Date of filing : 04-07-08 Date of order : 22-04-09 IN THE CONSUMER DISPUTES REDRESSAL FORUM, KASARAGOD CC.111/08 Dated this, the 22nd day of April 2009. PRESENT SRI.K.T.SIDHIQ : PRESIDENT SMT.P.RMADEVI : MEMBER SMT.P.P.SHYMALADEVI : MEMBER Dr. Sreekumar.C, Ruby Speciality Dental Clinic, } Complainant Near Bus Stand, Trikaripur. (Adv. P.Narayanan, Hosdurg) The Manager, New India Assurance Company Ltd, } Opposite party Temple Road, South Bazar, Payyanur.Po. (Adv. A.C.Ashok kumar, Kasaragod) O R D E R SRI.K.T.SIDHIQ, PRESIDENT The complainant a practicing dentist took a policy from New India Assurance Company Ltd under their Health Plus Medical Expenses Policy. During the subsistence of this policy complainant met with an accident and sustained injuries. Immediately after the accident complainant was taken to a Co-operative Hospital, Payyanur. He returned from hospital quickly on the same day. Again he affected with pain and has gone to KAM Hospital, Cheruvathur and treated there. The doctor advised him to take CT Scan. Then the complainant was removed to Sabha Hospital, Payyanur on the same day. Since the treatment necessitated the assistance of a specialized infrastructure, he continued his treatment from Medical College Hospital, Pariyaram. The complainant had altogether spent a sum of Rs.8000/- by way of medical expenses. Though a claim was preferred before the opposite party it was rejected on flimsy grounds. Hence the complaint alleging deficiency in service on the part of opposite parties in rejecting the claim. 2. According to opposite party the complainant had sustained dislocation of his left shoulder in the accident. He was treated at KAH Memorial Hospital, Cheruvathur on 9-12-07 and discharged on the same day. As per the Health Plus Medical expenses policy hospitalization for a period of less than 24 hours is admissible in case of injury amounting to fracture and not for dislocation since the complainant had sustained only dislocation of the shoulder, the claim is not allowed. Hence there is no deficiency in service on their part. 3. Complainant produced documents that is marked as Exts. A1 & A2. Documents of opposite party is marked as Exts B1 to B9. Both sides heard. Insurance is a contract by mutual consent and both parties are bound by the stipulations made thereon. The clause 1.4 specifically provides that expenses incurred on hospitalization for minimum period of 24 hours are admissible only to certain specific treatment mentioned in the said clause It no where provides that treatment for dislocation of shoulder less than 24 hours is admissible. That being so the complainant cannot claim a relief that is out side the coverage of the policy issued to him. Hence the complainant is not entitled for the reliefs and therefore the complaint is dismissed. Sd/- Sd/- Sd/- MEMBER MEMBER PRESIDENT Exts. A1. 2-4-08 Copy of lawyer notice. A2. postal acknowledgement card B1. 10-12-07 letter sent by complainant to OP B2. 17-3-08 letter sent by complainant to OP B3. 1-2-08 letter sent by complainant to OP B4.9-4-08 Reply notice. B5. Postal receipt B6. Returned postal cover. B7. Claim Form B8. Medical Certificate(Attending Doctors Report) B9. Health Plus Medical Expenses Policy. Sd/- Sd/- Sd/- MEMBER MEMBER PRESIDENT Pj/ Forwarded by order SENIOR SUPERINTENDENT
......................K.T.Sidhiq
......................P.P.Shymaladevi
......................P.Ramadevi | | 
