DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD

Dated this the 28^th day of February, 2024

Present     :   Sri. Vinay Menon V., President

                   :  Smt. Vidya A., Member              

                  :  Sri. Krishnankutty N.K., Member                                    Date of Filing: 12/06/2023  

                          CC/156/2023

K.S.Chandrabose,

Puzhakal House,

Mangalam, Anjumurthy (PO),

Palakkad – 678 682.                                                    -                 Complainant

(By Adv. M.J. Vince)

                                                                                                  Vs  

1. Manager,

Star Health & Allied Insurance Co. Ltd.,

Branch office,

4^th Floor, Fine Centre,

T.B. Road, Palakkad – 678 014.

2.   Zonal Manager,

Star Health & Allied Insurance Co. Ltd.,

Zonal office, 4^th Floor, Carmel Towers,

Cotton Hill (P.O.), Vazhuthacaud,

Thiruvananthapuram – 695 014.                        -           Opposite parties

  (OPs by Adv. M/s. Ratnavally & Kiran G Raj A.)

                                   ORDER IN THE QUESTION OF MAINTAINABILITY

            By Sri. Vinay Menon V., President.

1. The complainant is a beneficiary under a policy availed from the OPs. But the OPs failed to respect the claim of the complainant on the ground that the complainant was suffering from pre-existing disease that was not disclosed. Even though a complaint was filed before the Insurance Ombudsman, his complaint was dismissed.  This complaint is filed seeking the expenses incurred at the hospital, cost of proceedings, compensation and premium of the cancelled policy.
2. Even though the OPs had filed version, contents therein are not discussed as they are not relevant for considering the question of maintainability of  this complaint based on the bar of res-judicata.
3. Counsel for complainant argued that even if it is found that there was pre-existing disease, the complainant was entitled to Rs.45,519/- that was paid as premium. He contended that this question is not considered by the Ombudsman.
4. Complainant himself had submitted the Award passed by the learned Ombudsman in IO/KOC/A/HI/0684/2022-2023. We went through the contents of the said Award.
5. The ld. Ombudsman has passed a studied and detailed Award after considering the contention of both the parties. The said office had upheld the conduct of the opposite party insurance company that was taken under Condition 5.6 (Disclosure of Information Norms) of the policy which states that the policy shall be void and all premium paid thereon shall be forfeited to the company in the event of misrepresentation, misdescription or non-disclosure of any material fact by the policy holder.
6. The aforesaid award has made a detailed and studied appreciation of the facts and evidence that was adduced in the said proceedings, before disallowing the complainant’s claim and up-holding the contentions and action of the O.P. In short, the said Award in IO/KOC/A/HI/0684/2022-2023 covers the entire reliefs sought for by the complainant in the original complaint as well as the amended complaint filed before this Commission.
7. Office of the Insurance Ombudsman being a statutory body, authorized, empowered and competent to look into the said complaint has passed a studied order. They have come to a studied conclusion that there is no fault on the part of the insurance company and their conduct has been upheld. Any grievance of the complainant by the said Award will have to be dealt with by the complainant by approaching the Hon’ble High Court of Kerala under Article 227 of the Constitution.
8. In view of the Award passed touching all aspects of the dispute herein, dismissing the claim of the complainant, any further consideration of the facts and circumstances of the complaint will tantamount to sitting in appeal over the finding of the Ombudsman. Had the Award been in favour of the complainant, we could have very well considered the complaint on the ground of deficiency in service on the part of the O.P. But being otherwise, any finding contrary to the one passed by a quasi-judicial authority would be an endeavor in judicial absurdity.
9. The aforesaid being the facts, we desist from traversing into the facts and circumstances that were already judicially appreciated and a decision rendered. 
10. At the time of argument counsel for the complainant argued that there was a clear direction from the Ombudsman to the complainant to seek remedy in any other appropriate fora, should the complainant be dissatisfied by the Award of the Ombudsman. Per complainant, this opened the jurisdiction of this Commission to appreciate the facts and circumstance of this complaint. We are unable to appreciate this line of argument since the authority vested with this Commission is bestowed by the provisions in the Consumer Protection Act. No order made by any other Statutory Authority would bestow this Commission with any fresh authority or the complainant with a fresh cause of action.
11. Therefore, we hold that this complaint is barred by res-judicata.  Consequently, this complaint is not maintainable before this Commission.  We dismiss the complaint.

     Pronounced in open court on this the 28^th day of February, 2024.          

      Sd/-                                                                                                                              

                                                                                             Vinay Menon V

                                                        President

                                                          Sd/-

   Vidya.A

                       Member        

          Sd/-

Krishnankutty N.K.

                                                                                                          Member

NB : Parties are directed to take back all extra set of  documents submitted in the proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission Procedure) Regulations, 2020 failing which they will be weeded out.