SMT.MOLYKUTTY MATHEW : MEMBER

        This is a complaint filed by the complainant U/S 35 of  Consumer Protection Act 2019 for an order directing the  opposite parties to pay compensation of Rs.2,00,000/- with cost  to the complainant for the deficiency of service  on their part.

 The case of the complainant in brief:

   The  complainant  Mr.O.K.Gangadharan is a retired  bank employee of Canara Bank.  The 1^st OP is involved in the business of insurance and  the complainant was insured the personal insurance scheme conducted by 1^st OP, and 2^nd OP is the hospital in which the complainant’s operation is performed.  The complainant was insured under MD India Healthcare services(TPA) with policy No. 251100/50/20/10000379 with MDID card No.MDID 0035971101 .  The insurance coverage  is Rs.3,00,000/- and the complainant yearly remit Rs. 33,884/- as premium.  The  complainant was suffered Trans Urethral resection of prostate with features of urinary bladder outlet obstruction and significant RUV and left upper Ureteric calculus (14 mm).  Then the complainant was admitted in 2^nd OP’s hospital  on 1/3/2021.  To remove the renal calculus the key hole surgery was done on 1/5/2021 and he was discharged on 3/5/2021.  The complainant was handed over the entire documents to 1^st Op within the stipulated time.  The  discharge bill was about Rs.77,754/-.  The 1^st OP was agreed to pay the entire amount of discharge bill.  The 1^st OP had collected an amount of Rs.33,884/- from the complainant yearly as their  insurance premium.  The insurance covering the  entire hospital expenses also.  But after transferring the entire documents the 1^st OP is not ready to pay the amount and also they want additional documents from 2^nd OP.  Then the complainant collected all the documents from the hospital and transferred to 1^st OP and  nothing left with them.  But the 1^st OP is  not ready to pay the hospital bill.  The act of 1^st OP, the complainant caused much mental agony and financial loss. So there is deficiency  of service and unfair trade practice on the part of 1^st OP.  Hence the complaint.

      After filing the complaint notice issued to both OPs. 1^st OP’ notice  shown as “left”  and 1^st OP is set exparte.  2^nd OP is received the notice and filed their  version  before the commission that  the complainant underwent TURP,UR SI lithotripsy for BPH renal calculus on 1/5/2021.  He was discharged on 3/5/2021.  2^nd OP had given all the  documents, bills discharge summary at the time of discharge of patient  Mr.O.K.Gangadharan  on further request for extra documents.  But 2^nd OP had given all the documents required by the patient duly signed for the purpose of insurance claim. So there is no deficiency or  anything that warrant cause of  action for the complainant against this 1^st OP.  So there  is no deficiency  of service and unfair trade practice on the part of 2^nd  OP also .

            On the  basis of the rival contentions  by  the pleadings the following issues   were framed for  considerations

1. Whether there is any deficiency  of service on the part of  the opposite parties?
2. Whether the complainant is  entitled for  any relief?
3.  Relief and cost.

       The   evidence consists of the oral testimony of PW 1 and   Exts.A1 &A2  marked.   On OP’s  side  no oral or documentary evidence.

Issue No.1:

   After the death of complainant the legal heirs of complainant  filed the impleading petition IA 303/2022 dtd.19/10/2022 before the commission.  The IA NO.303/2022 allowed and the complainant’s daughter Vijnha(4^th  petitioner) adduced evidence  before the commission by submitting  her  chief  affidavit  in lieu  of her chief examination to the  tune of the pleadings in the complaint  and she  was examined  as PW1 .  The  documents Exts.A1 & A2 were marked on her part to substantiate her case. According to PW1 as per Ext.A1 document the discharge bill, the total amount  incurred for the 2^nd OP  hospital is Rs.60,250/-.  In Ext.A2 is the claim form for health insurance policy of Mr.O.K Gangadharan.  But OP’s side except the version of 2^nd OP, no evidence and documents produced by 1^st OP.  OP.NO.1 has no steps taken to prove their case also. The act of OPs the complainant caused much mental agony and financial loss. So  we hold  that there is deficiency  of service and unfair trade practice on the part of 1^st opposite party.   Hence the  issue No.1 found in favour of the complainant and answered accordingly.

Issue  No.2& 3: 

      As discussed above the complainant, Gangadharan(late) had remit Rs.33,884/- as premium yearly.  As per the discharge bill (Ext.A1) the complainant incurred Rs.60,250/- as the hospital expenses.  The insurance coverage include the entire hospital  expenses also.  But the 1^st OP not ready to pay the amount.  So the complainant is entitled to get the hospital expenses Rs.60,250/- along with Rs.15,000/- as compensation and Rs.5,000/- as litigation cost.  Thus the issue No.2&3 are also accordingly answered.

             In the result, the complaint is allowed in part directing the 1^st opposite party to pay Rs.60,250/- as the hospital expenses along with Rs.15000/- as compensation and Rs.5,000/- as litigation cost to the complainant within  30 days  of  receipt  of this order.   In default the amount of Rs.60,250/- caries 9% interest per annum from the date of order till realization . Failing which the  complainant is  at liberty to  execute  the  order as  per the  provisions  of Consumer Protection Act 2019.

Exts:

A1- Discharge Bill

A2- Insurance claim form

PW1-Vijnha(4^th complainant)

Sd/                                                                Sd/                                                 Sd/

PRESIDENT                                  MEMBER                                     MEMBER

Ravi Susha                               Molykutty Mathew                             Sajeesh K.P

eva                                                      

                                                        /Forwarded by Order/

                                                         ASSISTANT REGISTRAR