Date of Filing : 02.12.2011

  Date of Order : 26.03.2012

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KOLAR

Dated 26^th MARCH 2012

PRESENT

Sri. H.V. RAMACHANDRA RAO, B.Sc., BL,   …….                PRESIDENT

Sri. T.NAGARAJA, B.Sc., LLB.                        ……..     MEMBER

Smt. K.G.SHANTALA, B.A., LLB.                    ……..     MEMBER

Consumer Complaint No. 218 / 2011

Sri. Manjunath,

S/o. S. Gopala Krishna, Aged about 28 years,

R/at: Door No. 5/132, Kandavarpet,

Chikkaballapur – 562 101.

(By Sri. H.N. Narayanappa, Adv.)                           ……. Complainant

V/s.

1. The National Insurance Co. Ltd.,

    Kolar Branch, No. 1092/2, New Extension,

    Near Doomlight Circle,

    Kolar – 563 101.

2. M.D. India Health Care Service (TPA) Pvt. Ltd.,

    S.No. 46/1, E-Space, A2 Wing, 3^rd Floor,

    Pune Nagar Road, Vadgaonsheri,

    Pune – 411 014.

    (By Sri. L.N. Ramanath, Adv.)                           …… Opposite Parties

ORDER

By Sri. H.V. RAMACHANDRA RAO, PRESIDENT

Complainant has made this Complaint seeking direction to the Ops to pay insurance amount of Rs.1,00,000/- making certain allegations.

2.       Ops have filed version denying the claim. 

3.       The Complainant has filed affidavit in support of his claim.  Ops have filed memo stating that version be read as their evidence.  Documents are filed.  Arguments were heard.

4.       Points that arise for our consideration are:

(A)            Whether the Complaint is premature ?

(B)     What order ?

5.       Our findings on the above points are:

          (A)     Positive

          (B)     As per detailed Order for the following reasons.

REASONS

6.       Reading the pleadings in conjunction with the documents and the affidavit on record, it is an admitted fact that the Complainant had obtained Mediclaim Policy from the Ops.  Regarding certain medical treatment, Complainant has claimed the amount from the Ops and the Ops wanted original medical certificates etc. from the Complainant and on scrutiny of those original documents they are going to honour the claim or reject the claim as the case may be.  The original documents are not furnished yet.

7.       The apprehension of the complainant is that since they have claimed compensation under MVC, they are required to submit original documents to the MVC Tribunal constituted under the MVC.  Anyway, during the course of the arguments, it was suggested to the Counsel for the Ops to receive all the original documents from the Complainant now before the Forum, scrutinize the same and pass appropriate orders and return all the documents to the Complainant for which the Counsel for the Ops have readily agreed.  The statement is recorded.      

8.       Hence, we hold point accordingly and pass the following Order.

ORDER

1.       Counsel for the Complainant is directed to deliver all the original documents with list to the Counsel for the Ops before this Forum.

2.       Ops shall process the claim of the Complainant within 30 days from today and pass appropriate orders and return all the original documents to the Complainant keeping the copies thereof with it within 30 days from today.

3.       In case of order is going against the Complainant, he is at liberty to move the Forum as it deemed fit.

4.       Under the circumstances, parties to bear their respective costs.

5.       Return extra sets to the parties concerned under the Regulation 20(3) of the Consumer Protection Regulations 2005.

6.       Send copy of this Order to the parties free of costs.

(Dictated to the Stenographer, got it transcribed and corrected and pronounced in the open Forum on this the 26^th day of March 2012)

T. NAGARAJA          K.G.SHANTALA           H.V.RAMACHANDRA RAO

    Member                         Member                                       President

SSS