IN THE CONSUMER DISPUTES REDRESSAL FORUM, KOTTAYAM
Dated this the 28th day of December, 2022
Present: Sri. Manulal.V.S, President
Sri. K.M. Anto, Member
CC No. 155/2019 (Filed on 27/09/2019)
Complainant : K.S. Muhammed, aged 68 years,
Kallingapadathil (H)
Kalathukadavu, Erattupetta
Kottayam District, Pin- 686 579
Ph- 9961699007
(Adv.Akash K.R)
Vs
Opposite parties : 1. United India Insurance Company Ltd
No.406-412, Floor IV, Neelkanth
Corporate It Park, Kirol Road, Vidhyavihar
(west) Mumbai-400088.
(Adv.P.G.Girija)
2. Health Insurance TPA of India Limited
Noida, Uthar Pradesh (UP)
3. James George, Executive Engineer
Electrical Division Pala
(Adv.Deepthi.S.Nath)
4. P.Balakrishna Pillai, General Secretary
Poonushas TC 23/147(i) Valiasala
Chalai P.O, Trivandrum- 695036
Ph:0471 2477782, Mob.9447102107
5. Sri.George Kurian, Division Secretary
ThadavanalThekkummury, Puliyannur
Pin- 686 573, Mob.9446435768
(Adv.SasikumarAnikkadu)
O R D E R
Sri. K.M. Anto, Member
The Complaint is filed under Section 12 of the Consumer protection Act 1986.
The brief of the complainant’s case is as follows. The complainant retired from Kerala State Electricity Board on 31 March 2006. The complainant is getting monthly pension from Electrical Division at Pala. As per the decision of the KSEB Pensioners Association complainant had taken Health Insurance with Policy No.1004002818P116990600 of the Group Insurance of United India Insurance Company. But till date the complainant and his wife have not received the Insurance card for undergoing treatment as per the Policy.
An amount of Rs.11,564/- was deducted from the pension by the third opposite party and paid to KSEB pensioners Association. The complainant had approached the opposite parties for getting the Insurance card over phone and directly but it was not provided. This complaint is filed for getting the refund of the deducted amount and compensation for the sufferings due to the unfair trade practice and deficiency in service on the part of the opposite parties.
On admission of the complaint, copy of the complaint was duly served to the opposite parties. The first, and third opposite parties filed their version separately. The fourth and fifth opposite parties appeared and filed joint version.
The version of the first opposite party is that the complainant is covered under a group Insurance Policy availed by the KSE board Pensioners Association for a period from 15/02/2019 to 14/02/2020. The complainant and his wife Fousi are covered under this policy vide Group ID351240.
The first opposite party had furnished the Individual Health Insurance Cards of the members to the Insured, KSEB Pensioners Association. The first opposite party had not received any complaint regarding the non-issuance of the card from the insured or the complainant. Health Insurance card is not mandatory for availing claims under the policy. No claim of the complainant is repudiated by the first opposite party. There is no deficiency in service or unfair trade practice from the part of the first opposite party.
The version of the third opposite party is that as per the order of the KSEB an amount was deducted from the pension of the complainant and remitted to the account no.67396873589 of the KSEB Pensioners Association in State Bank of India, Karamana, Thiruvananthapuram on the request of the complainant. An amount of Rs.4956/- was deducted in the month of May and amount of Rs.1,652/- was deducted in the months of June, July, August, September. A total of Rs.11,564/- was deducted from the pension benefits of the complainant and had remitted to the bank account of the Association. No consideration was received by the third opposite party from the complainant. The deduction from the pension benefits was stopped as per the request of the complainant dated 28/08/2019.There is no deficiency in service on the part of the third opposite party.
The second opposite party neither cared to file the version or to appear before the commission to defend their case. The second opposite party was set exparte.
The version of the opposite parties fourth and fifth is as follows. The KSEB pensioners Association has initiated a group Health Insurance scheme with the first opposite party from the month of January 2019. About 8000 members joined the scheme during January and February months. The complainant joined the scheme later in May 2019.
The ID card of the members who joined the scheme in January and February were received earlier. There occurred a delay in processing the id cards of few members who joined the scheme in may including the complainant. And the ID card of the complainant was received and is kept by the fifth opposite party. The complainant had withdrawn from the scheme later on and as a result his id card became invalid.
The insurance ID card is not necessary for availing treatment benefits as per the scheme. Even without the ID card, the treatment benefits can be enjoyed on production of the Card number, Name and Policy number to the Hospital Authorities. The amounts deducted from the complainant was remitted to the insurance company as premium. There is no deficiency in service or unfair trade practices on part of the opposite parties.
