KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACADU THIRUVANANTHAPURAM APPEAL NO: 634/2009 JUDGMENT DATED:07..05..2010 PRESENT JUSTICE SHRI.K.R.UDAYABHANU : PRESIDENT SHRI.M.K. ABDULLA SONA : MEMBER The Manager, M/s National Insurance Company Ltd., 1st Floor, Municipal Shopping Complex, : APPELLANT Main Road, North Parur, Ernakulam. (By Adv: Sri.Prasannakumar Nair) Vs. Wilson. M.C, S/o M.P.Chacko, 35/495 C, Mangalassery, Mamangalam, Palarivattom, : RESPONDENT Kochi-25. JUDGMENT JUSTICE SHRI.K.R.UDAYABHANU: PRESIDENT The appellants are the opposite parties in CC:120/08 in the file of CDRF, Ernakulam. The appellant/National Insurance Company Ltd. is under orders to pay a sum of Rs.28,111/- to the complainant with interest at 12% from the date of complaint. 2. The case of the complainant is that the complainant’s wife who had undergone I.P.treatment at Lakeshore Hospital, Ernakulam during the mediclaim policy coverage period incurred by a sum of Rs.55,556/- for treatment expenses. But the opposite parties only allowed Rs.27,445/-. It is the case that the limitation clauses allegedly contained in the policy conditions were not issued to the complainant. 3. According to the opposite parties the amounts were paid as per the terms of the policy. 4. The evidence adduced consisted of the testimony of PW1, DW1, Exts.A1 to A3 and Exts.B1 to B3. 5. We find that the deductions made as can be seen in Ext.B2 computation sheet is as per Ext.B1 conditions of policy. There is no dispute that the computation made is not in accordance with Ext.B1 policy conditions. The contention is that the above policy conditions were not communicated to the complainant. DW1 the Branch Manager of the appellant has testified that the policy conditions along with the schedule were sent to the complainant. As per the above policy conditions for operation, theatre charges, anesthesia, medicines etc the maximum limit per illness is 50% of the sum insured. The sum insured is Rs.50,000/-. It was also brought out that the above limitations were incorporated vide B2 circular dated:23/3/2007. The policy coverage is for the period from 22/8/2007 to 21/8/2008. It is the case of the complainant that he has been holding the policy since 1998. There is no case that the company is not entitled to change the policy conditions as the policy is issued on yearly basis. Of course PW1 has stated that only the policy schedule was communicated and not the conditions of policy. It was contended by the counsel for the respondent that the opposite party/appellant ought to have produced documentary evidence to support the contention that the conditions of policy was communicated. DW1 the Branch Manager has stated that the conditions of policy along with the policy schedule was sent by courier. We find nothing has been brought out in the cross-examination of DW1 to discredit his evidence. In the circumstances and in view of the fact that the particular scheme envisaged only 50% of the sum insured to be paid for certain parts of treatment we find that the contention that the conditions of policy was not communicated does not appear to be true. The decision cited by the counsel for the respondent ie, the National Commission in United India Insurance Co. Ltd. Vs. M.K.J. Corporation (III (1996) CPJ 8 (SC) ) has no relevance in the context. In the circumstances the order of the Forum is set aside. The appeal is allowed. Office will forward the LCR to the Forum urgently. JUSTICE K.R.UDAYABHANU: PRESIDENT M.K. ABDULLA SONA : MEMBER VL. | 
