KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION  VAZHUTHACAD, THIRUVANANTHAPURAM

FIRST APPEAL 666/2011

JUDGMENT DATED: 09/01/2011

PRESENT

JUSTICE SRI.K.R.UDAYABHANU         : PRESIDENT

SRI.S.CHANDRAMOHAN NAIR    : MEMBER

Star Health and Allied Insurance Co.Ltd.,         APPELLANT

Branch Office, 1^st floor, Grand Plaza,

Fort Road, Kannur – 670001,

Rep.by its Branch Manager

(Appellant is rep. by the Zonal Manager,

Zonal Office,

Star Health and Allied Insurance Co.Ltd.,

Zonal Office, 1^st floor, Vijay Plaza,

SS.Kovil Road, Thampanoor,

Thiruvananthapuram.

(By Adv.P.S.Sureshkumar)

             Vs.

1. Varghese Joseph, S/o Joseph,                    : RESPONDENTS

     Uruppakattu House, PO.Balal,

     Via Parappa, Kasargod District.

2. Manoj.P.K., S/o Shashi,

     Vetayil House, Vallarikundu.P.O.,

     Via Parappa, Kasargod District.

JUDGMENT

JUSTICE SRI.K.R.UDAYABHANU         : PRESIDENT

          The appellants are the 1^st opposite party/LIC in CC.203/10 in the file of CDRF, Kasargode.  The appellants are under orders to honour the medi claim policy amounting to Rs.64000/- with interest at 9% and cost of Rs.3000/-. 

          2. The contention of the appellant is that illness was pre existing and that the complainant has not made a proper claim.

          3. It is the contention that the complainant had left shoulder pain previously and the treatment including rotator cuff repair under general anesthesia done on 12.8.10 is a consequence of the same. According to the appellant the treatment undergone was also for the left shoulder.  The appellant has not produced any documents before the Forum. 

          4. It is seen from the copy of the discharge summary that there is a mistake. Therein diagnosis is written as rotator cuff tear left shoulder  with impingment whereas in the same record the  complaint of pain right shoulder and history of fall at home is mentioned.   The ultra sound scan report of right shoulder mentions  full thickness tear of supraspinatous tendon with impingment.  The treatment  in Ext.A4 also mentions that MRI scan was performed on the right shoulder which also confirms the injury mentioned above.  Evidently it was only a mistake that at one portion of the discharge summary the left shoulder is mentioned instead of right shoulder.  The same is evident from the treatment records.  The same is highlighted to repudiate the  claim.  We find that there is no patent illegality in the order of the Forum.  In the circumstances we find that there is no scope for admitting the appeal.  The appeal is dismissed in limine.  The opposite parties are directed to make the payment within 2 months failing which the complainant will be entitled for interest at 12% from the date of complaint that is 29.9.06.

          The office will forward the  copy of this order to the Forum urgently.

                    JUSTICE K.R.UDAYABHANU       : PRESIDENT

                   S.CHANDRAMOHAN NAIR            : MEMBER

Ps.