Date of filing : 16-02-2011
Date of order : 30-01-2012
IN THE CONSUMER DISPUTES REDRESSAL FORUM, KASARAGOD
CC.37/2011
Dated this, the 30th day of January 2012
PRESENT
SRI.K.T.SIDHIQ : PRESIDENT
SMT.P.RAMADEVI : MEMBER
SMT. K.G.BEENA : MEMBER
Viswambharan, } Complainant
S/o.Narayanan Nair,
Kunnum Valappu House,
Peradkamoola, Kottoor, Po.Muliyar,
Kasaragod.671542.
The New India Assurance Company Ltd, } Opposite party
Regd. & Head office,
New India Assurance Building, 87,
MG road, fort Mumbai, Branch Office,
Kasaragod.
(Adv. A.C. Ashokumar, Kasaragod)
O R D E R
SMT.K.G.BEENA, MEMBER
Breftly stated the allegation of the complainant is as follows:
Complainant a holder of Pravasi Bartiya Bima Yojana Policy met with an accident and sustained grievous injuries during the subsistence of the said policy. He incurred a sum of `6,25,000/-(Rupees six lakh twenty five thousand only) towards the treatment. Though a claim is submitted the opposite party directed to produce all original bills of hospitalization in Dubai from where he met with accident and treated. But the opposite party offered `4400/- only. According to complainant he was unconscious for 42 days and brought to India after 60 days after the accident. The whereabouts of the original medical bills are not known to him and he has received the computerized copy from the company and was produced before opposite party. The originals of treatment details in Dubai were also produced. But opposite party is insisting to produce the original bills again and thereby committed deficiency in service. Hence the complaint.
2. According to opposite party, complainant had availed a Pravasi Bartiya Bima Yojana Policy valid for the period from 6-2-2008 to 5-02-2010 complainant filed a claim form with opposite party dated 5-10-2009 along with medical bills worth `4,400/- only. Complainant has not produced the original medical bills relating to his alleged treatment at Dubai even after request from opposite party. The opposite party is ready to further process the claim if the complainant produces the original medical bills or other genuine documents to prove his claim.
3. Complainant filed affidavit in lieu of chief-examination and produced documents A1 to A6. Complainant is cross-examined by opposite party’s counsel. Opposite party has no oral evidence. Both sides heard and documents perused.
4. Here, the complainant availed a Pravasi Bartiya Bima Yojana policy valid for the period from 6-2-2008 to 5-2-2010. The complainant met a traffic accident on 19-07-2009 at UAE and was seriously injured and is still under treatment. The serious injuries were to the head and nervous system. The complainant was unconscious for 42 days and brought to India 60 days after the accident on attaining consciousness. Opposite party emphatically denied about the originals of the treatment details were produced by the complainant to opposite party. The complainant deposed before the Forum that the originals of the medical bill are produced for the claim before the authorities in Gulf. But he has not received any compensation from Gulf. Opposite party was ready and willing to proceed with processing of the claim on receipt of claim form duly completed with medical bills and diagnosis reports discharge summary and other related papers. Opposite party produced Ext.B1 demanding all documents from the complainant’s brother on 22-09-2009 through Ext.B7 sent on 27-1-2011 by opposite party and reminded the complainant to produce the said documents within 15 days otherwise complainant will be constrained to process their claim for `4400/- only. Complainant could not produce the original medical bills before the insurance authorities so far.
5. This Forum believes complainant’s deposition before the Forum that he had submitted all the original bills before the Gulf authorities if so we allows 3 months further time for production of original medical bills before the opposite party. Opposite party made earnest effort to settle the claim. But due to non production of original medical bills by the complainant, opposite party could not settle the same.
Hence we allow three months further time to the complainant for production of original medical bills before the opposite party along with claim form and if the complainant produce the same before opposite party we directs the opposite party to proceed with processing of the claim. Failing which opposite party is liable to pay only the amount offered `4400/- to the complainant. There is no order as to cost
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
Exts
A1. Pravasi Bhartiya Bima Yojana Policy
A2. 27-01-2011 photo copy of letter sent by New India Assurance Company Ltd to
complainant
A3.Photocopy of Patient Transfer Request form
A4.Patient Transfer Request Form.
A5. Photocopy of Itinerary receipt
A6. Photocopy of Certificate for the persons with disabilities
B1.22-09-09 copy of letter sent by New India Assurance Company Ltd to P.Rathnakaran
B2.Claim Form for Pravasi Bhartiya Bima Yojana
B3.16-11-09 letter sent By New India Assurance Company Ltd to complainant
B4.7-12-09 copy of letter sent by Complainant to OP.
B5.Series Bills.
B6.24-12-2009 copy lf letter sent by New India Assurance Co.Ltd to P.Rathnakaran
B7.27-1-2011 copy of letter sent by New India Assurance Co.Ltd to P.Rathnakaran
B8. 30-3-2011 copy of letter sent by New India Assurance Company Ltd to complainant
B9.Pravasi Bharatiya Bima Yojana Policy clause.
PW1. Viswambaran.
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
Forwarded by Order
Pj/ SENIOR SUPERINTENDENT
