Date of Filing: 07-12-2013

    Date of Disposal: 13-08-2014

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, ANANTHAPURAMU

PRESENT: - Sri S.Niranjan Babu, B.A., B.L., President (FAC).

Smt.M.Sreelatha, B.A., B.L., Lady Member.

Wednesday, the 13^{th day} of August, 2014

C.C.NO.17/2014

Between:

L.Bhaskar Reddy

S/o L.Krishna Reddy

Advocate,

D.No.3-439-3,

Prasanthi Nagar,

2^nd Cross, Tapovanam,

Ananthapuramu.                                                                    …  Complainant

             Vs.

1. The Secretary,

Bar Council of Andhra Pradesh,

High Court of A.P., High Court

Premises, Hyderabad

1.  The Divisional Manager,

United India Insurance Company Ltd.,

Divisional Office-XIII, 4-5-439, 2^nd floor,

Sri Ranga Complex, Badi Chowdi,

Sultan Bazar,

Hyderabad – 95.

1.  I Care Health Management & TPA Services

Pvt. Ltd., rep. by its authorized signatory,

56, Syndicate Bank Officer’s Colony,

West Maredpalli,

Secunderabad – 500 026.

1. The Division Office,

United India Insurance Company Ltd.,

Rep. by its Divisional Manager,

Subash Road, Ananthapuramu.                                             ….  Opposite parties

This case coming on this day for final hearing before us in the presence of                   Sri M.Murali Mohan, advocate for the complainant and Smt.C.Sandhya Rani, Advocate for 1^st opposite party, Opposite parties 2 & 3 are called absent and set-exparte and                         Sri G.Seetharama Rao, Advocate for the 4^th opposite party and after perusing the material papers on record and after hearing the arguments on both sides, the Forum delivered the following:

O R D E R

Sri S.Niranjan Babu, President (FAC) : - This complaint has been filed by the complainant under section 12 of Consumer Protection Act, 1986 against the opposite parties 1 to 4  claiming a sum of Rs.36,138/- towards Medi-claim policy, Rs.20,000/- towards mental agony and Rs.10,000/- towards costs of the complaint along-with interest.

2.     The brief facts of the complaint are that: The complainant is a practicing advocate at Ananthapuramu.  As per the advertisement given by the 1^st opposite party, the complainant obtained Medi-claim policy from the opposite parties on payment of Rs.6,020/- on 18-08-2011.  The opposite parties 2 & 3 jointly issued cards bearing Nos.ICUI1400078833 & ICUI1400078834 to the complainant and his wife.  As per the policy the complainant and the policyholders can obtain medical reimbursement up-to a sum of Rs.1,00,000/- or free hospitalization to that amount.  As per the policy, the complainant and his family members are entitled to claim the benefit.  The 2^nd opposite party issued group medi-claim policy bearing No.052600/48/11/41/00000383 which is valid from 01-09-2011 to 31-08-2012. The complainant’s wife took maternity treatment at Mamatha Nursing Home, Ananthapuramu between 27-09-2011 and 03-10-2011.  As the hospital was not covered under the scheme, the complainant spent a sum of Rs.36,138/- towards treatment and made a claim alongwith medical bills to the 1^st opposite party in October, 2011 for reimbursement.  Then the 1^st opposite party expressed some doubts for which the complainant clarified the same through letter dt.17-10-2012.  Though the letter was served to the 1^st opposite party, there was no reply from the 1^st opposite party.  Then the complainant issued a legal notice on 26-06-2013.  Even after receiving the legal notice, the opposite parties neither replied nor settled the claim.  Hence, the complainant filed this complaint against the opposite parties claiming a sum of Rs.36,138/- towards amount spent by the complainant and Rs.20,000/- towards mental agony and Rs.10,000/- towards costs of the complaint.

3.         The 1^st opposite party filed a counter stating that it is true that as per the advertisement given by the 1^st opposite party , the complainant obtained a medi-claim policy from the opposite parties on payment of Rs.6,020/- on 18-08-2011 and the opposite parties 2 & 3 jointly issued the cards bearing Nos. ICUI1400078833 & ICUI1400078834 to the complainant and his wife.  Further submitted that as per the policy, the complainant and the policyholders can obtain medical reimbursement upto a sum of Rs.1,00,000/- or free hospitalization to that amount.  As per the policy the complainant and his family members are entitled to the benefit.  Further the opposite party submitted that it is true that the complainant has availed maternity treatment to his wife at Mamatha Nursing Home, Ananthapuramu between 27-09-2011 and 03-10-2011 and as the said hospital is not covered under the scheme, the complainant incurred a sum of Rs.36,138/- towards treatment and he has sent all the original bills in October, 2011 and requested for reimbursement.

4.         It is true that the opposite party expressed some doubts and called for explanation by phone for which the complainant clarified the same through a letter dt.17-10-2012 and after receiving the bills and medical papers the 1^st opposite party has forwarded the same to the 2^nd opposite party and requested them to make arrangement for reimbursement of the amount to the complainant.  The 1^st opposite party submitted that there is no deficiency of service on the part of the opposite party as claimed by the complainant and further submitted that after receiving legal notice from the complainant the opposite party has taken all necessary steps by contacting the opposite parties 2 & 3 with regard to reimbursement of the amount to the complainant.   Further the opposite parties submitted that the mediclaim scheme is introduced by the 1^st opposite party for the welfare of the advocates and their family members and unfortunately the opposite parties 2 & 3 have not properly responded and not taken any action for reimbursement of medical expenses incurred by the complainant.  The 1^st opposite party further submitted that there is no lapse on the part of the 1^st opposite party and there is no unfair trade practice or deficiency of service towards the complainant by the 1^st opposite party.  Hence, the opposite parties 2 & 3 are liable to pay the amount incurred by the complainant.

5.         Notice of opposite parties 2 & 3 returned.  The 2^nd opposite party called absent and 4^th opposite party not filed counter. 

6.         The complainant filed a memo stating that the above case is settled for a sum of Rs.31,000/-  without interest and costs towards full and final settlement of the claim and the complainant has agreed to receive the same with free will and volition.  Hence requested this Forum to pass an award for a sum of Rs.31,000/- towards the claim as full and final settlement against the opposite parties.

7.         In view of the above memo, the complaint is partly allowed and direct the opposite parties 1 to 4 to pay a sum of Rs.31,000/- to the complainant within one month from the date of this order.

8.         In the result, the complaint is partly allowed by directing the opposite parties 1 to 4 to pay a sum of Rs.31,000/- to the complainant within one month from the date of this order.

   Dictated to Steno, transcribed by him, corrected and pronounced by us in open Forum this the 13^th day of August, 2014.

                          Sd/-                                                                      Sd/-

               LADY MEMBER,                                                  PRESIDENT (FAC),

DISTRICT CONSUMER FORUM,                         DISTRICT CONSUMER FORUM,

             ANANTHAPURAMU                                              ANANTHAPURAM

APPENDIX OF EVIDENCE

WITNESSES EXAMINED

ON BEHALF OF THE COMPLAINANT:       ON BEHALF OF THE OPPOSITE PARTIES

-NIL-                                                                     -NIL-

EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT

• NIL -

EXHIBITS MARKED ON BEHALF OF THE OPPOSITE PARTIES

• NIL -

                         Sd/-                                                                       Sd/-

               LADY MEMBER,                                                  PRESIDENT (FAC),

DISTRICT CONSUMER FORUM,                         DISTRICT CONSUMER FORUM,

             ANANTHAPURAMU                                              ANANTHAPURAM

Typed by JPNN