BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AT MANGALORE
Dated this the 30th June 2009
COMPLAINT NO.15/2009
(Admitted on 03.02.2009)
PRESENT:
1. Smt. Asha Shetty, B.A. L.L.B., President
2.Sri. K. Ramachandra, Member
BETWEEN:
K.A. Razak,
So. U.A. Hassan,
RA. Koornadka House,
Darbe Post, Puttur,
Dakshina Kannada. …….. COMPLAINANT
(Advocate: Sri. Sanjay D)
VERSUS
1. The Manager,
United India Insurance Co. Limited.,
1st Floor, Prabhu Building,
Main Road, Puttur,
Dakshina Kannada.
2. The Manager,
TTK Health Care Services Pvt. Limited.
7, Jeevan Bhimanagar,
Main Road, HAL 3rd Stage,
Bangalore – 75. ……. OPPOSITE PARTIES
(Advocate for Opposite Party No.1 and 2: Sri.G.B. Prabhu).
***************
ORDER DELIVERED BY SMT. ASHA SHETTY, PRESIDENT;
1. The facts of the complaint in brief are as follows:
This complaint is filed under Section 12 of the Consumer Protection Act alleging deficiency in service against the Opposite Parties claiming certain reliefs.
The Complainant is the holder of mediclaim policy along with his family bearing policy No.070805/48/ 08/97/00000007 the said policy is valid from 5.4.2008 to 4.4.2009. The sum assured under the policy was for Rs.50,000/- each. The 2nd Opposite Party is the 3rd party administrator and the 1st Opposite Party issued the policy.
The Complainant alleged that on 23.5.2008 his wife had rashes on her body and admitted to Indira Hospital, Falnir, Mangalore on 24.5.2008 and she has been treated and discharged on 26.5.2008 and he spent Rs.4,052.95. Thereafter the Complainant submitted the claim form to the Opposite Parties but the Opposite Parties did not settle the claim hence the Complainant filed the above complaint before this Hon'ble Forum under Section 12 of the Consumer Protection Act 1986 (herein after referred to as ‘the Act’) seeking direction from this Hon'ble Forum to the Opposite Parties to pay Rs.4,052.95 along with interest at 12% p.a. from 28.5.2008 till payment and also claimed Rs.25,000/- as compensation and cost of the proceedings.
2. Version notice served to the Opposite Parties by RPAD. Opposite Parties appeared through their counsel filed version admitted the policy and contended that the discharge summary submitted by the Complainant did not contain any information hence they could not reimburse the amount and contended that there is no deficiency.
3. In view of the above said facts, the points now that arise for our consideration in this case are as under:
- Whether the Complainant proves that the Opposite Parties committed deficiency in service?
- If so, whether the Complainant is entitled for the reliefs claimed?
- What order?
4. In support of the complaint, Sri.K.A. Razak (CW1) filed affidavit reiterating what has been stated in the complaint and answered the interrogatories served on him. Ex C1 to C7 were marked for the Complainant as listed in the annexure. One Sri.V.P. Naik (RW1), Branch Manager of the Opposite Party filed counter affidavit and produced four documents as listed in the annexure.
We have considered the notes/oral arguments submitted by the learned counsels and we have also considered the materials that was placed before the Hon'ble Forum and answer the points are as follows: Point No.(i): Affirmative.
Point No.(ii) & (iii): As per the final order.
Reasons
5. Point No. (i) to (iii):
In the present case, the Complainant filed evidence and thereafter the Opposite Party also filed evidence. During the pendency of the proceedings Opposite Parties paid Rs.4,053/- being the medical expenses but not paid any compensation or cost of the proceedings.
The Complainant after receipt of the above amount pressed the complaint for compensation and cost of the proceedings. However this Forum in the interest of natural justice directed the cost of Rs.1,000/- to the Complainant but the Opposite Party not complied the same.
In the instant case, it appears on record that the Complainant’s wife got admitted on 24.5.2008 and she was inpatient till 26.5.2008. The above claim was settled recently i.e., on 9.6.2008 by filing a memo before this Hon'ble Forum paid Rs.4,053/-. By considering the facts and circumstances, we are of the considered opinion that there is an inordinate delay on the part of the Opposite Party to reimburse the mediclaim. However, the Opposite Party ought to have paid the entire amount at the earliest since they have not paid the amount the Complainant approached this Hon'ble Forum in order to get the relief. By considering the above, we hereby direct the Opposite Party No.1 i.e., United India Insurance Co. Ltd. to pay Rs.1,000/- to the Complainant as cost of the proceedings. The same shall be paid within 30 days from the date of this order.
6. In the result, we pass the following:
ORDER
The complaint is allowed. Opposite Party No.1 i.e., United India Insurance Co. Ltd., is hereby directed to pay Rs.1,000/- to the Complainant as cost of the proceedings. The same shall be paid within 30 days from the date of this order.
Copy of this order as per statutory requirements, be forward to the parties free of costs and file shall be consigned to record room.
(Dictated to the Stenographer typed by her, revised and pronounced in the open court on this the 30th day of June 2009.)
PRESIDENT MEMBER
(SMT. ASHA SHETTY) (SRI. K.RAMACHANDRA)
APPENDIX
Witnesses examined on behalf of the Complainant:
CW1 – Sri.K.A. Razak – Complainant.
Documents marked on behalf of the Complainant:
Ex C1 – 05.04.2008: Copy of the Insurance Policy.
Ex C2 – 28.05.2008: Copy of the letter with claim form.
Ex C3 – 12.08.2008: Copy of the letter.
Ex C4 – 22.10.2008: Copy of the registered Lawyer’s notice.
Ex C5 & C6 - : Postal acknowledgement (2 in numbers).
Ex C7 – 23.10.2008: Reply sent by the 1st Opposite Party.
Witnesses examined on behalf of the Opposite Parties:
RW1 – Sri.V.P. Naik, Branch Manager of the Opposite Party.
Documents marked on behalf of the Opposite Parties:
Doc. No.1: : Claim form submitted by the Complainant.
Doc. No.2: 16.05.2008: Discharge summary given by Dr.Mohammed Kunhi.
Doc. No.3: 02.07.2008: Copy of the letter addressed by 2nd Opposite Party to the Complainant.
Doc. No.4: : Medical expenses incurred by the Complainant’s wife.
Dated:30.06.2009 PRESIDENT
