Tamil Nadu

North Chennai

133/2014

S.IIlamvaludhi, - Complainant(s)

Versus

The Manager,Apollo Munich Health Insurance Co.Ltd., - Opp.Party(s)

V.Karthikeyan

27 Apr 2018

ORDER

 

                                                            Complaint presented on:  09.07.2014

                                                                Order pronounced on:  27.04.2018

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)

    2^nd Floor, Frazer Bridge Road, V.O.C.Nagar, Park Town, Chennai-3

 

        PRESENT: THIRU.K.JAYABALAN, B.Sc., B.L.,        PRESIDENT

              THIRU. M.UYIRROLI KANNAN B.B.A., B.L.,      MEMBER - I

 

FRIDAY  THE 27^th DAY OF APRIL 2018

 

C.C.NO.133 /2014

 

 

S.Ilamvaludhi,

No.23/47, Guruvappa Chetty Street,

Chindatripet,

Chennai – 600 002.

                                                                                    ….. Complainant

 

..Vs..

1.The Manager,

Apollo Munich Health Insurance Company Ltd.,

Regional Office: New No.4, Old No.319,

3^rd Floor, Velluvar Kottam High Road,

Nungambakkam, Chennai – 600 034.

 

2.Thiru.J.Saravannan,

Apollo Munich Health Insurance Company Ltd.,

Regional Office: New No.4, Old No.319,

3^rd Floor, Velluvar Kottam High Road,

Nungambakkam, Chennai – 600 034.

 

3.The Manager,

Reg. Off. Apollo Hospitals Complex.,

Jubilee Hills, Hyderabad – 500 033.

 

 

4.Thiru.Mahendra Kumar Mehta,

Insurance Agent,

No.81, Audiappa Naicken Street,

Chennai – 600 079.

.....Opposite Parties

Date of complaint                                 : 11.07.2014

Counsel for Complainant                       : V.Karthikeyan, G.Gurushothaman,

                                                                    R.Naresh Kumar

 

Counsel for 1 to 3Opposite Parties          : Mrs.Elveera Ravindran, K.Vinod

 

Counsel for 4^th opposite party                 : Ex-parte (on 10.09.2014)

 

O R D E R

 

BY PRESIDENT THIRU. K.JAYABALAN B.Sc., B.L.,

This complaint is filed by the complainant to direct the opposite parties to refund the money of Rs.32,668/- with 18% interest and also lab cost and compensation for mental agony with cost of the complaint u/s 12 of the Consumer Protection Act.1986.

1.THE COMPLAINT IN BRIEF:

          The 1^st opposite party Health Insurance Company Agent/4^th opposite party approached the complainant on 10.05.2014 and requested him to become a policy holder. The complainant also agreed to became a policy holder and issued a cheque for Rs.32,688/- towards premium amount. The complainant also furnished particulars of his wife and daughter.

2. On 26.05.2014 as required by the 1^st opposite party the complainant and his wife went to the Med All Precision Diagnostics Lab and undergone medical test.  They gave blood and urine tests. BP also checked. He also paid a sum of Rs.2,340/- for himself and Rs.990/- for his wife for the said purpose. Further, a person alleged to be a Doctor was sitting in another cabin questioned the complainant about various diseases and he also answered for the same.  When the complainant went to the lab on 29.05.2014 to collect the report, he was told that the report has been sent to the 1^st opposite party company. The 4^th opposite party informed him that their policy is accepted and the policy will be sent to his residence. On 06.06.2014 the complainant received message from the 1^st opposite party that the processing of the application is going on and later informed that for himself and his wife applications are rejected and their daughter application is accepted.

3. On 07.06.2014 the complainant received a letter  dated 30.05.2014 from the 1^st opposite party that they will retain Rs.6,302.27/- for his daughter and they will refund the balance amount of Rs.26,385.73/- out of the total amount of Rs.32.688/- paid by him. The lab report was not furnished to the complainant even though he has paid the test charges. Further the opposite party also not furnished the medical report to him is deficiency. Having the complainant paid the test charges, he is entitled for the tests report. Absolutely, there is no health defect to the complainant or his wife. Hence, failure to furnish policy to the complainant and his wife and without consent agreed to issue policy to his daughter proves the deficiency committed by the opposite parties. The complainant after issuing notice filed this complaint to direct the opposite parties to refund the money of Rs.32,668/- with 18% interest and also lab cost and compensation for mental agony with cost of the complaint.      

 

4. WRITTEN VERSION OF THE 1 to 3 OPPOSITE PARTIES  IN BRIEF:

          The opposite parties 1 to 3 admit that the complainant had applied for Health Insurance for the period 16.05.2014 to 15.05.2015 without any medical report. However, due to medical filings and personal medical history disclosed in the pre-policy checkup, the complainant and his wife were declined for the coverage in the policy and were asked to confirm their acceptance for his daughter to process the application. However, the complainant has not given his consent to his daughter and as per condition; the premium amount of Rs.32,688/- was paid by the complainant is refunded to his account through NEFT. Having the premium amount paid by the complainant was refunded to him, the refund sought in the complaint is not maintainable and the opposite parties are not committed any deficiency in service. The other averments sought in the complaint are denied. Hence this opposite parties prays to dismiss the complaint with costs.

