> <br /> (M.R. DEVAPPA), (K.S. PRASAD), (A.S. HEMALATHA),<br /> PRESIDENT MEMBER MEMBER<br />