DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD

Dated this the  14^th  day of  July, 2023 

Present      :    Sri. Vinay Menon V., President

                  :   Sri. Krishnankutty N.K., Member                               Date of Filing:  25/02/2022     

                                                                                  CC/42/2022

Abdul Nazar,

S/o.Checku,

Pullath House, Kaithachira P.O.

Mannarkkad Taluk, Palakkad – 678 582.       -                      Complainant

(By Adv.M.C.Kuriachan)

                                                                                                Vs

1. The Tata AIG General Insurance Company Ltd.,

Grand Bay, No.64/2451, FI, 3^rd Floor,

Kattakkara Junction, Kadavanthara Road,

Kaloor, Kochi – 682 017

2. The Manager,

Canara Bank, Mannarkkad Branch.               -                       Opposite parties                     (O.P.1 by  Adv.P.Prasad

  O.P.2 by Adv.K.Vijaya  )

O R D E R

By  Sri. Vinay Menon V., President

1. Gist of the complaint is that he had availed a medi-claim insurance policy from the first opposite party under the group insurance policy for the account holders of the  second opposite party bank. Complainant underwent hip surgery. Even though the complainant is entitled to the coverage of the medi-claim policy issued by OP1, first opposite party failed to indemnify the complainant. Aggrieved thereby, this complaint is filed. Even though complainant has not stated the date of transactions, the complainant noted on the rear portion of the memorandum of complainant (to a query put at the time of admitting) that hospitalization was on 10/06/2019 and  18/02/2022 and  repudiation of claim was on 10/06/2020.
2. Opposite party 1 filed version stating that the opposite party had issued the policy covering the period 10/6/2020 to 9/6/2021. From the documents produced by the complainant it could be seen that the complainant had attended the hospital on 10/06/2019 and 18/02/2022, both days out of the coverage area. The opposite party had no liability to indemnify the complainant during these periods.
3. Opposite party 2  filed version washing hands off liability on the basis of lack of privity of contract between the complainant and O.P.2 and other incidental pleadings denying their involvement or claim, insofar as the facts leading to the cause of action are concerned. 
4. Based on the pleadings, inorder  to adjudicate the dispute, the following Issues are to be decided:

1. Whether the complaint is bad for non joinder of necessary parties ?
2. Whether there was a policy with the first opposite party in force at the time of complainant’s hospitalization ?
3. Whether the complainant has submitted necessary documents before the first OP for processing the claim ?
4. Whether there is any deficiency in service or unfair trade practice on the part of opposite parties ?

5.         Whether the complainant is entitled to receive any of the reliefs sought for ?

6.         Any other reliefs?

4.         (i)         Complainant did not adduce any evidence even after granting enough time.  

(ii)        OPs filed proof affidavit. OP1 marked Ext.B1. 

Issue No. 1

5.         The second opposite party had contended that the complaint is bad for non joinder of necessary parties as the complainant had availed the policy from Appollo Munich Health Insurance Company Ltd. and hence they are a necessary party. The complainant is at liberty to have his choice of opposite parties in the party array. An order against the existing members will be passed only based on the pleadings and evidence adduced in the case.  Hence, if the complainant is of the opinion that Appollo Munich Health Insurance Company Ltd. need not be in the party array, it is his prerogative.

 Issue Nos. 2 & 3

 6.        Complainant’s case is that he had been hospitalized with problems relating to hip surgery / pain on 10/06/2019 and 18/02/2022. The first opposite party contended that the policy issued by them covered the complainant during the period from 10/06/2020 to 09/06/2021 alone and the periods during which the complainant had attended the hospital was beyond the coverage period.

7.         In order to substantiate his case, the complainant has not adduced any evidence. In fact he had failed to adduce any evidence at all.

8.         Both the opposite parties filed their respective proof affidavits.  OP1 filed and marked the policy  issued by them in favour of Abdul Nazar as Ext.B1. In the absence of any better evidence from complainant, Ext. B1 is a conclusive proof that the coverage was from 10/06/2020 to 9/6/2021.  

9.         Thus the case of the complaint fails miserably. We hold that the complainant had failed miserably to prove Issue  Nos. 2 & 3.   .

Issue Nos. 4 & 5

10.       Resultantly we hold that there is no deficiency in service on the part of opposite parties.  The complainant is not entitled to any of the reliefs sought for.

Issue No. 6

11.       The complainant has come up with a case that he was having coverage during a period when he was not at all covered. The complainant ought to have been diligent while pulling opposite parties before a court of law in a litigation. The complainant had not even cared to show the decency of approaching this Commission and tendering his apology to the opposite parties for filing such frivolous complaint.  Therefore we impose a nominal cost of Rs.5,000/- on the complainant payable to each of the opposite parties 1 & 2 (Total of Rs. 10,000/-).  The complainant shall comply with this order within a period of 45 days from the date of receipt of this order.

 12.      With the above findings and orders, this complaint is dismissed.

                  Pronounced in open court on this the   14^th day of July, 2023.        

                                                                                                                                  Sd/-

                                                                                                            Vinay Menon V

                                                                President

                        Sd/-

              Krishnankutty N.K.

                                                                                                                     Member

APPENDIX

Exhibits marked on the side of the complainant :

Nil

 Exhibits marked on the side of the opposite party:

Ext.B1 –  Copy of policy schedule 

Court Exhibit: 

Nil

Third party documents: 

Nil

Witness examined on the side of the complainant:

Nil

Witness examined on the side of the opposite party: 

Nil

Court Witness:

Nil

NB : Parties are directed to take back all extra set of  documents submitted in the proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission Procedure) Regulations, 2020 failing which they will be weeded out.