Orissa

Rayagada

CC/130/2018

Sri Mohan Mandangi - Complainant(s)

Versus

The Managing Director India Health Services Pvt., Ltd., - Opp.Party(s)

Self

07 Apr 2021

ORDER

DISTRICT   CONSUMER DISPUTES REDRESSAL COMMISSION,

POST  /  DIST: Rayagada,  STATE:  ODISHA,  Pin No. 765001.

                                                      ******************

C.C.case  No.      130      / 2018.                                     Date.          7. 4. 2021

P R E S E N T .

Sri   Gadadhara  Sahu,                                                      President.

Smt.Padmalaya  Mishra,.                                                 Member

 

Sri Mohan Mandangi,  S/O: Late  Mandangi Veranna, J.K.Pur, Po/Dist: Rayagada, State:Odisha, Pin No. 765 001.                                                                                                                                                                                                  …..Complainant.

Versus.

1.The Manager,The UnitedIndia Insurance Co., Ltd.,Mumbai. & 3 others.

…Oppositeparties.

Counsel for the parties:                         

For the complainant: - Sri  K.Ch.G.S.Kumandan, Advocate.

For the O.Ps   :- Sri  J.K.Mohapatra, Advocate, Advocate.

 

JUDGEMENT

1.The  crux of the case is that  the above named complainant alleging deficiency in service  against  afore mentioned O.Ps    for  non payment  of Medi claim amount a sum of Rs.3,21,802.72  towards Medi claim policy No.500/002817P112335/08 for which  the complainant  sought for redressal of the grievances raised by the complainant. 

Upon  Notice, the O.P  (insurance Co.) put in their appearance and filed  written version through their learned counsel in which  they refuting allegation made against them.  The O.Ps  (insurance Co.)  taking one and another pleas in the written version   sought to dismiss the complaint as it is not maintainable  under the C.P. Act.  The facts which are not specifically admitted may be treated  as denial of the O.Ps.  Hence the O.Ps   prays the forum to dismiss the case against  them  to meet the ends of justice.

 Heard arguments from the learned counsels of both   the    parties.        Perused the record, documents, written version  filed by the parties. 

This District Commission   examined the entire material on record  and given  a thoughtful consideration  to the  arguments  advanced  before us by  the  parties touching the points both on the facts  as well as on  law.

                                                    FINDINGS.

On the basis of the pleadings of the parties, the sole question of determination is  Whether  the complainant is entitled  to insurance claim made by him ?

The O.Ps in   their   written  version  contended  that  the complainant  was  retired  from ac;tive service  from  IOB bank on  DT. 31.;5.2017. The O.Ps  in their written version  contended that   the complainant was member of  service  policy  No. 500100 / 28 /16 /P110321838  and was under  insurance cover till 30.9.2017.  Again the complainant  had joined the retired employee  policy No.  500100 /28/17 /P112335108  i.e. from  1.10.2017  to 31.10.2017  as he has not paid pro-  rate  premium for the  period.  Further   the claim  made by the complainant the hospitalization period happended in the  uncovered period from 9.10.2017 to 14.10.22017.  Again the  O.P   had not received  any premium  during  the period  from  1.10.2017  to 31.10.2017.

        On perusal of the  written  version filed by the  O.P (insurance Co.) it is revealed that  the complainant  was  retired  from ac;tive service  from  IOB bank on  DT. 31..5.2017.   Further  O.Ps   had not received  any premium  during  the period  from  1.10.2017  to 31.10.2017.

The complainant had claimed  medi claim  for the period  from 5.10.2017  to  15.11.2017  and  submitted  bill to the O.Ps  for payment.

Though the insurance cover was not covered  on the above period  the  insurance company  had  repudiated the same.

On perusal of the  complaint petition and  written version  the complainant  is  not entitled  medi claim  from the O.Ps.

During the course of  hearing the complainant was  appeared in person   before the District Commission and  admitted that  the policy was lapsed  from ;1.10.2017  to 31.10.2017.

This  District commission is completely agreed  with the  written version filed by the  Insruance Company  and  the complainant is not entitled  the medi claim   as  prayed in  their petition.

In this back ground, we find no merit in this case to demand compensation to the O.P by  the complainant in shape of C.C.petition.

        Further no documentary evidence  or connected correspondence  filed by the complainant to substantiate that   the  premium  was paid  during  surgery  period.

In  view  of  our above observation, finding, evidence on record it is concluded that the  complainant miserably  failed to establish his claim before the District Commission  and hence  the petition is liable to be dismissed against the O.P.

Hence  to  meet the  ends of justice, the following order is passed

ORDER.

            In  resultant    the complaint petition is dismissed. on contest. Parties are left to bear their own cost.

   Serve the copies of above order to the parties free of cost.

 

Dictated and corrected by me

Pronounced on this       7th   Day of     April,,   2021.

 

Member.                                                             President