5. POINTS FOR CONSIDERATION:

          1. Whether there is deficiency in service on the part of the opposite parties?

          2. Whether the complainant is entitled to any relief? If so to what extent?

6. POINT NO :1 

          The admitted facts are that the  1^st opposite party Health Insurance Company Agent/4^th opposite party approached the complainant on 10.05.2014 and on his  request he  agreed to become  a policy holder and the complainant also issued cheque for Rs.32,688/- towards premium amount and  the complainant also furnished particulars of his wife and daughter and on 26.05.2014 as required by the 1^st opposite party the complainant and his wife went to the Med All Precision Diagnostics Lab  to  undergo medical test   and they gave blood and urine for tests and their BP also checked and  he also paid a sum of Rs.2,340/-  in Ex.A1 for himself and paid a sum of Rs.990/- under Ex.A2 for his wife  and for the said purpose and also furnished  answers to a Doctor  who  was sitting in the another cabin  about various diseases and the  lab furnished report only to the 1^st opposite party company  and not to the complainant  even though he had paid the fee for tests  and later he was  informed that for himself and his wife application are rejected and their daughter application is  accepted and awaiting for his consent.

          7. The opposite parties/insurance company sent Ex.A3 letter to the complainant that he is suffering with hypertension and his wife is having elevated HbA1c findings and hence their proposal was rejected  and awaiting for consent for his daughter to issue policy to her. Admittedly the complainant pleaded in his proof affidavit para 37 that on 26.07.2014 when he seen his pass book, came to know that the 1^st opposite party deposited an amount of Rs.32,688/- on 11.06.2014. The complainant paid only the said sum of Rs.32,688/- towards premium. He had not given his consent to issue policy to her daughter. Therefore, it is clear that the premium amount paid by the complainant for issuing policy was refunded to him.  

          8. The complainant alleged deficiency against the opposite parties is that though he paid the medical tests charges, he had not been furnished with the medical report and on the other hand it was sent to the insurance company is deficiency and further insurance company also not furnished the report to him and further, the insurance company after making him to incur an expenses of Rs.2,340/-  and 990/- towards medical tests and the policy also not issued in their favour and after refusing to issue the policy failure to refund the medical tests charges proves that the opposite parties committed deficiency in service.

          9. The opposite parties would contend that the complainant made an offer to issue Family Floater Policy to his family and after medical tests it was found that the complainant and his wife were not found fit and however their daughter is fit to issue policy and for the same consent was not given by the complainant and hence the entire premium amount paid by the complainant refunded to him and therefore the opposite parties have not committed any deficiency in service.

          10. Admittedly the complainant paid the medical test charges to the Med All Precession Diagnostic Lab. Therefore the said lab owes a duty to furnish report to the complainant. Having the complainant paid the amount to the said lab; he can seek refund only from the said lab. The said Med All Precision Diagnostic Lab has not been party in the complaint. For the money paid to the lab, the complainant cannot seek refund from the insurance company. The insurance company already refunded the premium amount paid to them.  Since, we arrived above that the complainant can seek refund of lab charges paid by him and report only from the lab and the said lab has not been made as a party and in the circumstances of the case, it is held that  the opposite parties have not committed any deficiency in service.

11. POINT NO:2

Since the Opposite Parties have not committed any Deficiency in Service, the Complainant is not entitled for any relief and the Complaint is liable to be dismissed.

          In the result the Complaint is dismissed. No costs.

          Dictated to the Steno-Typist transcribed and typed by her corrected and pronounced by us on this 27^thday of April 2018.

 

MEMBER – I                                                                PRESIDENT

LIST OF DOCUMENTS FILED BY THE COMPLAINANT:

Ex.A1 dated 26.05.2014                   Lab Bill issued to the complainant

Ex.A2 dated 26.05.2014                   Lab Bill issued to the complainant’s wife

Ex.A3 dated 30.05.2014                   Letter sent by the 1^st opposite party to the

                                                    complainant

 

Ex.A4 dated 10.06.2014                   Representation sent by the complainant to all the

                                                    opposite parties

 

Ex.A5 dated 13.06.2014                   Lawyer Notice issued to the 1^st opposite party with

                                                    postal receipt

 

LIST OF DOCUMENTS FILED BY THE OPPOSITE PARTIES :

 

Ex.B1 dated 18.06.2014                   Copy of NEFT e-mail confirmation

 

Ex.B2 dated 16.05.2014                   Copy of application form

 

Ex.B3 dated 26.05.2014                   Copy of PPC of complainant and his wife

 

Ex.B4 dated 30.05.2014                   Copy of Letter

 

Ex.B5 dated NIL                      Copy of inland letter sent to complainant

 

 

 

 

MEMBER – I                                                               PRESIDENT