The complainant filed proof affidavit and marked documents Exhibits A1. The 1st, the 4th and the 5th opposite parties filed proof affidavit. The third opposite party filed proof affidavit and marked documents Exhibits B1 to B4.
On the basis of the complaint version of the opposite parties and evidence adduced we would like to consider the following points.
- Whether there is deficiency in service on the part of the opposite parties
- If so, what are the reliefs and costs.
For the sake of convenience, we would like to consider point No1 and 2 together.
On the basis of the complaint and version of the opposite parties and evidence adduced both parties agree that the complainant had joined the Group Health Insurance Policy of the first opposite party. The complainant and opposite parties further agree that an amount of Rs.11,564/- was deducted from the pension benefits of the complainant by third opposite party and had remitted the amount as premium for the month from March to September 2019 to the first opposite party, the insurance company.
Ext B1 is the order of Kerala state Electricity Board dated 11.01.2019 giving sanction for the recoveries from pension on behalf of the tailor-made Group Medi policy from pensioners/family pensioners based on their option and subject to their willingness obtained in writing. First installment of premium to be deducted from pension payable on February of the members who had opted for two lakh policy i.e., Rs.4,956/-.Thereafter @ Rs.1,652/- p.m. till November 2019 and to remit the said amount to the bank account of KSEB Pensioners Association. The above recovery shall be affected only after obtaining willingness in writing from the pensioner/family pensioner to be kept under custody of the Head of pension disbursing office.
Ext B2 is the written willingness of the complainant for the recovery of the insurance premium towards the Health Insurance scheme sponsored by the Kerala state pensioners Association before the third opposite party.
It is evident that the Third opposite party had effected the recovery of premium amounts from the pension benefits of the complainant based on the Ext B1 order of the KSEB and the Ext B2 written willingness of the complainant. The deducted amounts were remitted to the account of the KSEB pensioners Association. And the first opposite party had acknowledged the receipt of the premium amount deducted from the complainant.
Section 2 (d) of Consumer Protection Act 1986 defines Consumer as“Consumer” means any person who –
- Buys any goods for a consideration which has been paid or promised or partly paid and partly promised, or under any system of deferred payment and includes any user of such goods other than the person who buys such goods for consideration paid or promised or partly paid or partly promised, or under any system of deferred payment when such use is made with the approval of such person, but does not include a person who obtains such goods for resale or for any commercial purpose; or
- (hires or avails of) any services for a consideration which has been paid or promised or partly paid and partly promised, or under any system of deferred payment and includes any beneficiary of such services other than the person who (hires or avails of) the service for consideration paid or promised, or partly paid and partly promised, or under any system of deferred payment , when such services are availed of with the approval of the first mentioned person (but does not include a person who avails of such services for any commercial purpose) (explanation – For the purposes of this clause, “commercial purpose” does not include use by a person of goods bought and used by him and services availed by him exclusively for the purposes of earning his livelihood by means of self-employment)
The complainant does not have a case that he had given any consideration to the opposite parties 3 to 5 for availing any service. Thus, the complainant is not a consumer of the opposite parties 3 to 5 as per the consumer protection Act 1986.
The deduction of the premium amounts by the third opposite party is as per the Ext B1 order of the KSEB and that too on the basis of the Ext B2 written request by the complainant.
The first opposite party admits that they had received the premium amounts deducted by the third opposite party and the complainant and his wife were covered under the insurance policy. The complainant had no case that he was denied treatment from any of the hospitals under this policy or his medical claim was repudiated by the first opposite party.
On the basis of the above discussed findings, we are of the opinion that the complainant failed to prove deficiency in service on the part of the opposite parties. The complaint is liable to be dismissed. The complaint dismissed.
Pronounced in the Open Commission on this the 28th day of December, 2022.
Sri. K.M. Anto, Member sd/-
Sri. Manulal.V.S, President sd/-
Appendix
Exhibits marked from the side of complainant
A1- Photocopy of advertisement in the Association Masika
A2- Copy of deduction certificate issued from the Executive Engineer, Electrical Division Pala.
A3- Copy of the address of Karamana Pensioners association Leaders and Pala Electrical Division Association Leaders.
Exhibits marked from the side of opposite parties.
B1- Copy of order dated 11/01/2019 issued by KSEB
B2- Copy of written willingness of the complainant.
B3- Copy of complaint dated 27/08/2019.
B4- Copy of receipts issued by SBI Pala Branch.
By Order
Sd/-
Assistant Registrar
