Order no.  18    dt. 02.07.2008

            Complainant is found absent. O.p. nos.1 and 2 are present. It is appearing from the record for a long time complainant is not appearing. O.ps. have filed their respective affidavit with regard to the dispute raised by the complainant. Considering the age of the case matter is taken up for hearing.

            Heard ld. Counsels for the o.p. nos.1 and 2. Perused the affidavit filed by the o.ps. and complaint filed by the petitioner.

            In this consumer complaint petitioner has claimed Rs.38,057/- from the o.p. no.1 along with other consequential reliefs alleging deficiency in service on the part of the o.p.in the following facts and circumstances.

            Petitioner obtained a Group Medical Insurance Policy on 20.12.01 from o.p. no.2 by depositing required premium. Accordingly, o.p. no.2 issued receipt on 20.12.01. O.p. no.1 issued certificate in the name of the petitioner by which the medical expenses incurred by the petitioner for treatment was covered under the policy no.510402/48/01/17748 being certificate no.122200210047171 expiring on 19.12.02 for   an over all limit sum of Rs.35000/-. Subsequently her aforesaid policy was renewed by the complainant through o.p. no.2 on 20.12.02 vide policy no.510402/48/01/07784 on payment of required premium and the validity of the policy covered the period from 20.12.02 to 17.12.03.

            Due to maternity problem petitioner was under treatment from 2.11.03 to 10.11.03 and was admitted in the hospital as per advice of doctor and she incurred total expenditure for her treatment Rs.38057/-. Petitioner duly informed the fact of medical treatment to o.p. no.1 and submitted claim for reimbursement of expenses on 1.12.03 through o.p. no.2. On several representation o.p. no.1 neither paid the amount spent for treatment of the petitioner nor disposed of her claim without any cogent. Hence petitioner submitted representation repeatedly without any result. Thereby petitioner moved this forum for above relief.

            O.p. no.2 in their affidavit has categorically stated that requisite premium against the individual policy holder under the Group mediclaim Insurance  has been collected and duly deposited in the office of o.p. no.1 and o.p. no.1 issued individual certificate to the investor. O.p. no.1 has stated in their affidavit that in the instant case adequate premium against the complainant was not paid by o.p. no.2 to o.p. no.1. As such, no liability is caste upon them. O.p. no.2 solely and wholly responsible.

            It is undisputed petitioner paid the premium and the policy of Group Mediclaim Insurance Policy and his policy was renewed for the period from 20.12.01 to 17.12.03 vide policy no. 510402/48/01/17784. The policy of the petitioner could not have been renewed unless premium is accepted by o.p. no.1. In that case there is no ground before this forum as to why they withheld disbursement of the petitioner’s claim for long time which is amounted to deficiency in service on the part of the o.p. no.1. Under the circumstance, petitioner is entitled to relief. Accordingly the consumer complaint succeeds and it is awarded in the following terms.

            O.p. no..1 is directed to dispose of the claim of the petitioner and pay the amount Rs.35,000/- (Rupees thirty five thousand) only along with compensation Rs.3000/- (Rupees three thousand) only and litigation cost Rs.500/- (Rupees five hundred)  only within two months from date, failing which it will carry an interest @ 8% p.a. till realization.

            Let copy of this order be supplied to the parties free of cost.