O R D E R

[Delivered by Sri B. Srinivasu, Member]

          This Complaint is filed on 01-03-2014 by the Complainant, under Section 12 of the Consumer Protection Act, 1986, (registered on 19-04-2014), praying to direct the Opposite Parties to settle the claim of the Complainant by paying an amount of Rs.21,253/- which was incurred by the Complainant for treatment; to pay an amount of Rs.5,000/- towards mental agony and to grant costs of the Complaint.

1.       The brief facts of the Complainant’s case are as follows:

          The Complainant took a Policy of Reliance Care For You Plan Policy, bearing Contract No.18657986 on 17-03-2011 form the Opposite Parties and the period of the Policy is three years.  In view of illness, the Complainant was admitted for treatment in Help Hospital, Vijayawada, on 20-11-2013 and discharged on 23-11-2013 and incurred an amount of Rs.21,253/- and intimated the same to the 1^st Opposite Party for payment.  But, the 1^st Opposite Party did not respond.  On 18-12-2013, the Complainant gave a letter to the 1^st Opposite Party, by mentioning all the details and the same was received by the 1^st Opposite Party but the 1^st Opposite Party did not settle the claim.     

2.       The Opposite Parties 1 and 2 jointly filed written version, admitting the taking of Policy by the Complainant and further contending that the Complaint is premature as Complainant himself failed to submit requisite documents before the Opposite Parties as per the terms and conditions of the Policy and the regulations of IRDA.  Three reminders were issued by the Opposite Parties on different dates to the Complainant to submit requisite documents i.e., consultation papers related to chest pain; consultant advice letter for hospitalization, letter from treating doctor stating details past medical history of the patient and attested copies of indoor case papers containing admission notes, daily doctor notes, nurse chart etc., to be submitted within ten days.    

3.       Chief affidavit of the Complainant is filed and the same is received as evidence of P.W.1.  One M. Sreedhar Patnaik, Senior Territory Manager, Reliance Life Insurance Company India Limited, having its Branch Office in Machilipatnam filed his Chief Affidavit and same is received as evidence of D.W.1. 

          Exs.A-1 to A-3 are marked on behalf of the Complainant.  Exs.B-1 to B-4 are marked on behalf of the Opposite Parties 1 and 2.

4.       The points that fall for determination in this C.C. are;

(1)      whether there is deficiency in service on the part of the Opposite Parties 1 and 2;

(2)      whether the Complainant is entitled for the reliefs as prayed in the Complaint.

(3)      to what relief.

5.       Heard both sides and perused the documents filed on both sides. 

Point No.1:

6.       As could be seen from the material available on record, it is clear that the Complainant took a Reliance Care For You Plan Policy, bearing Contract No.18657986, on 17-03-2011, under the original of Ex.A-1 and the period of the Policy is three years and the same was not disputed by the Opposite Parties.  In view of illness, the Complainant was taken treatment in Help Hospital, Vijayawada from     20-11-2013 to 23-11-2013.  A perusal of copy of a statement, bearing M.R. No.73628 for a period from 20-11-2013 to 23-11-2013 i.e., a part of Ex.A-2, wherein, it was mentioned that the Complainant incurred an amount of Rs.21,253-56 Ps. towards his treatment.  Ex.A-3 is a photo copy of letter dated 18-12-2013 addressed by the Complainant to the 1^st Opposite Party, enclosing Ex.A-2 i.e., a bunch of photo copies of Medical Bills, Prescriptions and Laboratory Reports belongs to the Complainant. 

7.       The contention of the Opposite Parties is that the Complainant failed to submit consultation papers related to chest pain; consultant advice letter for hospitalization; letter from treating doctor stating details past medical history of the patient and attested copies of indoor case papers containing admission notes, daily doctor notes, nurse chart etc.  Exs.B-3 and B-4 are the reminders dated 03-02-2014, 10-02-2014 and 17-02-2014, issued by the Opposite Parties to the Complainant to provide the above said documents.  But, the Complainant failed to submit the above said documents either to the Opposite Parties or before this Forum even at the time of the arguments.  Had the Complainant been given any reply for Exs.B-3 and B-4 as to the non-availability of the above documents or the relevancy of such documents to answer the claim perhaps, the position would have been otherwise and in such a case, the Forum will decide the necessity of such documents for resolving the controversy.  But, admittedly, the Complainant has not given any reply for Exs.B-3 and B-4 approach of which cannot be accepted.

8.       The further contention of the Opposite Parties is that the Complaint is premature as Complainant himself failed to submit requisite documents before the Opposite Parties as per the terms and conditions of the Policy and the regulations of IRDA.  The Complainant absolutely failed to prove his case and the Opposite Parties established their case.            

Point No.2:

9.       In view of the answering Point No.1, there is no deficiency in service on the part of the Opposite Parties 1 and 2, as the Opposite Parties 1 and 2 discharged their duties properly and issued remainders to the Complainant to submit the required documents and the Complainant failed to comply with the same.  Hence, the Complainant is not entitled to any reliefs from the Opposite Parties.  Accordingly, this Point is answered.     

Point No.3:

10.     In view of the answering Point Nos.1 and 2, the Complaint is liable to be dismissed without costs.

          In the result, the Complaint is dismissed but no costs.

          Typed by P.V.S.S. Prakasa Sastry, Junior Stenographer, to my dictation, corrected by me and pronounced by us in the open Forum, this the 20^th day of February, 2015.                                                              

                                                                                                                                       Sd/-

                                                                                                                                   President

                                                  Sd/-                                Sd/-

Member                          Member

District Consumer Forum-I,

Krishna at Machilipatnam

APPENDIX OF EVIDENCE

Witnesses examined

For the Complainant:                                    For the Opposite Parties:

P.W.1:          Palakurti Malleswara Rao.                            D.W.1: M. Sreedhar Patnaik,

(Complainant, by chief affidavit)                              Senior Territory Manager,

Reliance Life Insurance                         Company India Limited,

                                                             (2^nd Opposite Party, by chief affidavit).      

DOCUMENTS MARKED

On behalf of the Complainant:

On behalf of the Opposite Parties 1 & 2:

                                                                                                 Sd/-

                                                               President