KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION

VAZHUTHACAUD THIRUVANANTHAPURAM

APPEAL NO.411/12

JUDGMENT DATED 10.1.2013

(Appeal filed against the order    in CC No.302/08 on the file of CDRF,   Kannur  dated 19.04.2012)

PRESENT

JUSTICE SHRI.P.Q.BARKATH ALI                 --  PRESIDENT

SHRI.M.K.ABDULLA SONA                             --  MEMBER

1.      The Branch Manager,

M/s Cholamandalam  M.S.General

Insurance Co.Ltd, 2^nd Floor,

Pearl Building, Near Makkani,                   --  APPELLANTS

South Bazar, Kannur 670 002.

2.      M/s Cholamandalam  M.S.General

Insurance Co.Ltd, DARE House,

2^nd Floor, Old No.234,

New No.2, NSC Bose Road,

Chennai 600 001.

             (By Adv.V.Manikantan Nair)

                             Vs.

1.      Udayabhanu A.K,

          P.O.Panayal, Via Bekkal-671318,

          Kasaragod Dist.

2.      TTK Healthcare Services (P) Ltd,

          1400 B, Mareena Building,   

          M.G.Road, Cochin-16.

3.      Maxwealth Finane (Pvt) Ltd,

          Plot No.49, 3^rd Floor,

          Nagarjuna Hills, Punjagatta,

          Hyderabad – 500 082.

4.      ICFAI National College (INC)

          5^th Floor, Mirra Trade Centre,         --  RESPONDENTS

          Panchagudda Cross Road,

          Hyderabad – 500 082.

             (R1 by Adv.K.P.Jayaraj)

JUDGMENT

JUSTICE SHRI.K.R.UDAYABHANU,PRESIDENT

          This is an appeal filed by the opposite parties 1 and 2 in CC.No.302/08 on the file of Consumer Disputes Redressal Forum, Kannur, challenging the order  of the Forum dated April 19, 2012 directing the opposite parties 1 to 3 before the forum to pay Rs.1 lakh as claim amount under    Ext. B1 the Group Health Policy    taken by  the complainant and Rs.2500/- as costs.

          2. The case of the first respondent/complainant as testified by him as PW1 before the Forum and as detailed in the complaint in brief is this.

          3. PW1, complainant joined ICFAL Group Mediclaim  policy which was valid from October,  2007 to  September, 2008.  New born babies are also covered  under the policy.  His baby was born on September 22, 2007.  After undergoing treatment the baby expired on July 18, 2008.  The  complainant submitted the claim on May  30, 2008  for Rs.1,74,000/- with the first opposite party who is the Kannur Branch of the Insurance Company.  They forwarded the records to the second opposite party who is M/s.  Cholamandalam  MS General Insurance Company Ltd;  Chennai.  Third opposite party is the TTK Healthcare Services (Pvt.) Ltd; who is dealing with the affairs of the first and second opposite party.  The 4^th opposite party is the Maxwealth Finance (Pvt.) Ltd. dealing with the wealth management of the opposite parties 1 & 2 Company.  4^th opposite party is the facilitator of health insurance of 5^th opposite party ICFAI National College.  The opposite parties have not settled the claim so far.  Hence the complaint.

          4. 1^st appellant/1^st opposite party is the Branch Manager  M/s.Cholamandalam MS General Insurance Company Ltd; Kannur.  2^nd  appellant is its Head Office at Chennai.  They filed joint version  before the forum contending that the baby died out of congenital ailment and that therefore the risk of that baby is not covered under the policy in question.  They denied their liability.   The 2^nd respondent/3^rd opposite party, TTK Healthcare Services (Pvt.) Ltd. Cochin,   did not file any separate version.

          5. The 3^rd respondent/4^th opposite party is M/s.Maxwealth Finance (Pvt.) Ltd; Hyderabad who is the facilitator of Health Insurance  of 4^th respondent/5^th opposite party under whom the complainant was employed.  The 3^rd respondent/4^th opposite party   filed a separate version contending that it is for the 2^nd & 3^rd opposite parties to settle the claim of the complainant.

          6. The 4^th respondent/5^th opposite party under whom the complainant was employed filed a version stating that they are un-necessary parties to this proceedings.

          7. The complainant was examined as PW1 and he produced Ext.A1 to A7 before the Forum.   The Manager of the Insurance  Company was examined as DW1  and she produced Ext.B1 to B6.  One Court witness was examined as CW1 and Exts. C1 to C3 were also marked before the Forum.  On an appreciation of the evidence,  the Forum found that the Group Health  Policy  Ext.B3 covers new born babies also and rejected the contention of the appellants that the baby died out on the congenital disease   and directed the opposite parties 1 to 3 to pay the complainant  as claim amount of Rs.1 lakh  and awarded a cost of Rs.2500/-.  Opposite parties 1 & 2 have come up in appeal challenging the said order of the forum.

          8. The points that arise for consideration:-

1.                Whether Ext.B3 Group Health Policy  covers the

          risk of new born babies?

2.                Whether it is proved by the appellants that the new

born babies of the complainant died of congenital ailment?

3.                Whether the award of the forum can be sustained?

9. POINT NOs.1 TO 3:-

The first contention raised by the appellant was that new born babies are not covered by the Group Insurance policy.  There is no subsistence in the above contention.  Ext.A2 letter issued by 4^th opposite party to the complainant and Ext.B3, the copy of the policy show that the risk of the new born baby  is  also covered under the insurance policy.  The finding of the forum  on this point is thus   confirmed holding that the risk of the new born baby of the complainant is covered under Ext.B3 policy. 

10. The specific case of the appellants is that the new born baby of the claimant died of congenital disease which is not covered under the policy in question.    The appellants have failed to prove before the forum that the new born baby of the complainant died of any congenital disease.  Therefore the  Forum is perfectly justified in  rejecting the above contention of the appellants.

          11. For all these reasons, we are of the view that the Insurance Company is not justified in repudiating the claim of the claimant and   that the appellants/opposite parties 1 to 3  are liable to pay the claim amount of Rs.1 lakh  under Ext.B3 policy to the complainant.  The forum has also awarded a cost of Rs.2500/-.  We find no reason to interfere the said finding of the District Forum.  The District Forum awarded interest from the date of the complaint.  In the circumstance of the case, we feel that interest can be awarded from the  date of the impugned order of the District Forum and we do so.  

   In the result, we find no merit in this appeal and the same is hereby dismissed with a cost of Rs.3000/-.

JUSTICE  P.Q.BARKATH ALI  --  PRESIDENT

 M.K.ABDULLA SONA          --  MEMBER

SL